In other words, it’s critical for college students and others who recently moved out on their own to develop reliable medication management routines without parental scaffolding — and to advocate for their own health care needs at the doctor’s office.

[Free Resource: 2024 Scorecard of ADHD Treatments]

Here is the advice I give to my young adult patients:

• Incorporate medication administration into your daily routine. Use alarms or reminders on your phone, or associate medication with specific daily activities (e.g., breakfast or brushing teeth). Use a pill organizer to keep track of doses.
• Understand the expected effects and potential side effects of ADHD medication, and the likelihood that ADHD symptoms will return if doses are skipped. Also know that ADHD medication reduces the risk of substance use and improves productivity at work and in school.
• With your provider, brainstorm ways to adjust your routine to better support medication maintenance. Discuss different medication options, such as long-acting versus short-acting formulations.
• Regularly monitor medication effectiveness and side effects. Keep track of changes in symptoms or adverse reactions. Talk to your doctor about these and any other challenges with your medication regimen, concerns about mixing your ADHD medication with other medications or substances, difficulties adhering to the prescribed schedule, or struggles with getting timely refills from your pharmacy.
• If you experience significant side effects, worsening symptoms, or recognize a change or deterioration in your work performance, relationships, sleep, exercise routines, task management, or overall executive functioning skills, it’s important to tell your health care provider.

ADHD Medication Management: Next Steps

• Download: Get Control of Your Life and Schedule
• Q&A: ADHD Medication — Side Effects, Dosages, Precautions & More
• Read: How to Treat a Teen Self-Medicating ADHD

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The ongoing shortages of generic ADHD medications and chemotherapy drugs are addressed in new draft legislative proposal released on May 3 by Senate Finance Committee Ranking Member Mike Crapo (R-Idaho) and Chair Ron Wyden (D-Oregon), who said the proposed legislation would “tear down regulatory barriers that are preventing families from accessing critical drugs like those needed to combat ADHD.”

The draft legislation was announced on the same day the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association (CHA) sent a letter to the U.S. Department of Health and Human Services and Drug Enforcement Administration expressing their continued concern about the ongoing stimulant medication shortages.

“Families that rely on generic stimulant medications have been disproportionately affected by the ongoing stimulant shortages,” the letter said. “This situation only exacerbates existing health disparities among economically disadvantaged families who are enrolled in Medicaid and CHIP.”

The proposed legislation establishes a Medicare Drug Shortage Prevention and Mitigation Program, wherein hospitals, healthcare providers, group purchasing organizations, drug manufacturers, and others could earn payment incentives for improving their purchasing and contracting practices across the supply chain for generic drugs, including generic versions of ADHD medications such as Adderall and Vyvanse. The proposed legislation would also limit inflationary rebates under the Medicaid Drug Rebate Program (MDRP) for certain generic drugs susceptible to shortages.

“It is unacceptable that America is consistently running out of affordable and essential generic medicines,” Wyden said in a press release. “Once again, monopolistic middlemen have put market power and profit over families’ healthcare.”

Associations Urge Government to Address ADHD Medication Shortage

In their letter on ADHD medication shortages, the AAP, AACAP, and CHA call on the federal government to “convene all relevant stakeholders for a forum to discuss the impact these shortages are having on patients, families, and their providers and identify actionable solutions that will alleviate these shortages.”

“Pediatric providers, including child and adolescent psychiatrists, pediatricians, and children’s hospitals, along with the patients and families they serve, face an insurmountable struggle with stimulant medication shortages,” the letter said. “Untreated ADHD can contribute to worsening mental and behavioral health disorders, including mood and substance-use disorders, unintended injuries resulting from ADHD-related impulsivity and long-term impacts on relationships-building, educational achievement, and professional success. Parents and families may also be negatively impacted by the disruption that untreated ADHD can cause in the home, school, and work environments.”

According to the American Society of Health-System Pharmacists (ASHP), 323 medicines are currently in short supply, the highest number of ongoing and active drug shortages since the organization began tracking data in 2021.

ASHP reported that “new DEA quota changes, along with allocation practices established after opioid legal settlements, are exacerbating shortages of controlled substances (12% of all active shortages).” The Drug Enforcement Agency (DEA) classifies stimulant ADHD medications, such as Adderall and Vyvanse, as “Schedule I,” which indicates drugs with a high potential for abuse.

FTC, HHS Seeks Public Input on ADHD Medication Shortage

The Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS) are seeking public input to understand how the practices of pharmaceutical middlemen contribute to drug shortages and impact patients, hospitals, healthcare providers (including small healthcare providers and rural hospitals), pharmacies, generic manufacturers, and other suppliers.

Sixty-three percent of the more than 6,200 public comments already submitted mention ADHD.

The deadline to submit public comments is May 30, 2024. Add your testimony at Regulations.gov.

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

Register to reserve your spot for this free webinar and webinar replay ►

Not available June 4? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

Despite highly esteemed and plentiful literature on the use of stimulant and nonstimulant medication to treat ADHD, relatively little information is available on the treatment of complex ADHD — that is, attention deficit disorder plus at least one comorbid condition like anxiety, depression, or an eating disorder. Few studies address the treatment of comorbid conditions, the order of treatment, or the treatment of cognitive deficits and/or hard-to-treat ADHD symptoms.

This presentation will integrate data from controlled and open trials to highlight strategies for illustrative cases of complex ADHD. Participants will learn:

• About new medications approved for ADHD and their use for complex and hard-to-treat ADHD
• About strategies to manage ADHD comorbidities
• About approaches for treating cognitive executive function deficits in ADHD

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

Timothy E. Wilens, M.D., is the Chief of Child and Adolescent Psychiatry, and (Co) Director of the Center for Addiction Medicine at the Massachusetts General Hospital. He is a Professor of Psychiatry at Harvard Medical School. Dr. Wilens specializes in the diagnosis and treatment of ADHD, substance use disorders, and bipolar disorder. Widely published, Dr. Wilens has more than 350 original articles, reviews, chapters, books and editorials to his credit. Dr. Wilens is a consultant to the National Football League, Major/Minor League Baseball, Bay Cove Human Services and Phoenix/Gavin House and is consistently named one of the Best Doctors in Boston and in America for psychiatry.

Treating Complex ADHD: More Resources

• Download: 2024 Scorecard of ADHD Treatments
• Sign Up: The Clinicians’ Guide to Treating Complex ADHD
• Read: Treatment Troubleshooting Guide for Patients
• Replay: Substance Use Disorder and ADHD: Safe, Effective Treatment Options with Dr. Timothy Wilens

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Closed captions available.

It began with an Adderall shortage in 2022. Today, prescriptions for many stimulant medications used as the first-line treatment of ADHD are consistently and frustratingly difficult to fill. So it’s unsurprising that ADHD features prominently in the majority of public comments submitted to the Federal Trade Commission (FTC) by stakeholders impacted by long-term medication shortages involved in the treatment of many conditions, including cancer. ADHD patients demand attention on their suffering.

But, by inviting public testimony on the stimulant shortage and pharmaceutical practices, I believe the FTC is only trying to find cover for the Drug Enforcement Administration (DEA). The DEA is the only governmental agency that sets production and distribution quotas for every drug company manufacturing controlled medication. The DEA decides how much of each medication can be released to pharmacies in any given month. Therefore, this problem traces its roots and long tendrils back to the DEA alone. No other agency has the authority to create and prolong it.

