DAILY BEAST, MICHAEL A. COHEN
“How do you get an ADHD person to clean their house? Assign them some homework.”
“What does ADHD stand for? Attention Deficit HEY DOUGHNUTS!”
“Why didn’t the ADHDer cross the road? He doesn’t know. He was planning to cross the road, and suddenly the day was over.”
For millions of Americans who suffer from Attention Deficit Hyperactive Disorder (ADHD), these jokes will receive a wry smile, but they also reflect a painful reality about struggling with ADHD—one made far worse by a close to nine month-long Adderall shortage around the country that seems to have no end in sight.
According to Matt Ford, a staff writer at The New Republic whose tweets last month about the challenge in tracking down Adderall medication went viral, it’s really hard explaining ADHD to people who don’t have it. “It just makes things harder,” said Ford. “It sounds simple. But, it’s harder for me to remember to do things to process things and to complete tasks. And things slip by.” When faced with the prospect of not filling his Adderall prescription, a drug he’s taken since he was a child, he worried, “Could I remember to do chores? Could I remember to do simple tasks, like paying bills, answering emails, and text messages” or even “do my job”?
These are not hypothetical concerns. Like Ford, I’ve taken Adderall and other stimulants after I was diagnosed as an adult. This past December and January, when I saw the number of pills dwindling, and it became a struggle to get a prescription filled for Adderall or its generic equivalent, the impact was profound and debilitating. (The fact that so many ADHD sufferers had to take on the mind-numbing task of calling pharmacies and figuring out who had Adderall in stock and then liaising with doctors to ensure that new scripts are written is perhaps the cruelest joke of the national shortage. We are, without a doubt, the people least equipped for such a job.)
Ask anyone who suffers from ADHD, and they will tell you that even on a good day, completing and following through on checking off the boxes on a to-do list can be a serious challenge. Indeed, the more tasks there are to complete, the more overwhelming it feels and the more difficult it can be to even begin. And paradoxically, the attention required to do one thing can be so exhausting that it makes it more difficult to go on to the next chore. Adderall or other ADHD medications have a chemical reaction in the brain that allows users to focus and concentrate in ways that would be impossible without it.
As Dr. Richard Friedman, Professor of Clinical Psychiatry and the Director of the Psychopharmacology Clinic at Weill Cornell Medical Center, said to me, “When you suddenly stop stimulants, you don’t just lose the effect of the drug, you have withdrawal. You have a discontinuation syndrome, which is even more debilitating… Your brain has been inundated with a drug that increases dopamine and now it’s not.”
In practical terms, the times I was without medication this past winter left me puttering around my apartment, searching for anything that would distract me from having to concentrate, which to the non-ADHD sufferer will seem easy, but for those of us afflicted, is a profound struggle. But I wasn’t just feeling inattentive, I was literally exhausted all the time.
ADHD is traditionally associated with children, and an estimated six million kids suffer from it. For children whose parents couldn’t get Adderall prescriptions filled, it led to trouble sleeping, focusing in school, keeping up with schoolwork, and other behavioral issues that can lead to interventions and even suspensions.
“Ask anyone who suffers from ADHD, and they will tell you that even on a good day, completing and following through on checking off the boxes on a to-do list can be a serious challenge.”
However, since the mid-2010s, adults are more likely to be diagnosed with and prescribed stimulants—though it’s likely that millions are undiagnosed. According to a recent study, 4.1 percent of Americans in employer-based health-care plans take stimulants. That would represent more than six million Americans, though the actual number is likely more and, by some estimates, could reach as high as 16 million). The number of Americans taking stimulants has risen by 30 percent over the past five years and increased even more dramatically during the pandemic.
Yet, even though patients have been reporting for months that they cannot get their prescriptions filled, the issue has received limited media focus and even less regulatory or political attention. Things have been so dire, said Friedman, that he began seriously exploring the idea of importing drugs from Canada to help his patients.
Paradoxically, one of the problems in addressing the issue is pinpointing a single explanation for why this shortfall is happening.
