Amid a nationwide shortage of Adderall, an ADHD medication, millions of patients are struggling to refill their prescriptions, and many are suffering from difficult withdrawal and rebound symptoms, including extreme fatigue, mood swings, headaches, and more.
Over the last 20 years, Adderall use in the United States has been on the rise. The growing use of telehealth during the pandemic, particularly for mental health issues, has also contributed to the increase in prescriptions for ADHD treatments, including Adderall.
According to IQVIA, 41.1 million Adderall prescriptions were filled in 2021, an 10% increase from the year prior. Separately, Trilliant Health found that Adderall prescriptions increased by 15% for people ages 22 and 44 between 2020 and 2021.
However, growing demand for Adderall has recently overshadowed limited supplies, making it more difficult for millions of patients with ADHD to access the drug. In October, FDA announced a nationwide shortage of Adderall, in part due to manufacturing delays at Teva Pharmaceuticals, one of the drug's primary producers.
According to Teva, its manufacturing delays have since been resolved, but "a surge in demand" has led to several back orders of Adderall. FDA says it expects the drug's supply issues to be resolved within the next 30 to 60 days, but so far supplies have remained scarce.
"I've had patients call 10, 15, 20 pharmacies in order to get their medication," said David Goodman, an assistant professor in the department of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine. "Now imagine you’re sitting on the phone, desperate to get needed medication, and pharmacy after pharmacy after pharmacy is telling you either they can't tell you or they don't have any, and 'we can't tell you when we're going to get it,' and that's where the panic sets in."
In the meantime, some patients are rationing their remaining medication or driving hours to different pharmacies to see if they can get a refill on their prescription. Many patients who rely on Adderall in their day to day lives are also experiencing withdrawal or rebound symptoms.
For example, Thomas Mandat, a 24-year-old who hasn't been able to refill his prescription for a month now, said he felt like he was in a "zombified" state after going without Adderall. "It's like if you sleep eight hours, but it feels like you only got three," he said.
Other common symptoms of withdrawal include mood swings, irritability, appetite suppression, headaches, intense fatigue, and gastrointestinal distress. Although not all patients will experience Adderall withdrawal, Brigid Groves, senior director of practice and professional affairs at the American Pharmacists Association, said the likelihood of withdrawal symptoms increases the longer a patient has been on the drug and the higher their dose.
"The people that depend on the medication for daily functioning, for going to work, for being a good mother, for going to class, are struggling," said Fairlee Fabrett, director of training and staff development for the child and adolescent division at McLean Hospital. "This [shortage] is not something to make light of."
According to Anish Dube, chair of the American Psychiatric Association's Council on Children, Adolescents, and Their Families, patients who cannot refill their Adderall prescriptions should call their doctors right away to plan alternative treatments.
Some doctors may recommend their patients switch to a different ADHD medication, such as Ritalin or Vyvanse, or an extended-release form of Adderall, which is in greater supply. Patients may also talk to their doctors about spreading out their doses or taking a lower dose to stretch their supply a while longer.
"The plus is, here's an opportunity to change medicine and see if there's a subjective improvement in the experience of the medication," Goodman said. "The downside to this is that the stimulants are not equally substitutable."
If patients are not comfortable switching medications, they could also consider non-medication treatments, such as cognitive behavioral therapy or a coach to help them with their ADHD.
Overall, health experts caution patients to be safe when looking for Adderall alternatives and avoid getting medication from unregulated sources. While there hundreds of social media sites or online dealers that claim to have Adderall available, many of these drugs may be counterfeit or dangerous.
In fact, the U.S. Department of Justice in October charged 23 people for trafficking counterfeit pills, including counterfeit Adderall that was laced with methamphetamine.
"Remember, if you're not getting your pills by a medical prescriber and they're not dispensed to you by an authorized pharmacy, you're taking literally your life into your hands," Goodman said. (Blum, New York Times, 11/16; Charles, CNN, 11/17; Palmer, Nexstar/The Hill, 11/17; Coleman, The Week, 11/18)
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