The DEA meets with every company that markets a controlled substance each March and April to determine how much of that company’s product can be released each month in the following calendar year. This process tries to predict in March of 2024 how much medication will be needed 21 months later in December of 2025. It is a crude and inadequate system that the DEA is too inflexible to relinquish.

For as long as the United States government has wrestled with combatting the distribution and use of illicit drugs, the DEA has used only one tactic — restricting the amount of drugs available to be sold legally. Now, the DEA is using the same playbook for ADHD stimulants.

Roots of the Adderall Shortage

Two years ago, the DEA decided that ADHD stimulants were being diverted and abused on a large scale, though there was virtually no evidence to support this belief. Studies have shown that a number of people (statistics vary) try stimulants but do not continue to take them without a prescription. About 90% of the diverted immediate-release stimulants are used by a narrow demographic: white male college students who use the drugs so they can stay awake. The medications are not being abused by people with ADHD, many of whom consider the drugs a lifeline for daily functioning.

[Read: Call to Action! Speak Up to End the ADHD Drug Shortage]

The DEA’s skepticism also came on the heels of increased rates of ADHD diagnosis and as a response to online providers who were sloppy about prescribing ADHD stimulants during the pandemic. The online clinics, however, never accounted for more than 1% of all prescriptions issued. And that problem was solved more than two years ago.

The DEA also observed that the number of people taking ADHD medications had been growing by 10% a year for 15 years. The growth rose largely from adults being diagnosed in later life. The relative number of children and adolescents taking stimulants has not changed in 20 years.

The DEA’s apparent logic behind its sweeping decisions was that these adults were abusing prescription stimulants, disregarding the well-documented evidence that ADHD persists after childhood. The rate of diagnosis and medication treatment is rising faster in every European country as well.  In the last year for which I had access to the drug company marketing studies (2014), the average age of diagnosis of ADHD was 31.

The DEA does not bother with facts. Its answer to this increased level of prescriptions: Decrease the amount of drug available regardless of consequences. Even when it became abundantly clear that placing quotas on drug companies had been a disastrous decision, the DEA did not reverse course. Even if the DEA decided in April to raise the allotments of drugs released to pharmacies, its current flawed and inflexible distribution mechanism would not allow for an increase until January 2025.

[Download: The Ultimate Guide to ADHD Medication]

I strongly suspect that the FTC is looking for an agency other than the DEA to blame. First, it said the drug companies were not making enough medication. But the drug companies were making and distributing as much as the DEA allowed them to. The idea that the drug companies were forgoing billions of dollars of profit was always unbelievable. Then the blame was laid on raw material shortages, but after two years, that explanation became hard to believe as well.

Then the FTC, FDA, and DEA blamed the telemedicine-only clinics that sprang up during the pandemic. However, the bad actors in this area have all closed down. Still, there has been no improvement in the shortage.

The time has long since passed for the DEA to admit its fault and fix its broken quota system. There has already been too much needless suffering by innocent people who did nothing to cause the DEA’s restrictions.

Give Your Input on the Drug Shortage

The deadline to submit public RFI comments to the FTC and U.S. Department of Health and Human Services (HHS) is May 30, 2024. Add your testimony at www.regulations.gov. (Direct link to the comment section)

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

Adderall Shortage & DEA: Next Steps

• News: ADHD Medication Shortage Comments Top Government Inquiry
• Download: ADHD Treatment Scorecard from ADDitude Readers
• Blog: “This Cannot Be the Price We Pay to Function.”
• Hub: Stimulant Shortage

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Women with ADHD can continue using the stimulant medication dexamphetamine and the painkiller acetaminophen (brand name: Tylenol) during pregnancy, according to two recent studies that refute a long-standing medical consensus.

An observational study published in the Archives of Women’s Health found that use of dexamphetamine (DEX), the main ingredient in brand-name ADHD medications such as Adderall, Dexedrine, Zenzedi, and ProCentra, does not put women or their babies at increased health risks. However, women who ceased using DEX during pregnancy were more than twice as likely to have a threatened abortion (mild to moderate bleeding during the first trimester) compared to those who continued DEX or who did not use the stimulant during pregnancy.¹

“This could indicate a possible association with DEX withdrawal,” the study’s authors wrote. “However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortion.”

The researchers analyzed a cohort of 1,688 women diagnosed with ADHD who gave birth in Western Australia between 2003 and 2018. Of the participants, 65% (547) ‘continuers’ took dexamphetamine throughout their pregnancy; 35% (297) ‘ceasers’ stopped using DEX before the end of the second trimester. A matched ‘unexposed’ group of 844 women had prescriptions for dexamphetamine before but not during pregnancy.

The three groups shared similar maternal health and labor and delivery characteristics, such as the onset of labor and delivery method. Complications during pregnancy, such as threatened pre-term labor, premature rupture of membranes, and bleeding in the second trimester, did not differ between the ‘ceasers’ and the ‘unexposed.’

Compared to the ‘continuers’ and ‘ceasers,’ the ‘unexposed’ group had a lower risk of:

• preeclampsia
• hypertension
• postpartum hemorrhage
• neonatal special care unit admittance
• fetal distress

While the findings illustrate the possible benefits of ceasing DEX before conception, the study’s authors noted that discontinuing ADHD medication puts pregnant people with ADHD at a higher risk for depression, anxiety, feelings of isolation, and family conflict. ²

“The results indicated that continuing to take dexamphetamine did not put women or their babies at increased health risks,” said Dani Russell, the study’s lead author, and a Ph.D. student from the University of Western Australia School of Population and Global Health. “Pregnancy can be a really stressful period for women with ADHD, so it is good to know that stopping their medication during pregnancy may not always be necessary.”

This research is part of a larger body of work investigating different ADHD treatments during pregnancy. The study’s authors said that more investigations are needed on the topic.

Acetaminophen Use in Pregnancy Not Linked With ADHD

A new study published in JAMA found that acetaminophen exposure during pregnancy does not increase the risk of autism, ADHD, or intellectual disability in children; however, factors such as genetics and the environment do. ³ This is the largest nationwide cohort study to date on acetaminophen usage during pregnancy. The study challenges prior research claiming that acetaminophen exposure during pregnancy may increase the risk of neurodevelopmental disorders in children. ⁴, ⁵

Scientists from the Karolinska Institute of Sweden and Drexel University’s Dornsife School of Public Health analyzed the prenatal and medical records of nearly 2.5 million children born in Sweden from 1995 to 2019, with follow-up through 2021. Of the 185,909 children exposed to acetaminophen in pregnancy, nearly 9% were diagnosed with autism, ADHD, or an intellectual disability, compared to about 7.5% of children whose mothers did not use the medication while pregnant. Children exposed to acetaminophen had marginally higher rates of diagnoses compared to those not exposed (1.53% vs. 1.33% for autism, 2.87% vs. 2.46% for ADHD, and 0.82% vs. 0.70% for intellectual disability).

The research team used the same database to conduct a second study focused on pairs of siblings whose mothers used acetaminophen during one pregnancy but not the other. This sibling control analysis found no evidence of increased risk of autism, ADHD, or intellectual disability associated with acetaminophen use during pregnancy.

“Associations observed in models without sibling control may have been attributable to confounding,” they wrote. “Results suggested that there was not one single ‘smoking gun’ confounder, but rather that multiple birthing parents’ health and sociodemographic characteristics each explained at least part of the apparent association.”

The study found acetaminophen had similar risks for neurodevelopmental disorders as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and anti-migraine medicines. (The FDA recommends against using NSAIDs, such as Aspirin and Ibuprofen, in the third trimester of pregnancy because they may cause a blood vessel in the fetus to close prematurely.)

