On Oct. 12, the U.S. Food & Drug Administration announced a shortage of amphetamine mixed salts, or Adderall, on their drug shortage website. Adderall treats attention deficit hyperactivity disorder and narcolepsy.
The FDA said that Teva, the company that manufactures 30% of Adderall in the pharmaceutical market, is facing manufacturing delays, and the eight other Adderall manufacturers in the market can’t keep up with the demand on their own. Since August, Teva has cited workforce shortages and manufacturing disruptions caused by packaging constraints as reasons for the supply problems. Additionally, a nationwide rise in demand for Adderall has made it challenging for Teva to keep up. According to the Centers for Disease Control and Prevention, 6 million children in the U.S. have been diagnosed with ADHD, and about 62% of those children have been prescribed medication. Furthermore, IQVIA, an analytics provider for the life sciences industry, found that Adderall prescriptions in the U.S increased to 41.4 million in 2021, up by 10.4% from 2020. From his anecdotal experience, Dr. Jeremiah Pamer (he/him), a primary care physician at EvergreenHealth, thinks plays a big role in the uptick of both ADHD diagnoses and Adderall prescriptions.
“I think that working from home and all the stresses of society with the pandemic… and a lot of anxieties feeding into the population in general are causing this,” said Pamer. “Oftentimes, anxiety is a component with this, whether it’s a diagnosable general anxiety disorder or something of the sort. I think anxiety at a baseline is going to be higher.”
Additionally, Pamer thinks several other factors besides the pandemic caused the increase in Adderall prescriptions.
“I think the most driving thing is recognition of the disorder, and then the second thing is people who seek out these diagnoses even if they don’t necessarily have strong indications,” said Pamer. “I hesitate to say this a little bit, but ADHD is generally diagnosed by patients self-reporting on forms. I firmly believe that, as a doctor, we can’t rely on [these] forms, but my point is that it’s really easy to get the diagnosis because it’s very clear what you would answer to get this diagnosis.”
Pamer said that self-diagnosis is not the most influential component for the increase of ADHD diagnoses and ADHD medicines, but it makes it very easy for people to get Adderall for what they want it for, which is increased function and clear cognition. Because of the effects Adderall has and the high chance it may be abused, the federal Drug Enforcement Administration sets annual Adderall production quotas. The DEA stated in its 2022 quota recommendations that, while it has observed a significant rise in demand for ADHD products, it has also grown increasingly concerned over how the increase may impact the misuse of these products. The DEA limited the 2022 quota to 21.2 million grams. The quotas the DEA sets are a projection based on current usage, and sometimes are unable to change fast enough to meet a sudden surge in demand. Consequently, the industry has been experiencing repeated shortages since 2015. Pamer thinks this artificial cap needs to be raised.
“I’m a doctor, I went to med school, did medical residency, I have my active medical license,” said Pamer. “I was trained on how to handle these medications. I know, for the most part, what to do here, and if these diagnoses are going up, you need to raise the quota on manufacturing these kinds of medications.”
The DEA’s precaution isn’t without reason. A study released in 2016 by the Johns Hopkins Bloomberg School of Public Health found that 614,000 teens ages 12-17 admitted to using Adderall for nonmedical reasons at some point. Adderall abuse causes almost 1,500 emergency room visits every year. Additionally, the study found that, from 2006-2011, treatment visits involving Adderall for adults between the ages of 18 and 25 did not change, but non-medical use of the drug increased by 67%, and emergency room visits skyrocketed by 156%. The Surgeon General of the United States, Vivek Murthy, who is also the Vice Admiral of the U.S. Public Health Service Commissioned Corps, also reported in 2016 that ADHD medications, such as Adderall, accounted for 5.3 million of the 18.9 million Americans who reported their misuse of prescription drugs. Pamer knows people who’ve gone to the doctor to sell most of their prescriptions because they need the extra money.
“This is happening,” said Pamer. “I don’t have a lot of control over this, but that’s the concern. And back then, you could get much larger supplies of pills at one time; it was much more lucrative. These days, we go to efforts to try and reduce that. Still, it’s pretty common to have college students abusing these medicines, whether there’s an actual diagnosis or not. You can study longer, you can study harder, you can be more focused and it can help people in that area. So yes, I think that [Adderall] is probably being overprescribed..”
Teva estimates that its 10-milligram dosage of Adderall is expected to rebound in October, but as of Nov. 10, it is still back-ordered. Many of its generic brand offerings are not expected to recover until March 2023. Spokesperson Kelly Dougherty stated in a press release on Oct. 13 that Teva expects inventory recovery in the coming months with intermittent delays through the end of the year. In the meantime, the FDA has provided a list of current manufacturers that have available stock.
