A perfect storm of factors has led to skyrocketing demand and critical shortages of medications used to treat attention deficit hyperactivity disorder (ADHD). Prescriptions for these stimulant medications jumped by over 1 million in 2020 and 2021, driven largely by adults seeking diagnosis and treatment during the COVID-19 pandemic. This surge in demand has pharmacies, patients, and healthcare providers across the U.S. struggling to access life-changing ADHD drugs like Adderall and Ritalin.
Pandemic Drives Increase in Adult ADHD Diagnoses
According to a study published this month in the journal JAMA Network Open, prescriptions for ADHD medications rose by 13.5% in 2020 over 2019 levels. Most strikingly, new prescriptions increased by 15.3% among adults aged 26 to 39 during the first year of the pandemic.
This growth accelerated into 2021, totaling over 1 million new prescriptions compared to pre-pandemic rates.
Experts attribute this unprecedented surge to several pandemic-related factors:
- Remote work/learning – Decreased structure and increased distractions at home made ADHD symptoms harder to manage
- Anxiety/depression – Overlapping psychiatric conditions may have exacerbated ADHD symptoms
- Self-reflection – More time for self-evaluation led some to initially seek diagnosis
Additionally, women disproportionately sought treatment, with new prescriptions jumping nearly 20% for this demographic. Researchers hypothesize women experienced higher rates of pandemic-related stressors like caregiving burdens.
|Increase in New ADHD Prescriptions
|Over 1 million
Adderall Shortages Hit Pharmacies Nationwide
Skyrocketing demand has severely constrained medication supplies across the U.S. Adderall, a widely-used stimulant medication, has been particularly hard to access. A survey conducted by the National Community Pharmacists Association found 71% of independent pharmacies are having difficulty filling Adderall prescriptions. Patients are reporting waiting lists of 3 months or longer for their vital medications.
These pervasive shortages are taking a serious toll on ADHD patients:
“My son needs it, just like somebody needs heart medication or any other lifesaving drug. You can’t just take away one of the tools he uses for learning. It’s not an option,” said one desperate mother seeking Adderall for her child.
With such extreme deficits between supply and demand, many pharmacies have been forced to limit each patient’s prescription amounts. Still, scarce inventory continues to leave many without access to treatment.
DEA Limits on Manufacturing Contribute to Shortfalls
Underlying supply chain issues exacerbate the medication shortages. The DEA limits the amount of Schedule II stimulant medications a pharmaceutical manufacturer can produce based on the previous year’s prescriptions. But prescription rates have massively outstripped expectations.
Manufacturers like Teva, Novartis, and Rhodes have petitioned the DEA to raise these quotas so they can boost production. However, these administrative hurdles take significant time. Until changes are enacted, structural barriers will continue forcing shortages and back-ordered medications.
Some opportunistic distributors are also capitalizing on shortfalls by diverting supply into cash-only sales at inflated prices. Reports indicate 30mg Adderall pills that typically retail for $7 are selling on the streets and online for over $30 each. This worsens availability through proper channels.
Healthcare Providers Overwhelmed by Demand
On the frontlines, mental health professionals have faced surging appointment requests for ADHD assessments. With limited providers specializing in adult ADHD, securing an evaluation often requires long waits.
In Nebraska, Dr. Renuga Vivekanandan shared her clinic schedules adult assessments 6-12 months out due to ballooning demand. Appointment delays then compound access issues if a formal diagnosis is required before pharmacologic treatment.
Once diagnosed, patients still require follow-up visits for medication management. But psychiatrists like Dr. Lenard Adler in New York City say their calendars have filled to capacity even without taking new patients:
“I have hundreds of emails that I have not opened yet from patients who want to come see me to initiate or change their stimulant medications that I have no short-term time slots for…”
This access crisis leaves many struggling with ADHD frozen on waitlists while their symptoms impair work, education, relationships and more.
Guideline Development Underway to Prepare for Future Demand
Though wait times currently stretch painfully long, mental health leaders recognize it will take years for demand to stabilize at this new elevated level. Treatment infrastructure and workforce shortages cannot be quickly resolved.
To expand system capacity, work has begun on the first U.S. guidelines for diagnosing and managing ADHD in adults. The American Psychiatric Association and experts across multiple disciplines are synthesizing evidence on best practices that can be adopted nationwide.
These new standards should help detect cases earlier and optimize patient outcomes. But their impact will take significant time to permeate into real-world practice.
As Dr. Frances Prevatt of the University of Florida explained:
“It does take a while for guidelines to actually hit the street in terms of actually impacting patient care…”
In the meantime, providers are advising patients to be proactive but patient. If current treatment isn’t working well, alternatives like cognitive behavioral therapy may help bridge gaps until medication access stabilizes. Open lines of communication with prescribers can also help navigate evolving options in this challenging landscape.
The path forward remains complex for balancing this intensified need for ADHD care with real-world constraints. But transparent understanding of the issues can help patients and their families make informed decisions while advocating for system-level solutions. It will take the cooperation of pharmaceutical companies, regulatory agencies, healthcare providers, and support organizations to develop innovative models that work for all those struggling with ADHD.
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