How To Cope With The ADHD Medication Shortage

The ADHD Medication Crisis: Everything You Need To Know 

If you take ADHD meds, you may have heard about - or directly experienced - the fact that there's currently a global shortage of many medications for ADHD. For many of us, this is more than an inconvenience; it's a mental health crisis and a significant barrier to being able to function on a daily basis. 🙁

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In this article, we'll discuss:

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• The widespread global shortage of many commonly prescribed ADHD medications
  
  
• How the significant price increases by drug companies have made getting stimulant medications even trickier for many with an ADHD diagnosis
  
  
• The difficulties and limitations involved in switching between different brands of ADHD medications
  
  
• Why the medication shortage is a mental health emergency and should be treated as such
  
  
• How misinformation about ADHD treatment options during this shortage is being used to target vulnerable people
  
  
• The risk of adults with unmedicated ADHD resorting to self-medication
  
  
• How non-stimulant medications can be helpful alternatives for managing ADHD symptoms when stimulant drugs aren’t available
  
  
• Adaptive strategies and the importance of trial and error in finding ways to cope with the medication shortage effectively.

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Stay with us as we explore the eight key things you need to know about the shortage, including the who, what, why and when. 

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Knowledge is power, afterall! 💪

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Medical Disclaimer

Our content is shared with love and care, offering you insights to support you on your ADHD journey. However, it's not medical advice. With the seriousness of medication management and shortages in mind, please consult your healthcare professional - such as a GP, psychiatrist, or pharmacist - before making any changes. They're your best allies, familiar with your health history and needs, ensuring your path forward is both informed and safe. 🥰

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8 Critical Things You Need to Know About the Stimulant Shortage

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1. There’s Been A Global Shortage of Common ADHD Medications Since 2022

For many people with ADHD, including myself, starting ADHD medication marked a significant turning point in managing ADHD symptoms and adapting to a world designed for neurotypical people. 🤩Starting stimulant medication allowed me to finish tasks, stick to hobbies, emotionally regulate, and navigate daily life that little bit easier.

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So, imagine my horror when, in 2023, I went to fill my monthly script for my medication and was told my usual Concerta was unavailable, with no alternative sources nearby. 😭That's when I first learned about the shortage of ADHD medication - and it's made my life complicated ever since.

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In October 2022, the FDA identified a shortage of Adderall, signaling the onset of broader availability issues affecting various ADHD medications, including Focalin, Ritalin, and Vyvanse.

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By fall 2023, the NHS in the UK announced a nationwide supply disruption impacting ADHD medications, mostly stimulants. Concurrently, Australia faced its own challenges, with Vyvanse shortages reported in August 2023 that are still ongoing at the time of writing this. 

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A ‘crisis report’ survey conducted by the charity ADHD UK in November 2023 revealed how these shortages are currently impacting the community, indicating that:

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• 8% of respondents could access their regular medication
• 27% had been without medication since the shortage began
• 33% reported going unmedicated for long periods
• 25% reported shorter periods of being without medication
• 70% of those affected resorted to rationing their medication and skipping doses.

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Which Medications Are Impacted?

Given the frequent changes in supply, it's crucial to regularly check your country's drug shortage database to stay informed. This includes the FDA for the US,  The Central Alerting System for the UK, and the Therapeutic Goods Administration for Australia. 

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Currently, the main ADHD medications impacted include:

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United States

• Amphetamine Aspartate, Amphetamine Sulfate, Dextroamphetamine Saccharate: Adderall and Adderall XR 
• Dextroamphetamine Sulfate: Dexedrine and Zenzedi 
• Methylphenidate: Concerta
• Lisdexamfetamine: Vyvanse

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United Kingdom

• Methylphenidate: Xaggitin, Concerta,  Xenidate, Equasym 
• Lisdexamfetamine: Elvanse and Elvanse Adult
• Guanfacine: Intuniv®, Tenex
• Atomoxetine: Strattera

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Many ADHD medications are available in both instant release and extended release (XL) forms. The availability of these medications can vary, with different forms experiencing distinct levels of shortage. Additionally, some medications experience brief periods of being available before swiftly falling into a shortage again. 🫤

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As a result, it's essential to consult the most recent updates from your country's drug shortage database to get accurate information about the specific medication and formulation you need, whether that’s immediate release or extended release.

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Why Is There a Shortage of ADHD Medications?

The shortage of ADHD medications, particularly stimulants like Adderall, has become a pressing concern for adults and parents of children with ADHD, healthcare providers, and policymakers. The reasons behind this shortage are pretty complex, and, frustratingly, there's no single reason why it's happening. 😑

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Here's a closer look at the key factors contributing to the current situation. 👇

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1. DEA Manufacturing Quotas

The Drug Enforcement Administration (DEA) sets manufacturing quotas for controlled substances, including ADHD medications, as a measure to limit misuse, such as for people with a substance abuse disorder. In 2023, it was reported that drugmakers shipped one billion fewer doses of ADHD medication than the DEA's permitted quotas, meaning drug companies didn't make enough ADHD medicines, even though they were allowed to.

