There’s an ADHD medication shortage, a fact you already know if you’re the parent of a child with ADHD. Pharmacies are running short of Ritalin, Adderall, and other drugs in common use for treating attention deficit hyperactivity disorder (ADHD). Some parents find themselves calling faraway pharmacies in hopes of locating a source for the medication. But all too often, the gambit fails. The lack of medication means that children with ADHD will almost certainly fall behind in their studies, as they are unable to concentrate in class and absorb their lessons. Physicians suggest that parents work with their child’s doctor to find alternative medications for the condition, but these are often expensive, and may not be as effective.

The shortage began about a year ago with Adderall, and then expanded to include other medications in common use for treating ADHD. In July, for example, the U.S. Food and Drug Administration (FDA) announced shortages of Concerta and Vyvanse, both very effective at treating children and adults with ADHD. These drugs all have the same purpose, to allow those with the brain disorder to focus on the work at hand. For adults, it’s about focusing on the job and everyday tasks like driving. For children, it’s their schoolwork. Without that medication, their education will suffer.

The U.S. Drug Enforcement Administration (DEA), has proposed stricter rules for telehealth providers who prescribe these medications. But for some parents, the new regulations will make it even harder to obtain the precious medication for their children. That may not be a bad thing.

Telehealth Led to “Over-Prescribing”

“The shortage partly occurred because during COVID and the shift to telehealth, many people started using online services to get evaluated and prescribed medications for ADHD,” says Alex Dimitriu, MD, a Menlo Park, California psychiatrist in private practice who prescribes stimulants for some of his patients with ADHD. “I had the experience of seeing a friend (with legitimate ADHD) go through one of these services, and it was frightening the ease with which he was able to obtain a controlled stimulant medication—after a very minimal 30-minute assessment.

“Telehealth and the commercialization of remote treatment for ADHD has been helpful in getting people more access to these meds and services, however, it has sometimes become too easy, which is quite concerning. Fortunately, there is now a pullback as we see regulators coming down on services that offer controlled substances, like ketamine or ADHD medications, often advertised over social media, and delivered with very minimal medical supervision.”

In addition to limiting the ability of telehealth providers to be free and easy with ADHD prescriptions, which Dimitriu describes as “over-prescribing,” the DEA imposes manufacturing quotas for the medications. Medications for ADHD, such as Adderall, are stimulants, which means they are controlled substances. The DEA limits production of these medications because of the high potential for abuse, addiction, and overdose. But this doesn’t tell the whole story: according to the DEA and FDA, drug manufacturers are producing one billion fewer doses than allowed by their 2022 quotas. And it doesn’t look as if things will be changing any time soon.

Demand Exceeds Supply

Manufacturing delays are an issue for Teva, one of the pharmaceutical companies that produces Adderall. Other drug companies, meanwhile, have not been able to produce enough of the amphetamine mixed salts needed to satisfy the need for Adderall in the wake of the shortage. Then, of course, the demand for ADHD medications was already increasing before the current shortage. That’s because the number of ADHD diagnoses have been steadily rising since 2016, with a steep increase between 2020-2021.

One of the reason for the increasing number of cases of the disorder is a better understanding of how ADHD affects women and girls. In boys, ADHD tends to cause outward impulsive, hyperactive behavior. With girls, on the other hand, there’s not much to see. They may seem quiet, and have trouble paying attention, but they aren’t climbing the walls like the boys.

As a result, experts now believe that girls were going undiagnosed for decades. Now light has dawned on the medical community, and more girls with ADHD are being evaluated and diagnosed. Treatment, however, is a different story. The drug manufacturers haven’t yet caught up with the demand owing to this growing sector of ADHD patients. This is understandable, considering that from 2003 to 2015, the number of privately insured women ages 15 to 44 who received a prescription for ADHD medication, increased by a whopping 344 percent.

