What to Do if You Can’t Get Your Meds
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If you’ve had trouble filling an Adderall prescription for yourself or your child, you’re not alone.
Many patients (and parents of patients) have found themselves struggling to fill orders for Adderall and other drugs to treat attention deficit hyperactivity disorder (ADHD) at their local pharmacies of late, says Ann Childress, MD, a psychiatrist in private practice in Las Vegas, Nevada, and the president of the American Professional Society of ADHD and Related Disorders.
Patients and parents report calling pharmacies many miles from home and still coming up short, says Dr. Childress. Others have asked their doctors for alternative medications for the condition, some of which have also been in short supply, and which may not be as effective as the drugs they were previously taking, she adds.
The problem has gotten worse as millions of children and teens across the country recently returned to school. For many students with ADHD, the start of the school year means resuming medication regimens that had been put on pause for summer vacation.
This could mean an uptick in demand for ADHD medicines just as the shortage has expanded to other ADHD drugs. This July, the U.S. Food and Drug Administration (FDA) announced shortages of the ADHD drugs methylphenidate (Concerta) and lisdexamfetamine (Vyvanse), too.
Shortages of immediate-release forms of amphetamine mixed salts (Adderall or Adderall IR), a widely prescribed ADHD drug, began about a year ago.
Adderall and other stimulant drugs used to treat ADHD are very effective for children and adults with the condition.
“ADHD is a brain disorder. When correctly diagnosed, drugs such as Adderall allow children to focus in school and adults to focus on their job and everyday critical tasks, such as driving,” says Jennifer McWilliams, MD, the division chief of psychiatry at Children’s Hospital and Medical Center in Omaha, Nebraska.
The U.S. Drug Enforcement Administration (DEA) recently proposed tightening telehealth prescribing rules for certain ADHD medications, which could create additional obstacles to access for some people.
What’s Been Causing the Adderall Shortage?
Several factors have made Adderall harder to come by in recent months.
For starters, Adderall and other stimulants for ADHD are considered controlled substances because they have a high potential for addiction and overdose. To limit abuse, the DEA sets manufacturing quotas for these medicines. But according to the FDA and DEA, drugmakers shipped one billion fewer doses than permitted by their quotas in 2022, a trend that appears on track to persist this year.
Teva, one of the drug companies that manufactures Adderall, reported experiencing “ongoing intermittent manufacturing delays,” in October 2022, according to the FDA.
While other drug companies are manufacturing amphetamine mixed salts, they haven’t been able to produce enough to meet the demand caused by the Adderall shortage, according to the FDA.
Another factor is that demand for stimulants typically prescribed for ADHD was increasing long before the Adderall shortage was announced by the FDA in October. The percentage of teen girls, adult women, and men receiving prescription stimulants has increased since 2016, especially between 2020 and 2021, according to data published in March 2023 in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC).
The diagnosis and treatment of ADHD have increased over time among women and girls, who have historically been underdiagnosed and undertreated for ADHD. A report published in January 2018 in MMWR showed that the number of privately insured U.S. women ages 15 to 44 who received a prescription medication to treat ADHD increased by 344 percent between 2003 and 2015.
Relaxed prescribing regulations (which changed during the COVID-19 pandemic to ensure that patients could still get their medications even when fewer people were doing in-person doctor appointments) also likely played a role. Before the DEA’s pandemic public health emergency rules kicked in on March 20, 2020, the DEA required an in-person visit to a doctor before controlled substances could be prescribed during a telehealth visit, But during the public health emergency, those rules were loosened, and prescriptions for Adderall and similar medications via telehealth without an initial in-person visit were permitted.
This made it easier for many more people to access the medication — including people without ADHD. “Although improved access to ADHD care through telehealth during the pandemic might have benefited some persons with ADHD symptoms, it might have also introduced the potential for inadequate ADHD evaluations and inappropriate stimulant prescribing,” according to the March 2023 MMWR report.
One such example: Cerebral, an online prescription and therapy app, is under federal investigation for possible violations of the DEA’s Controlled Substances Act (which regulates the medical use, potential for dependence or abuse, and safety of drugs and other substances) concerning its prescribing practices related to Adderall, the Wall Street Journal reported in June 2022.
The drugs are also in demand for people without ADHD because Adderall and other stimulants can create a mild high and may also improve focus and performance among people without ADHD. Adderall is illegal to use without a prescription.
Proposed Rule Changes Could Limit Virtual Adderall Prescribing
This easier access could soon be curtailed. The DEA, which regulates the supply of ADHD drugs like Adderall or Ritalin that are considered controlled substances, recently announced a proposed change in the rules for telehealth prescribing of the drugs.
The proposed rules are intended to improve the safety of online prescribing as telemedicine grows in popularity. “DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm,” Anne Milgram, the DEA administrator, said in a press release.
According to the DEA ’s proposed rules, doctors will need to evaluate a patient in person before prescribing controlled substances like Adderall and Ritalin by telemedicine for the first time, or the patient must be referred by another physician who has seen them in person. Doctors who have been prescribing controlled drugs via telehealth must now have an in-person evaluation of the patient within six months after the DEA implements its final rule in order to continue prescribing the medications.
The proposed rules also require the doctor to have DEA registration in both the state they practice in and the state where the patient lives. “That might limit access to doctors for patients who have few prescribing doctors in their state and can’t easily travel for the in-person evaluation,” says Dr. McWilliams.