The researchers said that, despite the study’s large sample size and long duration, their reliance on self-reported and prescription dispensing data introduced several limitations. Still, these findings coincide with the American College of Obstetricians and Gynecologists, which maintains that acetaminophen is safe for pregnant women to use.

The Archives of Women’s Health and JAMA studies highlight the importance of pre-conception or early pregnancy counseling, individualized treatment plans, and medication management and recommend that patients discuss all medication decisions with their doctor.

Sources

¹ Russell, D.J., Wyrwoll, C.S., Preen, D.B. et al. (2024). Investigating Maternal and Neonatal Health Outcomes Associated with Continuing or Ceasing Dexamphetamine Treatment for Women with Attention-Deficit Hyperactivity Disorder During Pregnancy: A Retrospective Cohort Study. Arch Womens Ment Health. https://doi.org/10.1007/s00737-024-01450-4

²Damer, E.A., Edens, M.A., van der Loos, M.L.M., van Esenkbrink, J., Bunkers, I., van Roon, E.N., Ter Horst, P.G.J. (2021). Fifteen Years’ Experience with Methylphenidate for Attention-Deficit Disorder During Pregnancy: Effects on Birth Weight, Apgar Score and Congenital Malformation Rates. Gen Hosp Psychiatry. https://doi.org/10.1016/j.genhosppsych.2021.09.003

³Lee, B.K., et al. (2024). Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA. https://doi.org/10.1001/jama.2024.3172

⁴Ji, Y., et al. (2019). Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure with Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2019.3259

⁵Bauer, A.Z., Swan, S.H., Kriebel, D. et al. (2021) Paracetamol Use During Pregnancy — A Call for Precautionary Action. Nat Rev Endocrinol. https://doi.org/10.1038/s41574-021-00553-7

Adults and caregivers harmed by the ongoing ADHD medication shortage have contributed thousands of impassioned, irate impact statements to a joint Request for Information (RFI) issued by the Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS) seeking public comment on drug prices and availability. Of the more than 5,600 public comments submitted so far, 62% (nearly 3,500) have mentioned ADHD and/or the stimulant shortage ongoing since October 2022.

Open through May 30, the RFI asks patients to submit comments, documents, and data regarding how the practices of two types of pharmaceutical drug intermediaries — group purchasing organizations (GPOs) and drug wholesalers — may contribute to generic drug shortages, including how both entities may influence the pricing and availability of pharmaceutical drugs. The RFI does not specifically ask about ADHD medications.

More than 300 medications, including chemotherapy drugs, medic drugs, antibiotics, and psychostimulants, are in short supply, according to David W. Goodman, M.D., LFAPA, an assistant professor in psychiatry and behavioral sciences at the Johns Hopkins School of Medicine. The RFI comments are overwhelmed with ADHD patients, in part, because “the shortage of ADHD medications has extended so long that there are more people actively engaged ‘in the conversation,’” he says.

“The ADHD drug shortage is now over a year old and continues to be problematic,” says Timothy Wilens, M.D., an associate professor of psychiatry at Harvard Medical School. “It is tiring to patients and clinicians, and it puts individuals at risk for academic and occupational difficulties and a myriad of other issues. In my practice, people are totally fed up with tracking down medications every month.”

Stimulant shortages continue to be a problem for many of the patients Ann Childress, M.D., treats at her private practice in Las Vegas. Childress, who is the current president of the American Professional Society of ADHD and Related Disorders (APSARD) says, “Each week, I have to rewrite several prescriptions to send to an alternative pharmacy because the patient’s regular pharmacy does not have the medication needed in stock. Many insurances will not cover brand-name medication in stock even when the generic is not available. I don’t think the shortage is going away any time soon.”

ADHD Patients Express Anger, Fear, Frustration in RFI

Harrowing personal stories of treatment disruptions and anxiety around finding — and paying for — ADHD medications were found easily in the comments submitted to the RFI.

“I get it: the FDA and DEA are looking to avoid Opioid Crisis II: The Stimulant Years. But attempting to absolve yourselves of your past failures at the expense of current patients is not the answer,” wrote Tiffany from Texas. “Especially considering ADHD patients are the least well-equipped to navigate complicated, multi-step tasks like calling multiple pharmacies — who often refuse to divulge inventory information without a valid script — and doctors who want us to verify a pharmacy has the drug in stock before they’ll send the script; finding and completing the necessary forms with insurance companies to beg for brand name coverage exceptions. And if, by some stroke of luck, we successfully amble through this Byzantine process with a filled prescription, we have exactly 29 days before we get to start it all over again, and all the while, our federal government is trying to gaslight us into believing there’s sufficient supply to meet demand.”

“When I try to fill my prescription, I’m made to feel like some kind of drug-seeker or addict,” wrote Susan from Washington. “People treat my diagnosis as spurious. People assume that I’m simply unwilling to tolerate the normal challenges of life and expect medication to make things easier. It’s hard not to wonder if people in power are deliberately creating this situation because they dislike people with my diagnosis, or if they don’t care enough about our needs to make a real effort.”

“This ADHD drug shortage has severely affected me,” wrote one anonymous commenter. “There have been many times I have been unable to fill my prescription. I work in a hospital with critically ill patients. Without medication, my inattention puts people’s lives at risk.”

“The shortage of necessary medication for ADHD is a huge problem for my family,” wrote Julia from New York. “Both my spouse and child take different medications to manage their ADHD symptoms. They choose not to medicate on days it would help but isn’t ‘necessary’ so that they can save medication for the most ‘necessary’ days. This kind of self-denial and hoarding is a ridiculous solution to a problem they did not create. My 18-year-old child is trying their best in school but feels they are not living up to their potential because they cannot participate appropriately. My child does not deserve to have their self-esteem eroded because a necessary medication that they deserve is not available to them.”

“My day-to-day living is unmanageable without Adderall,” wrote Sara from Florida. “I tried to go without medication for a few months because it was such a challenge to find… and I hated being treated like a drug addict at pharmacies. After a few months without meds, my impulsive spending led to an inability to pay my bills. I lost my home and endangered my job. All I did was think about the things I had to do and not do any of them.”

“I have had to leave one of my two jobs because I could not function at the level I needed to without my medication, and I suffered from a severe mental health crisis,” wrote Jennifer from Oregon. “My current insurance no longer covers the copay for Vyvanse, which costs upward of $400 for 28 pills. I have been relying on and thriving on this medication for half of my life, and it now costs more than my monthly car payment. Because of the astronomical costs, I have been unable to afford the medication that I need to function.”

“The ADHD medication shortage has negatively impacted every single part of my life and my child’s,” wrote Kelly from Iowa. “Attempting to fill prescriptions in the past two years or so has been an absolute nightmare. I have been forced to bundle my child up and drive up to 45 minutes away (one way) from our city to acquire our ADHD medication on many occasions. We have gone without or with a fraction of our prescribed dose for many days. I have spent time I could not spare searching for our ADHD medication. I have constant anxiety when one of our ADHD medications starts getting low each month. We have missed healthcare appointments, events, and social gatherings. We have lost friendships. My small business has suffered.”

According to an ADDitude survey of 11,013 adults and caregivers, at least 20% of ADHD patients were still impacted by the stimulant shortage in the summer of 2023. (Learn more about how the ADHD medication shortage has impacted ADDitude readers “Stop Treating Us Like We’re Addicts!” and “A Daily Nightmare:” One Year into the ADHD Stimulant Shortage.)