Part of the issue is certainly the aforementioned increase in prescriptions. During the pandemic, rules were changed to allow prescriptions filled after a telehealth session (previously, there were limited to in-person appointments). As a result, by one estimate, close to 40 percent of all stimulant prescriptions now come from online visits.
Another roadblock is what the FDA last October called “intermittent manufacturing delays,” which have been exacerbated by the supply chain issues that have wracked the global economy for more than two years.
Compounding the issue is that Adderall and other ADHD stimulants are Schedule II controlled substances, which means they have “a high potential for abuse” and thus are strictly regulated. As a result, the Drug Enforcement Administration, rather than the Food and Drug Administration, decides the amount of the drug that is produced annually and how much each pharmacy can purchase. The DEA refused to increase those quotas in January.
Rep. Abigail Spanberger (D-VA), who is one of the few members of Congress to raise concerns about the Adderall shortage, has buffeted the DEA and FDA with questions about the Adderall shortage. Yet, she still hasn’t received “a full explanation for why this is happening,” she told me in an interview last month. According to Spanberger, we still “don’t know how [the shortage] ends or when it ends.”
But the bigger issue, from her perspective, is that “no one was ringing the bell that we were on our way to having a shortage.” With the lack of media and political attention to the issue, the problem kept getting worse, and ADHD sufferers have been left in the lurch, forced to fend for themselves or find a solution on their own.
As Spanberger ruefully noted, “Part of the problem is that people don’t view these drugs as essential,” and because there can be abuse of Adderall, it creates a stigma around the drug and means that “people don’t look at it the same way” as they would another ailment. In our conversation, she hinted that one of the challenges in getting her House colleagues to join her in addressing the issue is the stigma around ADHD, and members don’t want to be seen advocating on an issue that can so easily be stereotyped and dismissed.
As Friedman noted to me, “There’s been a suspicion for a long-time that ADHD was dramatically overdiagnosed.” Certainly, the image of college students taking Adderall to cram for a test or finish a term paper has become a predominant one in popular culture. One telehealth company, Cerebral, which is now under federal investigation, pushed an advertising campaign that linked ADHD to obesity and linked vague symptoms to the condition. Perhaps not surprisingly, the company was writing prescriptions for 97 percent of users—and sometimes after online consultations as short as 30 minutes.
These stories, says Friedman, have “fed a public perception that [ADHD] is either a mild problem or an invented one, or even worse, the people diagnosed are just lazy.” For ADHD sufferers, these attitudes are frustrating to hear but are perhaps understandable. It’s difficult to explain to people who don’t suffer from ADHD why this affliction makes seemingly ordinary and everyday tasks so difficult or how simply taking a pill can mean the difference between a productive day and one that is not. People who take stimulants aren’t lazy, but without them, that’s what they become.
Another of the popular myths about ADHD and prescription stimulants is that those of us who take these drugs are addicted to them. But as Fridman pointed out, this is “a common misunderstanding. Addiction means taking increasing amounts of a drug in order to get high.” But when you take stimulants, “you don’t get tolerant to it. You don’t need more of it.” People aren’t taking Adderall to feel euphoric but, rather to function.
This is one of the abiding frustrations of the coverage around the Adderall shortage. ADHD is not well understood or appreciated, but as Ford said to me, for those of us who use it, it is “life-changing. My quality of life would be dramatically significantly worse,” he added, and “I would not have the career I have,“ if not for Adderall.
Jokingly he said combating ignorance about ADHD is important, but “all the people who would complain [it] about can’t focus enough to raise hell.” As long as there remain stigmas and misunderstandings about mental health, those who suffer from ADHD will struggle to help others understand why this affliction can be so debilitating—and how a simple pill can make such a difference. After all, how does one explain why tasks that seem so easy to others can be so challenging for us?
And perhaps that’s also the best explanation for why nine months into a national shortage that has affected the lives of millions of people, there is still seemingly no end in sight—and such muted urgency in fixing it.