Finding Viable Alternatives

The increasing demand, and lowered supplies mean that physicians sometimes have to get creative. If the pharmacy is out of one medication, a doctor may have to come up with a different treatment as a viable alternative. “My entire practice consists of patients with ADHD,” says Ann Childress, MD, a Las Vegas, Nevada psychiatrist in private practice, and president of the American Professional Society of ADHD and Related Disorders (APSARD). “Since the shortage, I have had to rewrite about a third of prescriptions because the medication is not available at the first pharmacy.”

Dimitriu likens the process of locating appropriate medication for his patients with ADHD, to a hunt. “The shortage in meds is quite frustrating for my patients who legitimately need these medications. I now have to call several pharmacies to hunt down who has which medication is stock. As these are controlled substances, it’s also challenging to cancel and re-write prescriptions to wherever they are available.”

At the same time, Dimitriu isn’t seeing much of a spike, if any, in cases of ADHD. “I am seeing a questionably minimal increase in ADHD diagnoses. Part of this may be that the return to work has been a stressor which required more attention and focus than when people were at home. Conversely however, for many patients, the return to work offered a helpful return to structure, and removal of all the distractions that occur at home. So in the end, it’s a wash.”

ADHD Medication Shortage—Adults Also Affected

While more women and girls are being diagnosed for ADHD, Childress points to another sector of the population that may be increasing the demand for medication. “What I am seeing are more adult patients who are wondering if they have ADHD. They often do have ADHD and have been struggling with the consequences their whole lives.

“ADHD can cause significant impairment at work, with family and with friends. Once these patients are treated, their lives improve,” notes Childress.

The shortage, of course, makes it difficult for adults and others with ADHD to obtain that critical treatment. While adults who go without treatment may not be able to perform well at work, children who go untreated for ADHD are in danger of never getting as far as entering the job market. Without treatment, children with ADHD are liable to earn poor grades, which in turn, can lead to dropping out of school altogether, which lands them on the streets. These same children are now vulnerable to developing substance abuse, and as they get older, may feel so hopeless that they don’t even try to find gainful employment.

What Should Parents Do?

All of this leads to the big question: What should parents do if they can’t find ADHD medication for their child?

Dimitriu says that there may be some other treatment the child can try, or even a different form of the child’s regularly prescribed medication. “Ask your doctor for alternatives. Look into short acting and long acting formulations as alternatives, including other non-stimulant medications for ADHD such as Clonidine and Bupropion, possibly Modafinil. Due to their higher cost, some medications are available as name brand, non-generic versions.

“Talk to their prescriber,” says Childress. “Sometimes it is as easy as sending to another pharmacy. If they normally go to a Walgreens, then maybe try a CVS. There are several manufacturers that make generic amphetamines and methylphenidates. Different chains may order from different manufacturers.

“The parents can also discuss switching to a brand name medication. However, their insurance may not cover the brand, even when the generic is not available,” says Childress, who notes that getting authorization to switch medications is not as simple as it sounds. “Prior authorizations take a lot of physician and staff time. We have to send information about previous treatments and often have to copy records to send in. That means I have to review the chart and flag notes that have to be submitted. One prior authorization can easily take 30 minutes of my time. Then, often I don’t get a response for several days.

Be Patient

Childress understands the parents’ frustration, but there isn’t much that can be done to speed things along. “Encourage parents to be patient—I know it is difficult because their children need the medication.”

Of course, lack of medication not only makes it difficult in school, but at home. ADHD manifests in a variety of ways. For example, it makes it difficult for children to plan out their day and organize themselves. They may need extra help from their parents, for instance with getting their clothes ready in the morning, and putting together the supplies and books they need for school. The child’s behavior may also try a parent’s patience, especially if the child has symptoms of hyperactivity.

Until the shortage of medication for treating ADHD ends, parents of children with ADHD will have to put extra effort into helping their children cope. When a parent feels that frustration rising, it can help to take some deep breaths to clear their head.  It can also help to remember that millions of parents are going through the same thing with their own children. The main thing to do is hold on and have hope that not too long from now, the supply of ADHD medication will finally catch up with the demand.

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