The deadline to submit public RFI comments is May 30, 2024. Add your testimony at Regulations.gov.

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

Treating ADHD with medication can lower overall risk of mortality and of hospitalizations, both psychiatric and non-psychiatric, according to two new Swedish studies.^{1, 2} These findings highlight the importance of ADHD medication use for long-term health and longevity, underscoring the urgent need to end the stimulant shortage that has prevented U.S. patients with ADHD from consistently accessing medication since the Fall of 2022.

Lower Risk of Death from All Causes

An observational study from Sweden, published in JAMA, followed nearly 150,000 adults and adolescents with a diagnosis of ADHD, tracking participants for two years following diagnosis.

The researchers found that use of ADHD medication:

• Reduced overall risk of death by 19%: Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.

• Reduced risk of overdose by 50%: Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide. This trend was particularly pronounced among men and significant in the category of accidental poisoning, where risk of death was lowered by almost 50%.

• Reduced risk of death from natural causes for women: ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women. Though it did not reduce this risk for men, medication use did not increase risk either. This is an important finding that may alleviate long-standing worries about the impact of stimulant use on cardiovascular health, among other concerns.

While the authors of the study caution that these findings show correlation, not causation, the results are encouraging for patients and clinicians with reservations about ADHD medication use, especially later in life.

Fewer Hospitalizations

A second Swedish study sought to investigate the effect of a variety of ADHD medications on rates of hospitalizations. Published in JAMA Network Open, the cohort study used nationwide medical and administrative databases to identify 221,000 people with ADHD, 56% of whom had a psychiatric comorbidity including anxiety or stress-related disorder (24%), and depression or bipolar disorder (20%). These individuals were then followed for up to 15 years.

The study found that a patient’s use of amphetamine, lisdexamphetamine, dexamphetamine, and/or methylphenidate significantly lowered the risk of:

• Suicidal behavior
• Psychiatric hospitalization
• Non-psychiatric hospitalization

Untreated ADHD in Adults Leads to “Dire Consequences”

The authors of the study featured in JAMA Network Open believe that the decrease in hospitalizations reflects the fact that ADHD medication use is associated with decreased risk for suicide attempts,³ substance use disorder,⁴ depression,⁵ car accidents,⁶ and unintentional injuries.⁷

“Impulsivity in adults can lead to dire consequences. The idea is that by improving impulsiveness and executive functioning, people are able to make better decisions,” explains Frances Levin, M.D., author of the JAMA editorial “Treating Attention-Deficit/Hyperactivity Disorder Matters,” ⁸ in a recent interview. “If you’re dealing with a substance use disorder (SUD) population, treating the ADHD allows them to better utilize clinical treatment for their SUD, and therefore reduce their risk of substance use and reduce accidental poisoning or overdose.”

“A Significant Public Health Problem”

The mortality risk study emphasizes the importance of treating ADHD, Levin explains: “Unlike other conditions, there’s often a sense that ADHD is over-hyped or it’s not a big deal, but this article demonstrates that this group is at higher risk of having both substantial morbidity as well as mortality.”

ADHD expert Russell A. Barkley, Ph.D., echoes this sentiment, stressing that ADHD is the number one factor affecting mortality for people with the condition. In other words, ADHD is not just a mental health issue; it’s a significant public health problem.

Barkley published a study in the Journal of Attention Disorders that found adults with ADHD could expect an 11- to 13-year reduction in life expectancy compared to neurotypical peers of a similar age and health profile.⁹

However, most of the ADHD-related factors impacting life expectancy — impulsivity, risky behavior, and inattention, to name a few — can be improved with interventions. Behavioral programs designed to improve overall health will also improve life expectancy, but only if ADHD symptoms are under control first, Barkley says. That requires more accurate diagnosis and more thoughtful treatment.

“When adults ask me questions about why they should try medication to manage their ADHD, my answer always comes down to two words: Medication works,” Barkley says in the ADDitude article, “Adult ADHD Treatment Options.” “When you find the right medicine, you can experience substantial improvements in your ADHD symptoms.”

Sources

¹ Li L, Zhu N, Zhang L, et al. (2024). ADHD Pharmacotherapy and Mortality in Individuals With ADHD. <em>JAMA.<em>doi:10.1001/jama.2024.0851

² Taipale H, Bergström J, Gèmes K, et al. Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes. JAMA Netw Open. 2024;7(3):e242859. doi:10.1001/jamanetworkopen.2024.2859

³ Chang  Z, Quinn  PD, O’Reilly  L,  et al.  Medication for attention-deficit/hyperactivity disorder and risk for suicide attempts. Biol Psychiatry. 2020;88(6):452-458. doi:10.1016/j.biopsych.2019.12.003PubMedGoogle ScholarCrossref

⁴ Chang  Z, Lichtenstein  P, Halldner  L,  et al.  Stimulant ADHD medication and risk for substance abuse.  J Child Psychol Psychiatry. 2014;55(8):878-885. doi:10.1111/jcpp.12164PubMedGoogle ScholarCrossref

⁵ Chang  Z, D’Onofrio  BM, Quinn  PD, Lichtenstein  P, Larsson  H.  Medication for attention-deficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study. Biol Psychiatry. 2016;80(12):916-922. doi:10.1016/j.biopsych.2016.02.018PubMedGoogle ScholarCrossref

⁶ Chang  Z, Quinn  PD, Hur  K,  et al.  Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes.  JAMA Psychiatry. 2017;74(6):597-603. doi:10.1001/jamapsychiatry.2017.0659ArticlePubMedGoogle ScholarCrossref

⁷ Ghirardi  L, Chen  Q, Chang  Z,  et al.  Use of medication for attention-deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co-occurring neurodevelopmental disorders. J Child Psychol Psychiatry. 2020;61(2):140-147. doi:10.1111/jcpp.13136PubMedGoogle ScholarCrossref

⁸ Levin FR, Hernandez M, Mariani JJ. Treating Attention-Deficit/Hyperactivity Disorder Matters. JAMA. 2024;331(10):831–833. doi:10.1001/jama.2024.1755

⁹Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164

Even after an ADHD diagnosis, many clinicians are reluctant or refuse to prescribe stimulant medications due to conflicting or outdated information, leaving many older adults with ADHD without proper treatment.

It’s never too late to seek a diagnosis and symptom relief. Use this Patient Resource to begin conversations about and pursue an evaluation for ADHD as an older adult.

In this download, you will learn

• Why it’s never too late for an ADHD diagnosis
• Why older adults with ADHD symptoms go undiagnosed or misdiagnosed
• Why stimulants do not increase cardiovascular risk
• Why ADHD treatment gets tougher with age
• And much more

In addition to draining limited reservoirs of stamina, time, and patience, the monthly ordeal of searching for stimulants often includes upsetting encounters with pharmacy staff. Among ADDitude readers who use ADHD medication, 38% report that they’ve been made to feel like a “criminal” or “addict” when trying to obtain their prescribed medication. They share stories of encountering wariness, annoyance, and even downright hostility at the pharmacy, all of which exacerbates an already exhausting ordeal. In some cases, this refill process is so fraught with negative emotion that readers report re-thinking their decision to take medication at all.

You’re not alone if you have been made to feel judged, embarrassed, or interrogated. Here, readers vent about experiences they’ve had while trying to locate prescribed stimulants in the middle of an unprecedented shortage.

