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.
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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.
