Parents and students are stuck in a web of confusion and frustration amid an Adderall shortage that has lasted more than a year, with grades slipping and caretakers driving for hours to fill prescriptions.
While ADHD can present in many forms, it commonly hurts children’s ability to concentrate in class and focus on their assignments, with the long-term effects showing up in academic performance.
“Their grades are suffering, they're falling behind academically and they're losing some motivation,” said Parker Houston, a pediatric psychologist and owner of Central Ohio Pediatric Behavioral Health, who has been working with students on coping strategies during the shortage.
With little hope for relief in sight, professionals are urging better communication among doctors, parents and schools to create an environment that can best help students who are missing their medication.
A year-plus and counting
On Oct. 12, 2022, the Food and Drug Administration (FDA) officially declared a shortage of the ingredients needed to make amphetamine mixed salts, the drug most commonly known as Adderall.
The shortage was first brought on by a disruption at a manufacturing plant run by Teva Pharmaceuticals, the largest supplier of Adderall in the U.S. But with that disruption since resolved, the ongoing scarcity is now attributed to heightened demand outpacing what drugmakers can supply.
The problem has not gone unnoticed, with House Democrats recently issuing a letter to both the FDA and the Drug Enforcement Administration (DEA) expressing their “continued concern” over their constituents being left in “limbo” trying to access the medication.
According to Mike Ganio, director of pharmacy practice and quality for the American Society of Health-System Pharmacists (ASHP), a year-long shortage is not abnormal. While shortages linked to isolated disruptions in the supply chain can resolve quickly, scarcity stemming from raw material acquisition or manufacturers waiting for permission from regulators to ramp up production can last significantly longer.
A lack of transparency in the manufacturing process makes it difficult to tell where the root of the problem lies.
Easier access, increased demand
During the COVID-19 pandemic, the DEA enacted telehealth flexibilities that permitted people to obtain prescriptions for controlled substances without needing to go to in-person appointments. That enabled easier access, both for those who were already on drugs such as Adderall and those who were new to it, which may partly explain the increased demand.
The DEA has extended these flexibilities to last through the end of 2024.
The Centers for Disease Control and Prevention says around 6 million children have been diagnosed with ADHD. Many in both K-12 and college rely on Adderall as the principal drug to help with diagnoses such as ADHD, which can present itself in numerous ways.
“There is not a single clinical profile that can be considered the typical manifestation of this condition. We all know that there is a multitude of symptoms and also a multitude of levels with which these symptoms can exhibit themselves,” said Stephanie Sarkis, a psychotherapist who specializes in ADHD, anxiety and narcissistic disorders.
Some cases are more mild and can be managed with therapeutic techniques and other drugs, but in more severe cases, Adderall can mean the difference between a student staying in school or not.
Trouble beyond the classroom
Outside of academics, a stimulant like Adderall plays a role in regulating mood and sleep, all crucial for young students.
Alternative treatments for ADHD are available, including drugs such as Ritalin, Vyvanse and Strattera. But several of those are also currently in shortage, and they aren’t a simple replacement for someone who is accustomed to something else.
Ganio from ASHP noted that some drugs within the same class are interchangeable, but this is not exactly the case when it comes to treating ADHD.
“When it comes to ADHD medications … there are subtle differences with how they work, for one. And two, the timeline,” said Ganio.
“If I change you from the medication you're on today to a new medication, there's probably going to be several weeks if not months of trying to find the right dose, giving it time to make sure it's having an effect,” he added. “We're talking neurologic receptors. It's not the same as trying to control blood pressure.”
One study showed almost a third of students with ADHD either drop out or delay high school graduation, double the number of those with no other mental health disorders.
“With medication support in those kids who have the most significant symptoms, there's a lot of improvement in grade [...] And then, also, there's a risk reduction in kind of impulsive risk-taking and decision-making, so motor vehicle accidents are reduced when kids can take their medications, substance abuse is reduced and criminal behavior is also reduced,” Houston said.
And the effort to get the medications for these students has been tough on parents, who have had to drive far distances or jump through hoops in the health care system to get the prescription if it even is available.
In the U.S., Sarkis said, a prescription can be “pharmacy specific,” which means a pediatrician will send it to one pharmacy. But if the medication becomes available at another pharmacy, the parents can’t just go get it at the other location. The family “has to go back to the provider to get a new prescription to get that new prescription sent to the new pharmacy,” she said.
The key to overcoming this is consistent communication between doctors and parents, as well as schools trying to fit in accommodations for students with ADHD who can’t get their proper medication.
'Trying to help with communication'
Houston has seen schools “really working hard on classroom-wide or grade-wide organization strategies for students,” such as making color-coded folders for each classroom, more consistently directly communicating with parents and offering more emotional and behavioral support.
“I have two elementary age students right now, and so I get somewhat frequent communication from [teachers] about ‘here are the assignments that are due this week’ and they send me a copy of them. I'll have like a digital copy in case one of my kids loses their copy,” he said. “I think they're really trying to help with communication back and forth.”
While Houston would like to be an “optimist” regarding the shortage, he said he is also thinking of how to plan for situations where access doesn’t improve. And he is far from the only physician with this mindset.
LaTasha Perkins, a family medicine physician based in D.C., said she is navigating the Adderall shortage by being aware of which pharmacies currently have it in stock and advising her patients to be mindful of how they use the drug.
This means sometimes telling parents to hold off on giving their child a dose on the weekends and making sure their homework is done by then. She also tells her college-aged patients not to share their medicine with their friends, no matter the temptation.
“This is not for your friends. This is for you,” said Perkins. “I can write you as many prescriptions as I want, but if there’s no supply then you can’t get it.”
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