“For the love of all that is holy and all that is not, the pharmacies need to stop treating us like we are addicts. Yes, I am desperate to get my ADHD medication. But it is not so I can abuse it or sell it! It is because I desperately need the medication that makes my brain work well enough so that I can keep my job, so that I don’t make mistakes that might be dangerous, like getting distracted driving. Treating us, every single time, like we are possible criminals? It just makes everything so much harder.” —An ADDitude Reader

“I have to meet with the pharmacist each time I pick up my prescription, as if I don’t know what the medication does. It’s extremely embarrassing and it makes me debate whether I need to take it at all. Because I’m Black, there’s an additional layer to the stereotype of being ‘on drugs.’” –Paris, California

[Read: How the Adderall Shortage Is Casting a Long Shadow on ADHD Treatment]

“I compare it to making a heart patient run a marathon before filling their medicine. They are asking us to do the hardest task (that the medicine helps us with) and then they look at you weird for making the mistakes that ADHD causes! It usually ends in tears monthly.” —Brandy, Louisiana

“I’ve had pharmacies tell me to “take my drug-seeking somewhere else” when I called to ask if they had 10 mg Adderall in stock. Others have commented that I ‘don’t look like the kind of person who uses this,’ as though ADHD has a ‘look?’” —Mel, Idaho

“I had to have the pharmacist speak to one of the techs once because she made a comment about ADHD being a ‘made up’ thing. I was incredibly offended and was made to feel ashamed.” —Jennifer, Colorado

“I feel uncomfortable each time I have to get my prescription filled — a prescription that helps me function and not self-medicate as I used to prior to my diagnosis. It is incredibly frustrating!”  — An ADDitude Reader in Tennessee

[Read: “This Cannot Be the Price We Pay to Function.”]

“It’s a crappy process that I repeat for myself and both of my kids. I feel like I am begging for meds; it makes me feel looked down on and judged.” —Sarah, Washington

“I feel like a criminal every time I call a pharmacy. Often, I just go without, instead of feeling like a criminal.” —Mary Kate, Massachusetts

“I have to mentally prepare myself before I call the pharmacy because I never know how they’ll react. Phone calls are one of my biggest anxiety triggers, so it’s been really difficult to manage.” —Rachel, Kansas

“The pharmacy often has to revalidate the prescription, which makes me feel like I am being monitored for misuse. Increased inaccessibility makes me second-guess my choice to get medication assistance for my ADHD.” —Isabella, Ohio

“If you call for a refill a day early, you can get labeled as a drug-seeker. If something isn’t working or isn’t helping, I can’t talk to my doctor the way someone might be able to do with a sprained ankle.” —An ADDitude Reader

“We have never had a problem misusing our medications or being over-prescribed, and yet most mainstream pharmacies act like we’re trying to do something wrong when filling these prescriptions. I worry about my child not being willing to deal with this when they get older if they still need these medications.” —An ADDitude Reader

“My medication was out of stock everywhere and when I called around, the vast majority of pharmacies were very cold and callous about it and treated me like I was a crazy person for asking questions. They acted like if I needed ADHD medication I must be abusing it. Absolutely zero empathy for the fact that you can’t access a prescribed medication you need.” —An ADDitude Reader

Adderall Shortage: Next Steps

• Free Download: 2024 Scorecard of ADHD Treatments
• Read: Call to Action! Speak Up to End the ADHD Drug Shortage
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Hub: Stimulant Shortage

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Adults and caregivers reported that the process of searching for the right medication — the one with highest efficacy, fewest side effects, and covered by insurance — is often frustrating, but essential. Persevering through the often confusing, time-consuming, and inconvenient process leads to better management of ADHD symptoms in the end for most. Here, ADDitude readers share their experiences, both the bothers and benefits of trialing medications.

“There was one person in an ADHD support group who made a comment that changed my life. She mentioned that the seventh medication she tried was the right one for her. That made me decide to give medication a second chance, and try a few more. I could not have finished my Ph.D. without it.” — Heather, Canada

“Trial and error is generally a nightmare. School is not the best place to observe how a new med is or isn’t working; teachers usually don’t have the time, energy, or patience to report back accurately. We also had to change formulations several times due to the whims of insurance.” — An ADDitude Reader

“There are not enough resources to help people navigate going on and off medications while trialing. How long should I be on it? What about side effects? How does this relate to hormone changes throughout the month for women?” — Madeline, UK

[Download: Free Guide to Hormones & ADHD in Women]

“Medication trials have taken so long because our doctors are scared to do anything. It’s something that should be done quickly to find the optimal dose but they keep us in limbo because they’re not confident in their ADHD knowledge. We’re having to wait and wait and wait while our kids are struggling. It has a ripple effect on our entire household.” — An ADDitude Reader

“The process of trying out one medication after another slowly and methodically is very difficult to manage for most people who have ADHD.” — Tyler, California

“It was 10 years before I found a medication that helped me more than it made me feel worse. It’s important to kick a medication if it’s not working, even if it has worked previously.” — Juniper, Oregon

[Read: The ADHD Medication Stopped Working! How to Troubleshoot Treatment]

“Trial and error is hard. Then you find a medication that works and the manufacturer stops making it or the generic version, and you have to start the whole process again. So frustrating.” — An ADDitude Reader

“Finding the right match for children takes time and clear communication with schools and caregivers, which is sometimes very difficult.” — An ADDitude Reader

“I don’t feel that I have found the right medication yet. I’m very sensitive to medication and side effects also make it difficult to try different ones.” — An ADDitude Reader

“I have a really hard time tracking my symptoms and noticing changes on my own.” — Ashley, Minnesota

“The process of finding the right one can be very frustrating, but it’s worth being patient.” — Ali, North Carolina

“I wish there were easier ways to find the right medications for people with ADHD rather than trial and error.” — An ADDitude Reader

“Be patient. Give the medication time as you adjust dosage. Try other types if you need to. Everyone is different, and when you find the one that works, it is life changing in a fabulous way!” — Marcia, New York

“I’m hopeful that neuroscience will someday be able to treat ADHD without endless failed attempts with medication.” — An ADDitude Reader

Medication for ADHD Trial and Error: Next Steps

• Read: How Do We Know the Treatment Is Working?
• Read: Time to Switch to a New ADHD Medication?
• Watch: How to Optimize ADHD Medication – Achieving Better Symptom Management
• Learn: ADHD Medication Options – Stimulants, Non-stimulants & More

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

I apprehensively open my prescription bottle and peer in. I pour its contents into my hand, double and triple checking my count of its contents. Dread washes over me; it’s time to get a medication refill.

The ADHD medication shortage that started in late 2022 – and still with no end in sight – has deeply and profoundly worn me down. I am exhausted. I am frustrated. I struggle immensely due to the extra time and effort I now have to invest to get the medication I need to function. Even though millions of us are affected by this shortage, I’ve felt isolated and hopelessly alone in navigating this overwhelming system that has failed us.

An Executive Function Gauntlet: The Outrageous Absurdity of Refills

I take both a long-acting and short-acting version of my ADHD medication, and have been doing so for a decade. Prior to the shortage, the process I followed to obtain medication was imperfect, but more doable than our current nightmare. I had grown accustomed to the task of getting a new prescription for each of my medications to bring to my pharmacy every month. I knew when I had to make an appointment with my doctor to request the prescriptions, and I diligently showed up to my pharmacy within the three-day refill window, as allowed by law, and was ready to wait the usual 45 minutes for both of my medications to be filled.

With the ongoing medication shortage, I only have about 10 blissful days a month where I’m not dealing with some aspect of refilling my medications. Now it’s not only a question of being within my three-day refill window but also relying on my medication to be in stock.

