The FDA has confirmed that there is a big Adderall shortage of the immediate-release form of amphetamine mixed salts (Adderall/Adderall IR, Teva). According to the agency, this shortage could last until 2023.
By the time Michael Kenneally was pacing outside a CVS in Cambridge, Massachusetts, this summer, he knew the pharmacist’s first name. Mr. Kenneally, who was 48 years old, had been told more than once that his prescription for Adderall couldn’t be filled. He kept calling and going to the store to check for 25 days.
Mr. Kenneally had been taking the drug for 25 years to treat his attention deficit hyperactivity disorder (ADHD). “I’ve been on it for so long that it’s hard for me to do anything without it,” he said.
He said that the day he went to the pharmacy was the first time he felt like a drug addict. He remembered thinking, “What am I doing here?” as he went back and forth in front of the glass doors.
After switching to mail delivery, Mr. Kenneally was finally able to fill his prescription, but every month he wonders if there will be another delay. In October, the Food and Drug Administration confirmed what he and many other patients had already seen: there is a shortage of Adderall all over the country.
On its website, the agency says that the Adderall shortage is still going on, even though some manufacturers have the medicine in stock. An F.D.A. spokesman said on Tuesday that the agency thought supply problems would be fixed in 30 to 60 days. One of the biggest companies that make Adderall, Teva Pharmaceuticals, had trouble hiring people more than a year ago, which slowed down production. A spokeswoman for Teva told The Times that those delays have been fixed, but that the company is now dealing with “a surge in demand,” which is the main reason for backorders.
Since 1990, the number of Americans who use Adderall has been going up. From 2006 to 2016, the number of prescription stimulants used to treat A.D.H.D. grew by 100%. Especially adult women have been using the drug more and more. In May, Margaret Sibley, an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, told The Times that more people may have taken ADHD drugs to deal with the stress of the pandemic. Online therapy start-ups have also said that they can quickly diagnose A.D.H.D. and write prescriptions for drugs.
Mr. Kenneally worries about how he will work without medicine. He is a process technician at a biopharmaceutical company. He said that after just a few days without Adderall, he felt very tired.
Fairlee C. Fabrett, director of training and staff development for the child and adolescent division at McLean Hospital in Massachusetts, said, “People who need the medication to go to work, be a good mother, or go to school are struggling.” “This is nothing to laugh about.”
After the first few days or weeks of withdrawal are over, which usually takes a week or two, people still have to deal with the fact that they will be without Adderall for an unknown amount of time.
“It plays mind games with you,” said Meri Romedy Barbian, a senior at the University of Mississippi who missed class to drive almost two hours to the only pharmacy she could find that had Adderall. “You’re like, ‘Oh my gosh, am I really this dependent on the medicine?'”
Adderall Withdrawal: A ‘Zombified’ State
Thomas Mandat, who is 24 years old and has ADHD, hasn’t been able to fill his prescription in a month. He was so tired the first two weeks that he didn’t take his medicine and he couldn’t eat. He had to force himself to drink protein shakes.
On the third day he hadn’t taken his medicine, he sat down at his desk at a Las Vegas financial services company and felt like his head was full of sludge. He said he felt like he was “zombified”: “It’s like when you sleep eight hours but feel like you only slept three.”
Dr. Fabrett said that not every person who suddenly stops taking Adderall will go through withdrawal. But if they do, they may experience mood swings, irritability, loss of appetite, and, in the worst cases, suicidal thoughts. Dr. Anish Dube, chair of the American Psychiatric Association’s Council on Children, Adolescents, and Their Families, said that they might also get headaches, feel jittery, be very tired, and have trouble with their stomachs.
Brigid Groves, senior director of practice and professional affairs at the American Pharmacists Association, said that the longer someone has been taking Adderall and the higher their doses, the more likely it is that they will have withdrawal symptoms.
