If you want to ruin a pharmacist’s day, all you have to do is try to fill an Adderall prescription.
Pat Cassidy, a 37-year-old from New Jersey who has been prescribed Adderall for 12 years, would know—he said he recently called 16 pharmacies in the span of two days after being told his medication was expected to be on backorder for two to three months.
Hours spent in conversation with pharmacy associates extended into the following day. Eventually, he hit a wall.
“I mean, at a certain point they’re like you know, fuck off,” he said.
Patients across the country are struggling to access Adderall, one of the most commonly prescribed treatments for attention-deficit/hyperactivity disorder, as a national shortage of the drug drags on.
“My life is turned upside down. My ability to deliver both at work and in my personal life the way I’m used to is compromised,” Cassidy said.
A labor shortage at Teva, the largest supplier of Adderall in the U.S, put the medication on backorder in August. Since then, several other pharmaceutical companies also reported shortages including Ameal and Sandoz. The three companies did not respond to a request for comment.
The pandemic brought a sharp increase in Adderall prescriptions, with mental health startups like Cerebral and Done prescribing Adderall to ADHD patients virtually. The easing of telehealth restrictions during the COVID-19 pandemic allowed controlled substances to be prescribed without an in-person medical evaluation.
In May, Cerebral was under investigation for possible violations of the Controlled Substances Act and was issued a subpoena by federal prosecutors. Around the same time, the Drug Enforcement Administration launched an investigation into the company’s practices. Cerebral announced in May that they would stop prescribing almost all controlled substances to new patients that month and existing patients in October.
Recently, Done was also being investigated by the DEA’s Diversion Control Division, which addresses the diversion of legally manufactured drugs from legitimate sources. Pharmacy giants CVS and Walgreens announced in late May that they would no longer fill ADHD medication prescriptions from Cerebral and Done. The pandemic caused most psychiatry appointments (app or otherwise) to go virtual, and whether pharmacies will still fill controlled substances from telehealth appointments has become hit-or-miss. This has become a problem for people who moved during the pandemic, but wanted to keep their doctor.
Adderall prescriptions rose to 41.4 million in 2021, up 10.4 percent from the year before, the Wall Street Journal reported.
Kristin, a 34-year-old from California who asked to be identified by her first name for privacy reasons, told Motherboard she began rationing her Adderall after learning that people were having difficulty accessing their medication, taking half and eventually quarter doses.
Sure enough, when it came time to refill her prescription, she said that she was told that her medication was on backorder. Discouraged and demoralized, Kristin spent a week relying on leftover medication and three days completely without it before she was able to access Adderall.
“The only thing that we can do is just call and hope for the best, and that seems really unfair,” she said.
Adderall is classified as a schedule II controlled substance, meaning that it has high potential for abuse, so prescriptions typically cannot be refilled earlier than 30 days since it was last filled, and there are also typically restrictions on how many pills a patient can get at a time. This has presented an additional hurdle for patients who are left scrambling at the end of their supply, and, even in the best-of-circumstances, have to tightly schedule their doctor appointments and pharmacy trip to keep a steady supply of Adderall.
Ellyn, a 32-year-old stay at home mom from Chicago, who also asked to be identified by her first name for privacy reasons, typically takes a 30 milligram dose of instant release Adderall daily. She first began having difficulty refilling her prescription in July, and ended up settling on a mixture of 10 and 20 milligrams twice a day after calling multiple pharmacies. When August rolled around, she said that her pharmacy told her the only instant release Adderall they had in stock was a bottle of 20 milligram tablets. In September, she felt lucky when the fifth place she called had 30 milligrams available.
“Making someone with an executive function disorder try to call a bunch of places and do things and organize things is the particularly cruel nature of this,” she said.
Like Kristin, she said that she has had to turn to leftover medication to compensate for delays in refills. At first, the pills accumulated naturally as the result of occasionally skipping a dose. Now, Ellyn said it’s something she’s doing consciously. While determining when to skip a dose, she asks herself whether she wants to “function and feel good” or save the medication in case she is unable to access it. Ultimately, it boils down to one consideration:
“Do I want to feel bad now or feel bad later?” she said.
There are currently more adults with Adderall prescriptions than there are with a formal ADHD diagnosis, according to Trilliant Health. But for patients with an official diagnosis, being unable to access their medication has resurfaced negative emotions associated with Adderall stigma.
“That stigma can have the effect of making us feel like criminals for attempting to take care of ourselves and our mental health,” Kristin said, noting that she feels like she has had to jump through hoops to prove that she’s the “model ADHD patient.”