At every turn, obtaining the medication I need requires executive functioning – the very area that is impaired in ADHD, and for which medication, along with employing strategies and learning skills, improves. My prescriptions have gone from being filled on the same day to being filled on different days and then weeks apart. This means shifting things around to make room for more trips to the pharmacy, more phone calls to disgruntled staff, more things to complicate my day-to-day life, all while undermedicated. (As it turns out, living with impaired executive functioning sure takes a lot of executive functioning.)

[Read: How to Weather the Persistent Adderall Shortage]

More than once, I’ve been scolded by pharmacy staff for making the mistake of calling to request my prescription release one day too early. (As many ADHDers know, staying on top of dates is no easy task.) I was acridly reminded that this is a scheduled drug and that my refill is not due yet. Each time it’s happened, I say, “My apologies, thank you for your help,” silently chastising myself for messing up the dates, loathing that I have to start this process all again the next day.

I also started rationing my medication, skipping doses on weekends to make sure I could at least have medication to do my job. After a few months of this, my frustration gave way to panic when my pharmacy said it had no idea when the next shipment would arrive.

I once contacted 15 different pharmacies over three days, trying to find a location that not only had medication in stock, but that would be willing to take my prescription. Pharmacy after pharmacy told me that their location was no longer accepting new ADHD patients. One pharmacy even had the audacity to laugh at my provider when they tried to call my prescription in. This system, designed to prevent drug abuse, was now forcing me into the role of a literal drug seeker despite being on my exact same dosages for ten years – the irony of which was not lost on me.

One pharmacy was willing to take my prescriptions, but getting there and back would easily take me an hour, and they could only put me on the wait list. Another pharmacy was closer, and while they didn’t have my exact dosage in stock, they told me that they’d be able to fill my prescription if my doctor split my dose between two lower-dose pills. I hesitated, anxious to make the request because my doctor had already submitted and cancelled two sets of my prescriptions that month. I worried that the back-and-forth would flag me as a troublesome patient. Thankfully my doctor was willing to accommodate. Still, I thought to myself that this cannot be the price we pay to function.

[Read: The Real Reason ADHD Medication Supply Is Lagging Demand]

Then there’s the work of verbally calling to release my prescriptions, which can take anywhere from three minutes to a very literal two hours on hold, only to be hung up on. I can’t just leave a voicemail to release my prescription – there is no way to confirm they received it without calling in again.

At my doctor’s appointments, on the phone with the pharmacy, and at the pick-up window, I started venting my frustrations in the form of humor. I joked that this system is an executive function gauntlet for people with ADHD – it certainly wasn’t designed with us in mind! Yet these jokes only got an occasional weary smile. Meanwhile, I simmered, knowing this “joke” was my real life.

Trapped in a Solitary, Multi-Year Riptide

I have educated myself on the  shortage, reading endless articles about it. I have observed how the different agencies, producers, and regulators involved shift the blame. Yes, it is a complex system, but that does not diminish any one participant’s part in making it better or making it worse. I have written to Congress. I have listened to countless stories of the strife everyday folk endure to get their prescriptions.

Every story I hear makes me feel like each individual with ADHD is on their own little island. We’re able to send along messages in a bottle, but we’re unable to collectively make those in power recognize our stories and our pain. I am sick of feeling trapped in this riptide all by myself, subject to forces that I cannot control, powerless to take care of my own physical and mental health. I am saddened that there doesn’t seem to be a way for the 8.7 million of us with adult ADHD (and parents of children with ADHD) to collectively advocate or have a say in this process. We deserve a seat at the table.

A Seat at the Table: How We Can Make Our Voices Heard

The ADHD medication shortage cannot go on. It has caused far too much damage and pain for those of us who simply want to live and work and achieve what we are capable of by limiting the burden of this neurodevelopmental disorder.

I have done all that I can on my part – following all of the expert advice during this shortage – to independently manage my health. I am working toward medical school, and I have thought long and hard about what I’d do if I could magically fix this system. Perhaps new monthly prescriptions should only be required in the first year that a newly diagnosed patient is trying different ADHD medications and dosages. From there, documentation attesting to ADHD and the continued need for medication can be submitted to the DEA, insurance companies, and any relevant regulatory board in order for a patient to be granted the privilege to have their medication treated like any other normal, regularly prescribed medication.

Pharmacies would be able to better predict their orders of stimulant medication instead of having to turn people away with valid prescriptions because they’re already overwhelmed with managing this shortage. I do not deny that stimulant medication has potential for abuse, and a regulatory system is appropriate for this class of medications. But the bottom line is this: There must be a way for diagnosed ADHD patients who have a history of established care to be able to reliably obtain their medications.

But work must be done on all fronts. Individually, we are isolated. Yet we have power in our multitudes and in our stories. It’s time to start to #ADDUsUp. We can all be #ADHDvocatesForChange.

• Share your stories of and frustrations with navigating the ongoing shortage, plus ideas for how to make the world better for neurodivergent individuals on social media using the above hashtags.
• As you share your story, tag celebrities with ADHD and ADHD organizations/platforms and demand that they unabashedly call out the shortages and seek not just answers, but change.
• Write to your U.S. representatives, the DEA, and the FDA, who must understand the real-life consequences of drug shortages and current policies for the millions of us who live with ADHD. Untreated or poorly treated ADHD wrecks lives, and medication is an important tool upon which we rely for our health and wellbeing. Highlight how policy at the governmental, regulatory, and healthcare system-level (including procedures at insurance companies and manufacturers/distributors of medications) directly impacts the care and wellbeing of ADHD patients.
• Submit comment to the Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS), which are seeking public input to understand how lack of competition and contracting practices may be contributing to drug shortages. The deadline to submit public comments is April 15, 2024.

Together we can elevate our voices, share our experiences, and demand more of our institutions and those in power. If we, a bunch of executive functioning-challenged ADHDers can get organized and start a movement, then those with power have no excuse for ignoring breaks in this system. It’s time for them to do their part, too.

ADHD Medication Shortage: Next Steps

• Special Report: ADHD Treatments Scorecard from ADDitude Readers
• News: ADHD Medication Costs Soar
• Hub: Adderall Shortage

Elizabeth (Elle) Sharrard is an aspiring medical student and a proud #ADHDvocate who hopes to empower people to use their voices to improve the world for all. Elle’s blog post inspired the creation of ADDitude’s call-to-action scripts for contacting representatives about the ongoing ADHD drug shortage.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

To what degree are ongoing nationwide ADHD drug shortages worsened by the role of pharmaceutical middlemen? This is the subject of a public inquiry recently launched by the Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS), which issued a joint Request for Information (RFI) on February 14.

The public has until May 30 to publicly submit comments at Regulations.gov.

The RFI asks patients to submit comments, documents, and data regarding how the practices of two types of pharmaceutical drug intermediaries — group purchasing organizations (GPOs) and drug wholesalers — may contribute to generic drug shortages, including how both entities may influence the pricing and availability of pharmaceutical drugs.

“When you’re prescribed an important medication by your doctor, and you learn the drug is out of stock, your heart sinks,” HHS Secretary Xavier Becerra said in a press release. “This devastating reality is the case for too many Americans who need generic drugs for ADHD, cancer, and other conditions. Today’s announcement is part of the Biden-Harris Administration’s work to tackle healthcare monopolies and lessen the impact on vulnerable patients who bear the brunt of this lack of competition.”