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2. Manufacturing Delays

Teva Pharmaceuticals, one of the largest manufacturers of Adderall, has faced multiple manufacturing delays. These delays disrupt the supply chain, leading to shortages at pharmacies.

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3. Increasing Demand for Stimulants

The rising diagnosis and treatment of ADHD, particularly among previously underdiagnosed groups like women and girls, have significantly increased the demand for medication. This surge is compounded by an increase in the amount of people taking stimulants for ADHD among diverse age groups, peaking between 2020 and 2021. 

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Ultimately, an increase in diagnosis can be a positive thing; it means that more people with ADHD that have lived their lives undiagnosed are getting the vital support they need. 🥰

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However, pharmaceutical companies have not adequately scaled up the production of amphetamine mixed salts, the crucial components of many ADHD drugs, leading to a pronounced shortage. This gap between the rising demand and insufficient supply has intensified challenges for those seeking treatment they’ve either relied on for years, or have waited patiently for.

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4. People Without ADHD Using Stimulants

The demand for Adderall and similar ADHD stimulants is not limited to those with a diagnosis; they are also sought for their performance-enhancing effects, for example, by college and university students. 

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This situation is compounded by many online mental health companies being investigated for inappropriate prescribing practices that many clinicians say are unethical and threaten the supply for those genuinely in need, further impacting the availability of these critical medications.

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5. A Domino Effect of Medication Switches

When one ADHD medication faces supply issues, patients often switch to similar drugs, leading to increased demand for those alternatives. This domino effect strains the supply of these alternatives, exacerbating shortages across the board. As more people are moved from their usual prescriptions to whatever is available, it places unexpected pressure on those medications, potentially leading to further shortages and compounding the challenge of accessing effective ADHD treatment.

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When is the ADHD medication shortage ending?

The outlook for resolving the ADHD medication shortage remains challenging both in the US and the UK. There's no clear resolution in the United States, with drugmakers and regulatory agencies struggling to meet the high demand for medications like Adderall, Ritalin, and Vyvanse. 

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Patients and doctors continue to struggle as medication restocks are short-lived or further delayed, and finding alternatives proves either tricky or more expensive. Similarly, in the UK, the shortage is expected to persist until at least April 2024, significantly impacting over 90% of patients. Efforts are underway to address these issues, but definitive solutions have yet to be realized, leaving many to navigate the shortage with limited support.

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2. Drug Companies Have Raised The Cost of Many Stimulant Medications

Since the ADHD medication shortage began in October 2022, the costs for key stimulant medications like Ritalin, Concerta, and Focalin have doubled or even tripled. 😳

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According to reports, retail pharmacy prices in the United States from late 2022 to December 2023 show significant hikes in the purchase prices for specific doses of methylphenidate (Ritalin and Concerta) and dexmethylphenidate (Focalin).

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This price volatility is partly due to drug manufacturers' ability to change list prices at any time. Over the past year, more than 4,200 drug products experienced price increases exceeding the inflation rate. 

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Typically, manufacturers adjust prescription drug list prices annually, with the most notable changes occurring each January. The surge in costs has a direct impact on patients in countries such as the US, for whom insurance coverage becomes a critical factor in deciding which ADHD medication to choose.

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You asked us….
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How can I see if a pharmacy has a medication in stock?

To check a pharmacy's stock, use online prescription stock checkers available on many pharmacy chain websites for brand name, medication dosage, and extended release options. For local pharmacies, calling or visiting in person is recommended for the most accurate information.

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3. Switching Between Brands Isn’t Always Possible

Many clinicians are now receiving prescribing advice on which medications to switch patients to, aiming for bioequivalence, which means the new drug works in the same way and with the same effectiveness as the usual brand, such as switching from a brand name version of methylphenidate to a bioequivalent, generic one. Bioequivalence is crucial in maintaining consistent symptom control while minimizing side effects during the switch.

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However, for some patients, switching between brands or types of ADHD medication isn't just a matter of finding a bioequivalent option. The variability in how medications are absorbed and their effectiveness due to minor differences in formulations - whether between generic and brand-name versions or among different stimulants - means that what works for one person may not work for another. This sensitivity to medication changes and the 'trial and error' nature of finding an effective alternative can be highly disruptive.

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4. The Global ADHD Medication Shortage Is A Mental Health Crisis

The ongoing global ADHD medication shortage has escalated into a mental health crisis, profoundly affecting individuals with ADHD and their ability to manage daily life. 

The ups and downs in medication availability can cause unpredictable dosing and withdrawal symptoms, making the treatment less effective. This inconsistency makes everyday tasks much harder, especially outside work, leading to skipped self-care routines and burnout.

Survey results from ADHD UK highlight the significant mental strain caused by the shortage, with a worrying impact on employment, education, and personal relationships.

