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AMERICA’S ADDERALL SHORTAGE: WHAT’S REALLY BEHIND IT?

 * July 11, 2023
 * David Brody, M.D.

Image by Haley Lawrence | Unsplash


Designation of the ADHD treatment, best known by its brand name of “Adderall” as
“in shortage,” has left many families searching for treatment for this severe
and disabling physical disorder of the brain.  Unfortunately, the shortage has
provided fodder for unscrupulous media to distort the true value of Adderall,
one of the treatments of choice for ADHD. These outlets took the opportunity to
mislead readers as to the cause of the shortage. For example, a headline from
The Daily Mail reads: “THE GRAPH THAT EXPLAINS AMERICA’S ADDERALL SHORTAGE – AS
IT’S REVEALED PRESCRIPTIONS DOUBLED DURING PANDEMIC.”

 

The Daily Mail headline states that the “explanation” for America’s Adderall
shortage is the pandemic. The pandemic did not cause the Adderall shortage but
merely brought it into sharp relief by forcing a dormant problem to reveal
itself. The current Adderall shortage was a long time coming.  It is due to
supply-chain challenges, intermittent manufacturing delays, and, most
importantly, insufficient reserves of its active ingredients, which are mixed
salts of amphetamine and dextroamphetamine.

 

Moreover, the fact that this is not the first such shortage to occur gives the
lie to those who connect it with a line of simple causation to the COVID
pandemic.  It is conveniently never mentioned that a similar shortfall began in
the fall of 2011 and lasted at least until the following spring, almost ten
years before “pandemic” became part of the person-on-the-street’s vocabulary.

 

A “shortage” of a prescription-only medication will occur if the number of pills
prescribed exceeds the number on hand to supply to pharmacies.   Data from the
analytics and research company IQVIA shows that the demand for Adderall has
risen nearly 27% in recent years, with prescriptions jumping from 35.5 million
in 2019 to 45 million last year.  This is what the Daily Mail offered as an
“explanation”  for the Adderall shortage. But this is not only an inadequate
explanation but a deceptive one.

 

In the early stages of increased demand, there was no shortage because
manufacturers had adequate reserves.  Increased demand cannot explain a shortage
unless the supply is limited, thus preventing those reserves from being
replenished. Supply of ingredients HAS been limited, so once manufacturers use
up their reserve of “ingredients,” they can no longer satisfy the increased
demand.

 

To truly explain the Adderall shortage, we need to know the cause of the
increased demand:

 

COVID increased the prevalence and severity of all psychiatric disorders, ADHD
included. COVID also led to a historic explosion in the use of telehealth, 
which enabled a previously huge and unmet need for treatment of ADHD too, at
long last, begin to be satisfied.  Thus, the increased demand for Adderall and
other stimulant medications for ADHD is not the result of abuse or misdiagnosis
but is caused by the power of telepsychiatry to reach patients who previously
could not access diagnosis or treatment.

 

If medicine is to fulfill its goals of the alleviation of human suffering by
treatment of disease, then the improved access facilitated by telepsychiatry
must be allowed to flourish.  Increases in “diagnosis of behavioral issues” due
to the stress of the pandemic and improved access to health care as a result of
“the move to telehealth appointments” are both among the causes of the increased
demand for Adderall, which led to the current shortage. The Daily Mail’s attempt
to delegitimize ADHD as a medical disorder is a disappointing but loud echo of
what many ADHD sufferers have heard their entire lives as a justification for
denial of treatment: “You don’t have ADHD, you just need to try harder and
concentrate.”

 

The crucial importance of maintaining an adequate supply of the treatments of
choice for ADHD is brought home by the fact that the suicide rate among ADHD
sufferers is five times that of the general population.  There are at least 9.2
million adults in the US with ADHD.  Simple math, using the known rates of
suicide, enables one to calculate that if treatment of ADHD eliminated the
“excess” risk of suicide that ADHD entails, the suicides per year among ADHD
patients would decrease by almost 5,000, from 6,200 to 1,321.  Of course,
treatment may not completely eliminate even the “excess” risk, but the figure of
5,000 lives saved is far too large for anyone to ignore.  These sobering numbers
ratchet up the urgency of forcefully telling the truth about Adderall and
similar ADHD treatments.

 

The bottom line: There is an Adderall shortage because ADHD has been
undertreated since Hippocrates first described the symptoms more than 2,400
years ago. The pandemic, in its only positive effect, enabled access to
treatment through technology.  As recently as 50 years ago, not only the
treatment but the way it was accessed would be regarded as miraculous.

 

We need not put this online genie back in the digital bottle. We do need to
empower telehealth companies of all stripes to reach people in need and thus
ensure a smooth flow of life-saving medications.

________________________________________________________________________________________________________________

David Brody serves as Clinical President at Done (donefirst.com) and
is board-certified, Stanford-trained general adult psychiatrist with 34 years of
post-residency experience in virtually all aspects and venues within
contemporary psychiatry. He has extensive experience in psychiatric leadership,
including Clinical President of a tele-psychiatry platform (current), Medical
Director of an entire county Community Behavioral Health Department, Medical
Director of a multi-ethnic, cultural-competence-focused community mental health
outpatient clinic, Medical Director of an inner-city acute locked psychiatric
unit and Medical Director of a Psychiatric Intensive Outpatient Program. He’s
working at Done. serving as the Clinical President where overseeing all aspects
of medical practices and clinical endeavors. Prior to Done, he worked as the
Medical Director at Rams, where he served as the Medical Director of audlt
outpatient, supervised psychiatrists, therapists, social workers and nurses. He
also spearheaded the training of psychology interns.

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