Clara Pitts received the news she desired earlier this year: she had been accepted to her ideal institution, Brigham Young University.
Clara and her family were all the more ecstatic about her accomplishment because of the obstacles she had to overcome to achieve it: a diagnosis of attention deficit hyperactivity disorder (ADHD) and, in the past year, difficulty obtaining ADHD medication.
“After maybe one or two weeks of not taking my meds and realizing the negative effect it had on my focus, that’s when I started to get worried that I wouldn’t be able to get any kind of help for my college applications and for my senior year of schoolwork,” Pitts said.
Clara’s search for ADHD medication earlier in the year. She was able to transition from Adderall to Vyvanse, but that medication has also become increasingly difficult to obtain. Now that she is about to begin her freshman year at BYU, she is concerned about navigating the shortages on her own.
“It’s just so terrifying not knowing if my medication will be consistent,” she said.
Clara is not isolated. Since last autumn, when one manufacturer encountered delays, there has been a shortage of ADHD medications in the United States, according to the Food and Drug Administration.
Since then, however, it has not improved. On the FDA’s shortages website, eleven manufacturers of Adderall or its generic counterparts are listed, and while some claim the medication is available, others do not expect the shortage to end until December.
Dr. Warren Ng, a professor of psychiatry at Columbia University Medical Center and president of the American Academy of Child and Adolescent Psychiatry, stated, “Many of the young people I’ve been treating have had difficulty obtaining their medications on a monthly basis.”
Ng stated that without medication, many children with ADHD fail classes, are held back from advancing to the next grade, are sent to the principal’s office, and struggle to complete their assignments. With treatment, he said, “a young person’s life can be transformed overnight. They are suddenly able to do the task that they desire.” And it can have a significant impact on their self-esteem, he said.
“I’ve seen kids who want to drop out of school, don’t want to continue with their educational path or drop out of college suddenly making the honor roll,” Ng said. And “instead of seeing, being seen as being lazy or dumb or slow, they can envision themselves really utilizing all of their mental, psychological and intellectual abilities to really see themselves for who they are, which is so much more.”
Erin Fox, a drug shortages expert at the University of Utah, explains that the back-to-school season is a crucial time for families to have access to ADHD medications, as some patients take the summer off and it’s a time for them to receive new prescriptions.
“It is unclear whether the pharmaceutical industry is prepared for this,” she said. “We are experiencing shortages of all controlled substances used to treat ADHD.”
Because the medications are stimulants, the government classifies them as controlled substances with a high potential for abuse. Since the Drug Enforcement Administration sets limits on how much of a substance the industry can produce, this adds an additional layer of complexity to an already opaque system for the pharmaceutical supply chain.
Missed Opportunities: DEA and FDA Uncover Unutilized Medication Doses in Joint Report
In a joint letter with the FDA, the DEA reported in August that last year, manufacturers did not produce as much as permitted.
FDA Commissioner Dr. Robert Califf and DEA Administrator Anne Milgram wrote in a letter that there were approximately one billion additional doses that could have been manufactured but were not.
The data collected thus far for 2023, they wrote, “show a similar trend.”
CNN attempted to contact each of the eleven manufacturers designated by the FDA for Adderall and its generics. Only Teva Pharmaceuticals and the Sandoz division of Novartis responded. Both claimed they were earning the maximum amount permitted.
“We don’t know how many prescriptions are being written, how much product the companies are making and what the gap is” in terms of prescriptions unfilled, Fox said.
Data indicate that prescriptions for ADHD medications have increased over the past decade. The FDA and DEA reported that between 2012 and 2021, stimulant dispensing increased by 46% in the United States.
Moreover, a March report from the Centers for Disease Control and Prevention of the United States revealed that prescriptions increased significantly among young adults during the pandemic.
In their letter, the FDA and DEA stated that it is “time to take a closer look at how we can best ensure that these drugs are prescribed thoughtfully and responsibly,” urging the development of additional clinical guidelines for diagnosing ADHD in adults.
Additionally, the FDA announced last week that it had approved multiple generic versions of Vyvanse.
Students like Clara and others returning to school while facing the drug shortage cannot wait for relief. According to Ng, the consequences of not having access to medications can be detrimental for some.
“A lot of young people that I’ve seen have just given up,” he said. “They’ve been so frustrated with trying to get their medications to treat their conditions that they’ve either just felt that, you know, ‘It’s too difficult, maybe I shouldn’t go to college, or maybe I shouldn’t have this job.’ … It makes me very sad because it’s giving up on the dream for themselves.”
Clara stated that despite these concerns, she is eager to begin college and intends to concentrate in electrical engineering.
“Personally, I think that robots are really, really cool,” she said as she packed up her room at home. “And so I’m hoping that I’ll be able to learn how to make robots and do some kind of cool robotics in college.”
She is concerned not only for herself, but also for others who are beginning school with ADHD and are unable to locate their medications.
“It’s really hard to know how many people, little kids, junior high kids, college students like me and even adults with their careers are now starting a new season of school and not having that available to them,” she said. “And I think time is going to tell whether or not we sink or swim as a collective ADHD community and whether or not this turns into a really huge thing with this new school year starting.”