More specifically, the federal agencies say they aim to learn:

• Whether and to what extent manufacturers, GPOs, and drug wholesalers are complying with their legal obligations under Section 3 of the Clayton Act and the Robinson-Patman Act.
• Whether and to what extent the available protections for GPOs under the Federal Anti-Kickback Statute affect market concentration and contracting practices by GPOs, as well as drug shortages.
• Whether and to what extent market concentration among GPOs and drug wholesalers has impacted smaller healthcare providers and rural hospitals.
• Whether and to what extent concentration among GPOs and drug wholesalers has disincentivized suppliers from competing in generic drug markets.
• What is the impact of the prevailing GPO compensation model, which may rely on rebates, chargebacks, and administrative fees from manufacturers and suppliers in exchange for favorable treatment, on generic manufacturers and other suppliers?

Since the U.S. Food and Drug Administration (FDA) first reported a shortage of Adderall in October 2022, millions of patients and caregivers have struggled to fill prescriptions with no end in sight.

According to a December 2023 report published in USA TODAY, the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023 for specific dosages of methylphenidate (i.e., Ritalin and Concerta); the average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period.

According to an ADDitude survey of 11,013 adults and caregivers, at least 20% of ADHD patients continued to be impacted by the stimulant shortage in the summer of 2023.

The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.

• Submit comment to the FTC and HHS
• Contact Your U.S. Congressional Representatives
• Send a letter to the DEA
• Send a letter to the FDA

Give Your Input on the Drug Shortage

The Federal Trade Commission (FTC) and U.S. Department of Health and Human Services (HHS) are seeking public input to understand how lack of competition and contracting practices by two pharmaceutical drug middlemen groups — group purchasing organizations (GPOs) and drug wholesalers — may be contributing to drug shortages.

The agencies are seeking public input on a variety of subjects under this topic, including whether and to what extent lack of competition among these pharmaceutical middlemen groups impacts patients, hospitals, healthcare providers (including small healthcare providers and rural hospitals), pharmacies, generic manufacturers, and other suppliers.

Submit comments by May 30, 2024 at www.regulations.gov. (Direct link to the comment section)

Contact Your U.S. Congressional Representatives

• Find contact information for your U.S. Congressional Representatives here.
• Send the following message to your representative. (Want to send an email? Consider doing it via democracy.io)

Dear Representative,

Millions of American caregivers and patients with attention deficit hyperactivity disorder (ADHD) have endured unprecedented healthcare disruptions and adverse outcomes since the Federal Drug Administration first reported shortage of Adderall, the amphetamine mixed salts used to treat ADHD, in October 2022.

Patient advocates and legislators have called on federal agencies to help combat the nationwide Adderall shortage, yet it continues to impact the health and wellbeing of millions. In fact, the shortfall has extended to methylphenidate (Ritalin), lisdexamfetamine dimesylate (Vyvanse), and more ADHD medications.

Stimulant medication is a first-line treatment for ADHD, a neurodevelopmental condition that impacts all facets of living throughout the lifespan. Research shows that stimulants are effective, safe, and vital to improving the health outcomes of individuals with ADHD.

The drug shortage has created immense hardship for individuals already living with a highly stigmatized condition. Some caregivers and patients must endure hours of phone calls and travel each month to access pharmacies that can fill their prescriptions. Providers have switched patients to less-than-optimal-but-available alternative medications. Desperate patients are endangering their lives by procuring counterfeit drugs on the black market and using illicit substances to self-medicate.

Patients unable to access their prescribed ADHD medications have lost jobs, and their ability to carry out daily tasks or adequately care for their children, many of whom have ADHD as well. The shortage has led to lower academic performance and increased behavioral and emotional problems for children, who may bear the repercussions for a lifetime.

Patients who can access their ADHD medication must now contend with higher drug prices, which are outpacing inflation. In some cases, prices for stimulant medications have doubled and tripled since the shortage began, further derailing treatment for many.

The causes for the shortage are mystifying, especially as the DEA, FDA, and drug manufacturers trade blame. Many caregivers and patients with ADHD feel the FDA’s and DEA’s lack of transparency and unwillingness to take meaningful action to end the shortage reflects a deep-seated belief that ADHD is not a valid diagnosis or a real, debilitating condition.

I urge you to identify steps that relevant agencies and policymakers can take to end this shortage. I support any legislative proposals to this end, including calling a congressional hearing to understand what the FDA and DEA are doing to mitigate the shortage and improve treatment outcomes for patients prescribed ADHD medication.

I appreciate your timely focus and attention to this dire situation. The livelihood of millions of Americans depends on your swift action.

Sincerely,

Contact the DEA

The Honorable Anne Milgram
Administrator
U.S. Drug Enforcement Administration
8701 Morrissette Drive
Springfield, VA 22152

Dear Administrator Milgram,

Millions of American caregivers and patients with attention deficit hyperactivity disorder (ADHD) have endured unprecedented healthcare disruptions and adverse outcomes since the Federal Drug Administration first reported shortage of Adderall, the amphetamine mixed salts used to treat ADHD, in October 2022.

Patient advocates and legislators have called on federal agencies to help combat the nationwide Adderall shortage, yet it continues to impact the health and wellbeing of millions. In fact, the shortfall has extended to methylphenidate, lisdexamfetamine dimesylate, and more ADHD medications.

Stimulant medication is a first-line treatment for ADHD, a neurodevelopmental condition that impacts all facets of living throughout the lifespan. Research shows that stimulants are effective, safe, and vital to improving the health outcomes of individuals with ADHD.

The drug shortage has created immense hardship for individuals already living with a highly stigmatized condition. Some caregivers and patients must endure hours of phone calls and travel each month to access pharmacies that can fill their prescriptions. Providers have switched patients to less-than-optimal-but-available alternative medications. Desperate patients are endangering their lives by procuring counterfeit drugs on the black market and using illicit substances to self-medicate.

Patients unable to access their prescribed ADHD medications have lost jobs, and their ability to carry out daily tasks or adequately care for their children, many of whom have ADHD as well. The shortage has led to lower academic performance and increased behavioral and emotional problems for children, who may bear the repercussions for a lifetime.

Patients who can access their ADHD medication must now contend with higher drug prices, which are outpacing inflation. In some cases, prices for stimulant medications have doubled and tripled since the shortage began, further derailing treatment for many.

In August 2023, your agency issued a joint statement with the FDA outlining steps to alleviate the shortage. The letter assured Americans with ADHD that your agency takes ADHD and its treatment seriously. Your agency’s subsequent lack of action and transparency suggests that you do not.

I understand that the DEA cannot compel a manufacturer to begin or change their drug production, however I also know that the agency has the authority, responsibility, and opportunity to adjust production quotas and to otherwise move us toward solutions to these significant drug shortages. I urge the agency to stop pointing fingers and start devising solutions to a dangerous ongoing health crisis. I call on the DEA to expedite plans to ensure patient access to the full suite of medications used to treat ADHD, and to do so with urgency.

The livelihood of millions of Americans depends on your swift action. Thank you very much for your timely focus and attention to this important issue.

Sincerely,

Contact the FDA

Send this letter as an email to the FDA

The Honorable Robert Califf
Commissioner of Food and Drugs
U.S. Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, Maryland 20993-0002

Dear Commissioner Califf,

Millions of American caregivers and patients with attention deficit hyperactivity disorder (ADHD) have endured unprecedented healthcare disruptions and adverse outcomes since the Federal Drug Administration first reported shortage of Adderall, the amphetamine mixed salts used to treat ADHD, in October 2022.

