The increase in ADHD diagnoses contributes to Adderall deficiency

In October 2022, the FDA announced a shortage of dextroamphetamine/amphetamine (Adderall; Teva Pharmaceuticals Industries Ltd),¹ a common stimulant prescribed to people with attention deficit hyperactivity disorder (ADHD). Characterized by impulsivity, inattention, and hyperactivity, the condition is thought to affect 8.4% of children and 2.5% of adults in the United States.² Brand-name and generic formulations of the drug increase levels of the neurotransmitters dopamine and norepinephrine in ADHD patients, improving focus and motivation and reducing some negative behavioral traits.^3.4

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The shortage began when Teva Pharmaceuticals, the leading supplier of both the branded and generic versions, experienced packaging capacity issues that led to a nationwide supply chain disruption.^4-6 With Teva unable to supply its usually high production, demand has increased exponentially. Patients have turned to other ADHD drug providers, but have not been able to meet the rapidly growing demand.^4.5

As of March 2023, Teva continued to experience unprecedented demand.⁴ While there is no official Adderall shortage, the generic version is expected to sit on backorders until spring, drug shortage expert Erin Fox told NPR.⁵

The shortage has been exacerbated by a variety of factors, most notably an increase in ADHD diagnoses and prescriptions, as well as federal regulations.^1.7 The number of such diagnoses grew by 31% from 2010 to 2017. Between 2019 and 2020, prescriptions increased by 7.4% among adults aged 22-44, more than doubling the recorded increase between 2020 and 2021.⁷

The COVID-19 pandemic may have facilitated more diagnoses by highlighting existing and previously undiagnosed cases of ADHD. One response to the growing number of diagnoses has been a growing number of prescriptions, which rose from 35.5 million to 45 million between 2019 and 2022, although a survey of readers of ADDItitudea journal focused on ADHD, found that only 26% had received a formal diagnosis during the pandemic.³

The federal government also relaxed its regulations, allowing telehealth providers to prescribe the drug to patients without seeing them in person. This increased the number of stimulants prescribed and led the United States Drug Enforcement Administration (DEA) to investigate those it believed were overprescribed. The DEA classifies dextroamphetamine/amphetamine as a Schedule II substance, placing it in the same category as opioids, which are heavily regulated.⁴

Despite higher number of prescriptions, DEA’s share of total brand and generic dextroamphetamine/amphetamine production^3.4 it hasn’t increased to meet growing demand, and experts don’t think it will.⁴

Shortages have not only affected quantity, but have also uncovered a growing backlash against quality. Patients have recently taken to TikTok to denounce the ineffectiveness of dextroamphetamine/amphetamine, some claiming it doesn’t work as well as before and others that it’s fake or different.

Videos associated with ADHD medications not working have been viewed more than 15 million times on the service.8 One reason for the perceived change may be that the shortage has forced doctors to prescribe different ADHD medications, has said Sandy Mitchell, clinical pharmacy specialist at VCU Health.¹

While patients who have switched to a generic product shouldn’t experience drastic differences, some may be more sensitive to the differences, said Anish Dube, president of the American Psychiatric Associations Council on Children, Adolescents, and their Families.¹ In general, it’s not as easy to switch medications as you might think, said Duane Gordon, president of the Attention Deficit Disorder Association, adding that different ADHD medications ultimately perform the same function, but they could be it takes months to find the right dose.⁴

References

1. FDA announces Adderall shortage. FDA. October 12, 2022. Accessed April 26, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall
2. What is ADHD? American Psychiatric Association. June 2022. Accessed March 16, 2023. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
3. True S. Not my problem: Regulators and drug makers deflect blame for ADHD drug shortages. The Baltimore Banner. March 8, 2023. Accessed March 13, 2023. https://www.thebaltimorebanner.com/community/public-health/adhd-medication-shortage-causes-BDDT6SACVZDGXE7ZIAZOONAQ7Q/
4. The shortage of Gatlin A. Adderall puts Teva and others in a difficult situation. Investors Business Daily. April 5, 2023. Accessed April 5, 2023. https://www.investors.com/news/technology/teva-stock-what-we-know-and-do-not-about-the-adderall-shortage/
5. Lupkin S. Many people with ADHD cannot get their medications due to a shortage of Adderall. All things considered. February 22, 2023. Accessed March 16, 2023. http://www.npr.org/2023/02/22/1158826128/many-people-with-adhd-cant-get-their-medication-amid-adderall-deficiency
6. Kansteiner F. Teva Runs Into Adderall Supply Problem As ADHD Diagnoses Rise, Pledges To Urgent Restocking. Fierce Pharmaceuticals. August 3, 2022. Accessed April 5, 2023. https://www.fiercepharma.com/manufacturing/teva-focuses-refueling-adderall-supply-channels-several-branded-and-generic-doses-go
7. Disbrow, J. Op-ed: DEA and FDA Rules Exacerbate Adderall Shortage. CNBC. February 28, 2023. Accessed April 11, 2023. https://www.cnbc.com/2023/02/28/op-ed-dea-and-fda-rules-exacerbate-adderall-shortage.html
8. Blum D. People with ADHD say Adderall is different now. What is going on? New York Times. March 9, 2023. Accessed March 16, 2023. https://www.nytimes.com/2023/03/09/well/live/adhd-adderall-shortage.html