One misconception fueling Adderall stigma is the belief that the medication is a performance enhancing drug taken for the sole purpose of increasing focus.
Dr. David W. Goodman, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, dispels this notion, saying that stimulant medication is not for the purpose of diminishing ADHD symptoms for productivity, but is much more encompassing.
“We’ve always talked about educational deficiencies as a result of ADHD, but we’ve been lacking in discussing the social implications,” said Goodman.
In addition to cognitive repercussions, withdrawing suddenly from Adderall can result in a broad range of reactions. Goodman said that patients may feel lethargic, amotivated, irritable, and experience an increase in appetite.
“People become very adamant about having their medicine—not because they’re abusing the drugs, but because they realize how important the medicine is to their daily functioning at work and at home,” he said.
Ian Wrobel, a 33-year-old from Missouri who works in public service, said that being off Adderall has caused him “personal distress” and that he has been without his medication since August 30, after learning that his pharmacy did not have the dosage he was prescribed.
Wrobel, who estimates that he has contacted around a dozen pharmacies, said that in his 12 years of taking the medication, he has never gone over a week without it. In lieu of Adderall, he credits an “unholy amount” of caffeine for getting him through the day.
Wrobel said that “for about 30 seconds” he considered purchasing Adderall off the black market, but the thought was fleeting, and he refuses to entertain the idea.
“I don’t trust the black market. I do not trust it with a thousand-yard stick,” he said.
Despite initial hesitancy, he is currently considering an alternative ADHD medication with his doctor in anticipation of a future shortage.
“I’m just scared of trying something different, since I’ve been so used to what I’ve been given for so long,” he said.
A survey conducted by the National Community Pharmacists Association between July 25 and August 5 revealed that 64 percent of small pharmacies that responded had difficulty acquiring Adderall. Now, CVS and Walgreens are also experiencing shortages, Bloomberg reported.
As patients like Wrobel consider switching medications, others continue to hold out hope for Adderall, putting additional pressure on doctors to be on hand and within reach if the medication suddenly becomes available. But in the case of patients like Ellyn, feeling dependent on a medical professional gives rise to new concerns.
“What if he’s on vacation or has a couple days off? I don’t expect him to live and die by his computer,” she said.
A combination of timing and luck seem to dictate whether patients will be able to secure their medication, resulting in frequent back-and-forths with doctors who are tasked with canceling prescriptions and writing new ones. Cassidy, from New Jersey, said that constantly reaching out to his doctor, who is located in Texas, made him worry about how he’d be viewed by them.
“They’re usually suspicious because any controlled substance, people ultimately can abuse those medications in some way, shape or form,” he said.
The American Society of Health-System Pharmacists (ASHP), a group that represents tens of thousands of pharmacists, lists a shortage of several different doses of amphetamine mixed salts (the generic for Adderall) in both extended release and short release versions, from a variety of manufacturers. Shire, which makes brand-name Adderall, did not submit information to the ASHP. Dr. Erin Fox, senior director of drug information and support services at University of Utah Health which compiles the drug shortage data for ASHP, said she first began receiving reports of shortages in early April. By late August, the issue had worsened enough for the University of Utah Drug Information Service to report an official drug shortage on the ASHP site. Dr. Fox said that Adderall shortages typically last anywhere from four to eight months before products are fully restocked and that companies have disclosed anticipated release dates toward the end of September or early October.
She said that despite a slight worsening in recent weeks, based on estimates that pharmaceutical companies have provided things should begin to improve.
“It does feel a little bit like ‘Groundhog Day’ but that shortage resolved and hopefully this one will resolve again soon,” she said, referencing the Adderall shortage in 2015.
The U.S. Food and Drug Administration, meanwhile, has not declared a shortage of Adderall.
Until the shortage is resolved, patients will continue to engage in all-consuming outreach, consider alternative options and in the case of Cassidy, conclude that he is pissing off his doctor.
“It’s a broken system because the doctor is pissed off when you go back to them,” Cassidy said.
The shortage has become a source of anxiety for Ellyn, who said that her prescription has been getting filled later and later each month. As time progresses, and her backup supply dwindles, she has become increasingly concerned with each approaching refill date.
Frustration fuels Kristin’s efforts to obtain Adderall, and though she isn’t keen on giving up, being unable to dedicate ample time to outreach leaves her with scant options in the case that her prescription cannot be immediately refilled in the future.
“I guess I just have to learn to live without a drug that I’ve been taking for 15 years,” she said.
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