Patient advocates and legislators have called on federal agencies to help combat the nationwide Adderall shortage, yet it continues to impact the health and wellbeing of millions. In fact, the shortfall has extended to methylphenidate, lisdexamfetamine dimesylate, and more ADHD medications.

Stimulant medication is a first-line treatment for ADHD, a neurodevelopmental condition that impacts all facets of living throughout the lifespan. Research shows that stimulants are effective, safe, and vital to improving the health outcomes of individuals with ADHD.

The drug shortage has created immense hardship for individuals already living with a highly stigmatized condition. Some caregivers and patients must endure hours of phone calls and travel each month to access pharmacies that can fill their prescriptions. Providers have switched patients to less-than-optimal-but-available alternative medications. Desperate patients are endangering their lives by procuring counterfeit drugs on the black market and using illicit substances to self-medicate.

Patients unable to access their prescribed ADHD medications have lost jobs, and their ability to carry out daily tasks or adequately care for their children, many of whom have ADHD as well. The shortage has led to lower academic performance and increased behavioral and emotional problems for children, who may bear the repercussions for a lifetime.

Patients who can access their ADHD medication must now contend with higher drug prices, which are outpacing inflation. In some cases, prices for stimulant medications have doubled and tripled since the shortage began, further derailing treatment for many.

In August 2023, your agency issued a joint statement with the DEA outlining steps to alleviate the shortage. The letter assured Americans with ADHD that your agency takes ADHD and its treatment seriously. Your agency’s subsequent lack of action and transparency suggests that you do not.

Although I understand that the FDA cannot compel a manufacturer to begin or change their drug production, the agency has the authority, responsibility, and opportunity to move us toward solutions to these significant drug shortages. I urge the agency to stop pointing fingers and start devising solutions to this dangerous ongoing health crisis. I call on the FDA to expedite plans to ensure patient access to the full suite of medications used to treat ADHD, and to do so with urgency.

The livelihood of millions of Americans depends on your swift action. Thank you very much for your timely focus and attention to this important issue.

Sincerely,

Small studies suggest that an individual with trauma may be predisposed to ADHD, just as anyone with a history of trauma is predisposed to depression, anxiety, and post-traumatic stress disorder (PTSD).

The task of a good diagnostician is to identify a patient’s current diagnoses and treat them, focusing particularly on the most pressing and problematic symptoms. If all of those appear to be symptoms of PTSD, we treat that with a different kind of therapy called trauma-focused cognitive behavioral therapy (TF-CBT). If we find that ADHD symptoms linger even after the trauma is addressed, then we add in ADHD treatment as well. The general rule is to treat the most pressing problem first, then determine whether there are other problems, such as ADHD, that also require treatment.

Q: What do you think about genetic or blood testing, and using those results to choose a prescribed medicine?

These blood tests look at the enzymes in the liver and some of the blood cells to learn how antidepressants, in particular, metabolize in an individual. Enzymes come in different variants, some of which may metabolize an antidepressant very quickly. Other variants of the same general enzymes metabolize medication very slowly.

[Read: What to Expect When You Start Depression Medication]

If someone metabolizes an antidepressant quickly, they’re going to need a higher dose. A slow metabolizer given a doctor’s standard dose will be more likely to have higher blood levels of the medication and more likely to experience side effects.

Q: Can taking certain medications during pregnancy cause ADHD in the child?

The medications people most commonly worry about during pregnancy are SSRIs taken for depression or anxiety. However, there is no evidence that taking SSRIs poses a risk. On the other hand, we do know that taking opioids or heavily abusing stimulants, such as methamphetamine or cocaine, can have a negative effect. Opioids, the top concern on my own list, have been linked to birth defects. Federal and state health agencies provide resources online about reducing the risk of birth defects through behavioral and environmental exposures.

[Read: Treating for Two – ADHD Meds in Pregnancy]

Q: What do researchers think will be different about ADHD treatment in, say, 10 years?

ADHD is a final common pathway of external symptoms. Like a bad cough, it can have many different causes. A cough might occur because of allergies, an infection such as pneumonia, or even cancer. We can find many causes using physical examinations, X-rays, blood tests, and so on.

We don’t yet have precise tools to do that for ADHD. But there is reasonable hope that advances in research will help us develop testing to identify an individual’s specific ADHD causes. And when we figure that out, we can begin to think about preventing and treating ADHD in a very person-specific way. But this is 10 to 20 years away.

PTSD Symptoms and ADHD: Next Steps

• Read: The Science of Fear – Probing the Brain Circuits That Link ADHD and PTSD
• Learn: A Playbook for Post-Traumatic Growth
• Read: Getting Meds Right – Is It in the Genes?
• Learn: The Future of ADHD Research Looks Like This

As if the ADHD medication shortage wasn’t frustrating enough, patients are now forced to contend with higher prices that could further derail treatment. Certain ADHD medications have doubled or tripled in cost since the shortage began in October 2022, according to a report published in USA TODAY.

The newspaper analyzed the prices that retail community pharmacies pay for common ADHD prescriptions. For specific dosages of methylphenidate (i.e., Ritalin and Concerta), the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023. The average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period, according to the December 2023 report.

“Drug manufacturers may change the list prices of their drugs at any time after launch,” says the Assistant Secretary for Planning and Evaluation (ASPE), principal advisor to the Secretary of the U.S. Department of Health and Human Services. “Over the period from January 2022 to January 2023, more than 4,200 drug products had price increases, of which 46% were larger than the inflation rate. The average drug price increase throughout the period was 15.2%, translating to $590 per drug product.”

The average price change between 2021 and 2022 was 11.5%, an increase of $172, on average.

“Most drug manufacturers make changes to their prescription drug list prices in either January or July of each year, with the greatest number of changes taking place in January,” ASPE reported. “From January 2022 to January 2023, price changes ranged from a decrease of 99% to increases of over 3,000%.”

Drugs.com reported that, without insurance coverage, a supply of 100 capsules of 10mg of Adderall XR costs around $759.54, while 100 tablets of 5mg short-acting Adderall costs around $1,139, depending on the pharmacy. A supply of 100 capsules of Vyvanse costs around $1,306.

Insurance coverage is the most important deciding factor when choosing an ADHD medication for 19% of recent Medscape survey respondents with ADHD, according to Ann Childress, M.D., during a presentation at the 2024 APSARD conference on January 17. ADDitude readers have likewise felt the sting of cost increases for their prescription stimulants.

“My son is on Adderall XR 10mg. The price went from $10 in December to $54 in January to $158 this month,” says one reader. “When I called our prescription care plan, they said the price increase was due to supply and demand. It’s scary how the cost of a medication can fluctuate so much. Fortunately, we have covered the cost, but what about families who can’t?”

Says another reader, “The price differential is extreme: Adderall XR costs about $5 for a 30-day supply; Vyvanse costs $165 for a 30-day supply.”

One reader found a solution with the help of her physician and pharmacist. “My son’s doctor prescribed Cotempla XR-ODT, but my insurance wouldn’t cover it until he tried two other medications first,” the reader says. “It would cost $350 per month if they did approve it. Thankfully, our doctor knew this was a problem for many of his patients. He sent the prescription to a pharmacy that input the manufacturer’s coupons after verifying what our insurance would and would not pay for. Now, our copay is only $35. I’m so grateful for our doctor and the pharmacy who helps their customers get the medicine they need without going bankrupt.”

The U.S. Food and Drug Administration (FDA) first reported a shortage of Adderall in October 2022. More than a year later, millions of patients and caregivers still struggle to fill prescriptions, with no end in sight.