Dr. Dube said that even people who take a low dose of Adderall can go through withdrawal. He also said that the version of Adderall that works quickly may be more likely to cause withdrawal symptoms than the version that stays in the body longer.
A.D.H.D. Rebound Symptoms
Dr. Dube said that patients’ ADHD, which led them to start taking medication in the first place, can get worse when they stop taking it suddenly.
Snezhana Kostornova, a 31-year-old psychology student who took Adderall up until two months ago, has been dealing with symptoms of withdrawal. A few weeks ago, she turned on the water in her bathroom sink to wash clothes by hand, but she got sidetracked when she went to get soap, watered her plant, and then looked for curtains online until the water ran over her feet. Ms. Kostornova said that she is just taking each day as it comes because of the lack of Adderall. She sometimes wears earplugs when she goes outside because the noises can be too much for her to handle, which is a sign of ADHD.
Without a clear idea of when the shortage will end, Ms. Kostornova doesn’t know how to plan for her future. She thinks about putting off graduate school. Should she tell her teachers that she’s stuck? Without her medicine, it’s hard for her to respond to texts from family and friends. Should she tell them that? “You just have to think about how much you can do before your deck of cards falls down,” she said.
Edward DiNola, a 35-year-old game programmer and designer in Orlando, has become almost nocturnal without Adderall. His sleep schedule is all over the place and hard to predict. After a week without his medicine, he went to bed at 7 a.m. one day. “Not being able to control your own energy is a bit of a curse,” he said. He was told he had ADHD when he was in his early 30s, and he said that Adderall was like glasses for his brain. “It helps me get my thoughts in order and gives me a little more control.”
Natalie Rotstein, who is 24 and uses they/them pronouns, has been taking Adderall for the past 12 years. She said that not being able to get it is “a safety concern.” Over the past month, they have been very careful about how much medicine they take because they are afraid that one day they won’t be able to get their prescription filled. They’re afraid of running a red light in Los Angeles, and at work, they’re afraid of forgetting to tell patients to take off their jewelry before going into the MRI machine, which can burn the skin.
Piecing Together Temporary Solutions
Source Newyorktimes, Dr. Groves said that there aren’t many ways for people who crash from Adderall to deal with the depression and tiredness that can come with it. In the meantime, it’s important for patients to keep up with basic health habits like staying hydrated, eating healthy foods, and getting enough sleep.
Dr. Dube said that people who can’t get their medicines should call their doctors right away to figure out what to do. Some doctors may suggest switching to a different drug for ADHD, such as Ritalin or Vyvanse. Not everyone reacts the same way to every drug, though, and many people who have tried other brands end up choosing Adderall because it has fewer side effects.
“Once you find a medication that works for you and makes you feel good, it’s hard to switch,” Dr. Fabrett said. “It’s not fair that we’re putting these decisions in the hands of our patients.” She tells patients to think about what they need to get through the shortage and whether the risk of side effects from trying a new medicine is worth it.
Patients are doing everything they can to stay somewhat in control. A 34-year-old woman in Georgia named Taryn Shumaker has been cutting her pills in half or quarters. “I feel like I’m getting ready for the end of the world,” she said.
Mr. Kenneally changed to extended-release Adderall, which he thinks works less well but is easier to find. He also divides up his pills, sometimes going without them on the weekends so he has enough for work.
Dr. Groves said that it’s not unusual for people to stop taking Adderall. Even when there isn’t a shortage, some people take “medication holidays,” but they should only do this after talking to their doctors, she said. She also said that only some A.D.H.D. medicines can be cut in half, so it’s important to check with a doctor first.
Dr. Fabrett also said that you can talk to your doctor about taking a lower dose or spreading out your doses. People with ADHD can try things like cognitive behavioral therapy or find a coach for people with ADHD that don’t involve drugs.
Dr. Fabrett said that it’s important to remember that these are only temporary solutions that help people get from A to B. “This won’t always be like this.”
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