Low Supplies Of Adderall And Prescription Startups Fueled Crisis

Topline

Ritalin is the latest attention deficit hyperactivity disorder (ADHD) medication in short supply—after a months-long Adderall shortage—leaving patients who rely on these drugs to manage daily symptoms without proper treatment.

Patients have reported difficulties in acquiring Ritalin and Concerta. (Photo by XAMAX\ullstein bild … [+] via Getty Images)

ullstein bild via Getty Images

Key Facts

Shortages of Adderall, a medication used to treat attention deficit hyperactivity disorder, have increased demand for other ADHD medications like methylphenidate (including brand names Ritalin and Concerta), which are now facing their own shortages.

The FDA announced a shortage of Adderall in October, noting that Teva Pharmaceuticals, the country’s largest Adderall producer, was experiencing manufacturing delays.

Though the FDA’s drug shortage database now lists most dosages of Teva Adderall as available, other manufacturers — including Alvogen, Rhodes Pharmaceuticals and SpecGX — do not have available Adderall or are facing supply constraints through the spring, according to the database.

The FDA does not have methylphenidate, the generic name for Ritalin, listed in its drug shortage database, though the American Society of Health-System Pharmacists lists a variety of methylphenidate drugs as facing shortages due to active ingredient issues or the drug being on backorder.

A Johnson & Johnson spokesperson (whose company Janssen Pharmaceuticals Inc. produces Concerta) told Bloomberg earlier in January Concerta is available but the company is “aware of some supply challenges in the market,” and a Novartis spokesperson told Bloomberg that one dose of Ritalin faced a “temporary interruption” while denying the extended release Ritalin LA was on backorder.

Symptoms of ADHD include inattention (including short attention span, poor organizational skills and being easily distracted), impulsivity, and hyperactivity (like fidgeting or an inability to stay on task), according to Johns Hopkins Medicine.

Key Background

The ADHD medication shortage dates back to last summer with the Adderall shortage, though manufacturers have struggled to meet surging demand for the medication since 2019. Teva Pharmaceuticals began facing supply issues in August, with both Adderall and generic amphetamine mixed salts on backorder due to “packaging capacity constraints” and worker shortages. By the end of August, other major generic Adderall manufacturers including Amneal Pharmaceuticals and Rhodes Pharmaceuticals also reported the medication being on backorder after prescriptions surged. In October, the FDA confirmed the Adderall shortage, and Teva projected their supply issues would not be resolved until at least March. The shortage comes as ADHD diagnoses and Adderall prescriptions steadily increase — diagnoses more than doubled between 2007 and 2016, and Adderall prescriptions rose more than 10% between 2020 and 2021.

Surprise Cause: Startups

The medication has recently been easier to acquire because of looser pandemic-era rules that do not require in-person visits for prescribing certain substances, allowing health startups to prescribe Adderall over the phone. Some startups like Done and Cerebral, aided by advertising campaigns on TikTok and Instagram, can diagnose ADHD after a 30-minute phone call, a practice that has sparked criticism and made some workers uncomfortable, though Cerebral Chief Medical Officer Dr. David Mou told the Wall Street Journal the company does not pressure practitioners to prescribe anything (Cerebral stopped prescribing ADHD medication in May).

How Doctors Recommend Patients Navigate The Shortage

Doctors recommend calling different pharmacies to ask whether they have the appropriate medication in stock, The Washington Post reported, because different pharmacies may have different supplies. Exploring alternative medications in consultation with a healthcare provider may also yield results (though demand for other ADHD medications has also created shortages, creating a “domino effect,” Yahoo News reported). Maintaining good health through sufficient sleep, eating well, exercising and limiting screen time can all help mitigate symptoms of ADHD, doctors told The Washington Post.

Tangent

Other high-profile drug shortages include Ozempic, the diabetes drug frequently used for weight loss, and children’s flu and cough medicine. Ozempic is an injectable medication used to lower blood sugar and hemoglobin A1C in type two diabetics — but one side effect is weight loss, leading doctors to prescribe it for weight loss in patients without diabetes (Ozempic is not FDA approved for weight loss). The drug earned a reputation late last year as a Hollywood drug and a viral internet phenomenon, thanks to its use by celebrities including Elon Musk, who took to Twitter to credit the drug (and fasting) for his weight loss. The use of Ozempic for non-prescription purposes sparked criticism for creating a shortage that has left diabetics who rely on the medication without the treatment they need. Other drugs facing a shortage include children’s Tylenol, Advil and Motrin because of the “tripledemic” — the concurrent spread of Covid-19, influenza, and respiratory syncytial virus (RSV). In response, pharmacies began placing limits on how many children’s pain medication products a consumer can purchase.

Contra

Though several widely used drugs have faced shortages in recent months, the total number of drug shortages are actually down from previous years, according to the FDA. In 2011, the FDA reported 251 drugs in shortage, but in 2021, the FDA tracked 41 shortages and averted 317 shortages.