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Nationwide Adderall shortage has prescribers, pharmacists and physicians waiting for relief

 A nationwide Adderall shortage has Midwestern prescribers, pharmacists and physicians waiting for relief.
Susan McClellen
Courtesy of University of Iowa Hospitals and Clinics
A nationwide Adderall shortage has Midwestern prescribers, pharmacists and physicians waiting for relief.

When Kara's Adderall supply ran short, she started making calls.

She'd call every pharmacy in her area until she found one that could fill her prescription. Sometimes when she arrived, there would already be a group of people there, having also made desperate calls in order to get the medication.

Kara, who asked to go by only her first name, has attention-deficit/hyperactivity disorder, or ADHD. She was diagnosed at the age of five during the early 1990s, and has been prescribed various medications to help her focus throughout the day.

Today, ADHD is usually treated with Adderall. But a shortage that has been in effect since last fall has made the medication scarce. Production issues and increased demand, both exacerbated by the pandemic, have meant the shortage is ongoing.

While medicated, Kara's mind is clear, quiet and focused. The 36-year-old can show up on time to work, do household chores and go about her day without issue.

"It's like the chaos clears," she said.

Without medication, Kara feels distracted and everyday tasks become harder to accomplish. If she didn't have an adequate supply, she was forced to ration what Adderall she did have, selecting certain days to not take her pills so she wouldn't have to worry about running out before she could get her prescription refilled.

"My life begins to disintegrate, because [Adderall is] everything that I need to keep on track," she said. "It's what keeps me showing up at work on time, it's what keeps my laundry done, it's what keeps my house clean, my cats fed, my dishes — everything."

To make matters worse, demand for Adderall has only increased since the pandemic and the rise of telehealth visits, with ADHD diagnoses trending upward without enough supply to match it, as the Drug Enforcement Administration sets limits on its production. To avoid the constant scavenging, Kara has switched to a new medication — which, consequently, is much more expensive.

"We are in a Hunger Games situation with all the newly diagnosed people, and all the existing diagnosed people are fighting each other for meds," she said.

According to Michael Brownlee, chief pharmacy officer at University of Iowa Hospitals & Clinics, the Adderall shortage has also led to similar shortages in Adderall alternatives, like non-stimulant drugs and antidepressants.

"We are in a Hunger Games situation with all the newly diagnosed people, and all the existing diagnosed people are fighting each other for meds."

"A lot of those other medications that may not have been first-line therapy — like an antidepressant or a nonstimulant medication — are now coming to the forefront to be used as primary treatment because of the shortages," Brownlee said. "And that's where it's creating a lot of challenges for patients where they may have been stabilized on a medication and they're having to switch now to something that may be less effective."

Adderall is a Schedule II stimulant, as it has a high potential for abuse. As such prescribers like Kara cannot transfer their prescription to a different pharmacy before contacting their physician first. That creates a back and forth for patients contacting pharmacies to see if they have Adderall in stock, and their physician to send a prescription.

"You can see how this has created a challenge not only on the patient or the family side, it's also created a lot of challenges on the provider and pharmacy side as well," Brownlee said.

While no guaranteed end to the shortage is in sight, Brownlee did say that when the national Public Health Emergency is lifted in May, which allowed patients to obtain an Adderall prescription through an initial telehealth visit, it could provide some relief by summertime. In the short term, he says talking to a provider is the most important first step for people with ADHD to help them navigate the shortage safely, without them feeling like they need to make those decisions themselves and take potentially harmful substances.

"There are other treatment options that are available," he said. "It could be that the brand name drug is available and not the generic, so we want that conversation about switching to another medication to be with a provider, with a pharmacist, so that we can help them navigate through what the options are. When they see that there may not be any options, there could be potentially something for them to switch to."

Samantha McIntosh is a talk show producer at Iowa Public Radio. Prior to IPR, Samantha worked as a reporter for radio stations in southeast and west central Iowa under M&H Broadcasting, and before that she was a weekend music host for GO 96.3 in Minneapolis, Minnesota.
Ben Kieffer is the host of IPR's River to River
Josie Fischels is a Digital News producer at Iowa Public Radio. She is a 2022 graduate of the University of Iowa’s school of journalism where she also majored in theater arts (and, arguably, minored in the student newspaper, The Daily Iowan). Previously, she interned with the Denver Post in Denver, Colorado, and NPR in Washington, D.C.