Adderall, a drug commonly prescribed to treat attention deficit hyperactivity disorder (ADHD), has been in short supply for months. Generic versions known as mixed amphetamine salts are available, but not in sufficient quantities to meet nationwide demand. How widespread is this problem? And what are the consequences, and possible solutions, for adults who rely on this medication to manage ADHD, a brain disorder characterized by inattention, being easily distracted, and impulsive behavior?
"Currently, there isn't reliable information about how many people are affected by the shortage," says Dr. Craig Surman, associate professor of psychiatry at Harvard Medical School, scientific coordinator for the Adult ADHD Research Program at Massachusetts General Hospital, and coauthor of Fast Minds: How to Thrive If You Have ADHD (or Think You Might). But if you're concerned about a shortage of ADHD medicine — or experiencing one — here's what to know.
Why is this shortage in the news?
Recent news stories have featured anecdotal reports of people calling multiple pharmacies to fill their prescriptions, sometimes in vain. However, problems like this have long been par for the course, says Dr. Surman, noting that similar shortages have occurred in the past. In addition, stimulants such as Adderall have a high potential for misuse, so prescriptions and refills are controlled.
For people with ADHD who take Adderall and related medications as prescribed, the drugs can make a huge difference, both mentally and physically. "The simple health benefits can even include things like getting enough sleep because they got their work done earlier in the day and don't have to stay up late to finish, and they go to the gym because they remember to bring their shoes," Dr. Surman says.
How do Adderall and related medicines work?
Prescription stimulants for ADHD include mixed amphetamine salts (Adderall) and methylphenidate (Concerta, Ritalin). They raise brain levels of dopamine and norepinephrine, two neurotransmitters that play important roles in the prefrontal cortex, a brain region that helps regulate thoughts, actions, and emotions.
Stimulants have a range of effects, increasing alertness and energy, and (in the case of 70% of people with ADHD) improving ability to focus. They also can have less desirable physical effects, such as appetite suppression and increased heart rate and blood pressure, and should only be used as prescribed by a physician.
Newer nonstimulant medications, such as atomoxetine (Strattera) and viloxazine (Quelbree), are approved by the FDA to treat ADHD in adults, while guanfacine (Intuniv) is also approved for children. These medicines all increase availability of norepinephrine. Side effects for nonstimulant ADHD drugs vary, and can be similar to those of stimulants.
People often respond better to one of these ADHD medications than another, so unless a person already knows what works best, a shortage could be a time to try another treatment. Adderall also comes in different dosages and formulations, and speaking to a pharmacist might clarify if another form may be more available. But often, the supply problem can be resolved by asking if your regular prescription is available within the same pharmacy chain at a different location, says Dr. Surman.
Rollercoaster dosing can cause problems
Sometimes, people intentionally skip stimulant doses — for example, on weekends — to stretch out their prescriptions. However, this can create withdrawal symptoms like fatigue unless people taper off. In other people, amphetamines have less effect over time. Some prescribers recommend taking breaks to rejuvenate the effectiveness of the medicine, says Dr. Surman.
So-called rollercoaster dosing may have downsides. To be diagnosed with ADHD, you must have symptoms in at least two settings, such as work and home. If you only take the medication sometimes (such as on the days you work), you may miss out on its benefits for managing other aspects of your life, such as relationship and self-care commitments.
"My patients tell me that when they're off their medication, they have to work harder to manage their daily lives," says Dr. Surman. Something has to slide, and it's usually self-care, such as doing things like preparing their schedule ahead of time, so they have time to eat healthfully and exercise.
What about coping strategies for ADHD?
Other ADHD treatments include coping strategies that improve organization and minimize the sense of feeling overwhelmed. These techniques aren't a replacement for medication. Still, because life circumstances can change, it can be helpful to periodically revisit your need for medication.
"A medication shortage may give you a chance to ask, what is the medicine actually doing for me?" says Dr. Surman. If you can adjust your environment in ways that reduce unrealistic demands, you might be able to manage well without medication.
Some people outgrow symptoms, or learn to manage them so well that the disorder is no longer a factor in their everyday lives. And still others with ADHD enjoy long stretches in which their symptoms are not noticeable or problematic. But others rely on medications, coaching, and therapy into old age. "If someone has ADHD challenges that only can be managed with stimulants, they may need to be more strategic until some of these shortages are straightened out," says Dr. Surman.