ADHD med shortage requires patients to seek alternatives

by Cyna Mirzai-

Blacksburg, Va., Feb. 16, 2023 — The nationwide shortage of the common ADHD medication Adderall is leading patients to test new forms of medication. Photo credit: Cyna Mirzai

A shortage of the immediate-release formulation of amphetamine mixed salts, commonly referred to by the brand name Adderall, has been ongoing since October 12, 2022. A direct stimulant on the central nervous system, Adderall is a medication prescribed to people diagnosed with attention deficit/hyperactivity disorder (ADHD).

According to the FDA, one of the manufacturers of amphetamine mixed salts, Teva, is experiencing ongoing intermittent manufacturing delays. While there are other manufacturers producing amphetamine, there is not enough supply to continue meeting U.S. market demand through those producers. 

A rise in demand for Adderall is a large contributor to the shortage, with an increase of almost 20% in 2021 over 2020. Chad Alvarez, System Pharmacy Director of Carilion Clinic Roanoke, said he noticed an increase in demand from patients in the past few years.

“During the pandemic, people were working at home or helping their children with their schoolwork and many began noticing symptoms of ADHD,” Alvarez said. “With the increased use of telemedicine during the pandemic, we saw an increase in demand for those types of prescriptions.”

Many patients are currently prohibited from calling ahead to pharmacies asking about Adderall, since the treatment is a labeled controlled substance by the DEA, according to HCPLive.  A legally controlled substance cannot be transferred from one pharmacy to another, leading many patients to look for temporary alternatives to Adderall.

Blacksburg, Va., Feb. 16, 2023 — The shortage has led Main Street Pharmacy to turn away customers in need of Adderall since late last year. Photo credit: Cyna Mirzai

Alternatives work differently for patients depending on their particular case, Alvarez said. Whether it is an adult who used Adderall for years or a child who was prescribed last month, the benefits of each alternative provide varying results. 

“I always encourage patients to have a conversation with their provider on alternatives,” Alvarez said. “Other ADHD medications like Focalin, Vyvanse, Concerta and Ritalin are currently available in higher quantities and can treat attention deficit issues. It is definitely worth the conversation with your provider to figure out what will work best for you.”

An alternative for patients who currently have Adderall pills is to begin dose-skipping. Patients can skip a dose on days when attentiveness is not critical to accumulate a reserve that will last them longer through the shortage, if advised by a doctor.

If patients do not want to try alternatives, they can choose to stay off medication until the shortage ends, but Dr. Jeremy Courts, owner of Main Street Pharmacy in Blacksburg, warns patients to be prepared for shifts in behavioral changes.

“You probably won’t have intense withdrawal symptoms but you’re going to be irritable and have trouble focusing,” Courts said. “When you don’t have Adderall but need Adderall, your quality of life goes down.”

As of now, the shortage is expected to continue through April 2023.

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