Although the rules aren’t as restrictive as they were before the pandemic, they may still make it more difficult for some people with ADHD to get the medications even when supply bounces back.
The proposed rules were open for public comment until March 31. The DEA originally planned for the new rules to go into effect by May 11, 2023, when the public health emergency ends. But after receiving a record 38,000 comments on the proposed rules, the DEA instead extended its timeline.
“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards,” said Milgram in a press release issued May 3, 2023.
Initially, the DEA subsequently issued a temporary rule to continue pandemic-era telemedicine prescribing of controlled medicines through November 11, 2023. That meant that any patients already prescribed controlled substances via telemedicine on or before that date would be able to continue receiving their prescriptions from their current providers through November 11, 2024.
On October 6, the DEA and U.S. Department of Health and Human Services (HHS) announced that they will issue the final rules for telemedicine prescribing by fall 2024. In addition, the DEA and HHS issued a second extension of the aforementioned COVID-19 telemedicine flexibilities through December 31, 2024.
“Patients should be following this closely so they know what they need to do in order to get their prescriptions going forward,” says Christina Markus, a pharmaceutical law attorney with the law firm King and Spalding in Washington, DC.
What to Do if You’re Having Trouble Getting Your ADHD Meds
The ADHD drug shortages have shown some signs of waning, according to the FDA.
“Manufacturers are working to meet the demand and the FDA is helping with anything we can do to increase supply. Supply is increasing, and the FDA is continuing to offer assistance,” says James McKinney, a spokesperson for the FDA.
While shortages of certain formulations of Adderall have been resolved, other formulations remain in shortage, according to the FDA. Concerta and Vyvanse remain in shortage as well, per the FDA.
The FDA recently approved generic versions of Vyvanse capsules and chewable tablets from more than a dozen manufacturers, which may help ease the shortage.
In the meantime, if you’re still having trouble getting your medication, here are five expert-recommended strategies to help you get the treatment you need.
Establish a Relationship With Your Local Pharmacy
If you were taking a stimulant medication like Adderall that was working well for you, it’s worth calling several pharmacies in your area to see if any of them have that medication in stock, says Jack Turban, MD, an assistant professor of child and adolescent psychiatry at the University of California in San Francisco.
Your local pharmacy may also be able to help you with this, says Ryan Sultan, MD, a psychiatrist at Columbia University in New York City who studies medical interventions for ADHD. “At large chain pharmacies, pharmacists can call around to other branches to see if they can fill your prescription. And at smaller pharmacies, the pharmacist may be able to contact distributors to see what they have on hand or are getting in,” says Dr. Sultan.
Ask About Alternative Doses of Your Usual Medication
If your usual medication is unavailable, ask your prescriber about the availability of smaller doses, or if larger doses can be divided into smaller ones, such as splitting a 10 milligram (mg) tablet into 5 mg ones, says Alex Dimitriu, MD, a psychiatrist in private practice in Menlo Park, California, and a medical reviewer for Everyday Health, who prescribes stimulants for some of his patients with ADHD.
There may also be an extended-release version of certain medications such as Adderall XR, which may work for you, Dr. Dimitriu adds. They don’t need to be taken as frequently as other ADHD medications.
If you find yourself responding differently to an alternative medication dose — or if you notice new or worsening side effects — talk to your doctor, says Dimitriu.
See if Your Doctor Could Temporarily Switch You to Another Medication
If you’re not able to find the medication anywhere, despite your best efforts, there are other similar stimulant formulations you can talk with your prescriber about taking on a temporary or longer-term basis, says Sultan.
Each formulation may work differently for different people, so it could take some trial and error to find a suitable alternative, he adds.
Potential alternative drugs could include modafinil (Provigil), armodafinil (Nuvigil), and bupropion (Wellbutrin), all of which may have some benefit for ADHD, says Dimitriu.
Alternative drugs could be covered by your insurance at a lower or higher rate than your current drug, notes Childress. For more expensive drugs, Childress recommends asking your pharmacist about discount coupons and programs to help you afford alternative medications if you need them.
Talk to Your Doctor About Whether Adderall Is Really the Right Drug for You
While stimulants are generally safe and very effective for ADHD when prescribed appropriately, they can come with side effects including decreased appetite, sleep problems, and increases in heart rate and blood pressure, says Turban. “That’s why it’s so important for patients to have appropriate medical and mental health screenings prior to starting them and regular medical follow-up while taking them,” Turban says.
If you’ve benefited from stimulants for ADHD, but have had bothersome side effects, the shortage might prompt you and your doctor to consider nonstimulant medications such as guanfacine (Intuniv), clonidine (Catapres), and atomoxetine (Strattera), he says.
Ask Your Doctor About Nondrug Treatments and Lifestyle Management Strategies
People with ADHD who take medication often also work on behavioral management strategies such as time management, organization, and task prioritization to help them manage their symptoms. If you’re having trouble getting your medication, consider talking to your doctor about whether you might be able to bolster your condition management with more of these nondrug approaches.
These types of strategies could be very helpful for you as an alternative to medication or while you’re waiting for a drug to come back in stock or for a new drug to begin working, Dimitriu explains.
Although these strategies may not replace some of the effects of medication, evidence shows that certain nondrug treatments are still very effective. For instance, one study published in the September 2019 issue of Psychiatry Research showed that cognitive behavioral therapy (CBT) on its own was no less effective than a combination of medication and CBT.
Additional reporting by Lisa Rapaport.
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