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The 2023 survey revealed:

• Employment Concerns: 91% of people with ADHD are worried about the effect of the shortage on their job performance, with 44% worried they will lose their job.
  
  
• Educational Impact: 92% of those in education are anxious about how the shortage will affect their grades and future opportunities.
  
  
• Relationship Strain: 75% report concern over the impact on their relationships, with 28% fearing the potential loss of these relationships due to how their medication supports their ability to manage social interactions and emotional regulation.
  
  
• Suicide Risk Increase: The ADHD community already faces a higher suicide risk, with 1 in 10 men and 1 in 4 women with ADHD attempting suicide. The current crisis has led to more than 38% of individuals experiencing new or increased suicidal thoughts.

In summary, not being able to access regular ADHD treatment profoundly affects people's mental health and should be considered a mental health crisis that demands urgent, targeted actions from the FDA to ensure the availability and accessibility of these crucial medications.

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5. There’s A Rise In Misinformation About Treating ADHD

In response to the ADHD medication shortage, the rise of 'smart supplements' or nootropics has sparked a significant debate. These supplements, marketed as cognitive enhancers, promise to improve mental performance and focus, attracting attention from those seeking alternatives for ADHD management. 

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Nootropics fall into three categories: dietary supplements, synthetic compounds, and prescription drugs, such as stimulants.

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However, the increasingly popular trend of 'smart supplements' during the stimulant shortage has raised concerns among health experts and ADHD advocacy groups about the lack of solid evidence supporting their effectiveness and potential health risks, including interactions with prescribed medications. Critics argue that the marketing of these supplements exploits those in need during the shortage and spreads dangerous misinformation.

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Despite the controversy, some experts see potential in nootropics, acknowledging that substances like caffeine, L-theanine, and Bacopa monnieri may offer marginal cognitive benefits, particularly when paired with healthy lifestyle choices. 

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Prescription nootropics, approved for specific conditions, are effective, but caution is advised for non-prescribed use. Anybody with ADHD considering these supplements should consult healthcare professionals to make informed, safe decisions, particularly if they are taking their ADHD medication inconsistently. 

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6. There’s a Risk of Adults With ADHD Self-Medicating

The ADHD medication shortage has led to a dangerous trend of self-medication among adults, with people desperate for treatment turning to prescription or illegal drugs, caffeine, exercise, or alcohol to manage their symptoms. 

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However, substances like marijuana and alcohol, while temporarily boosting dopamine levels, can worsen ADHD symptoms and lead to dependence or increased impulsive behavior.

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According to recent news reports, such as those from the BBC, many countries are now witnessing a concerning rise in the unregulated online sale of ADHD medications, with dealers exploiting the shortage to sell medicines through encrypted apps. While it may seem tempting as a last resort, this black market puts individuals at risk of consuming medications that may contain harmful chemicals or even be counterfeit. Health experts warn against resorting to this, highlighting the dangers of adverse reactions and the potential worsening of symptoms.

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Overall, self-medicating can disrupt daily functioning, affect job performance, academic success, and personal relationships, and significantly increase mental health concerns, including suicidal thoughts. It also acts as a stepping stone to addictions or substance misuse. 

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You asked us….
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How do you focus when you run out of ADHD meds?

If you're out of ADHD meds, try to avoid relying heavily on extra caffeine and sugar. Try getting plenty of sleep, staying hydrated, doing morning exercise, and eating protein-rich foods. These simple steps can help you stay focused naturally and avoid energy crashes.

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7. Non-Stimulant Medications Might Be a Good Alternative

While stimulants are often the first choice in treating ADHD, research suggests that non-stimulant medications provide a valuable alternative for those who don't respond well, experience adverse side effects from stimulants, or have pre-existing conditions such as bipolar disorder. 

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These alternatives, including FDA-approved options like Strattera, Qelbree, Intuniv, and Kapvay, work differently from stimulants to manage ADHD symptoms. Non-stimulants, like tricyclic antidepressants, specific norepinephrine reuptake inhibitors, and alpha-2 noradrenergic agonists, offer solutions for patients who might not find stimulants effective or face significant side effects, potentially with fewer concerns related to abuse potential and less impact on appetite and sleep.

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These medications may take longer to show full effectiveness but can offer benefits for those seeking alternatives due to side effects or personal preference. Given their varied mechanisms and potential for fewer side effects, non-stimulant medications can be a suitable choice, particularly for patients with concurrent conditions like anxiety, issues with blood pressure, or those seeking a lower risk of dependency.

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Finally, off-label medications like Wellbutrin and Provigil, which are wakefulness-promoting drugs, are sometimes prescribed to treat ADHD. 

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Switching from a stimulant to a non-stimulant medication or another alternative is a significant decision and requires careful planning. Having an open discussion with your doctor about the potential benefits and drawbacks of making such a change is crucial. Your healthcare provider can guide you through the process, considering your medical history, current health status, and specific ADHD symptoms.

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You asked us….

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What to do if you run out of ADHD meds?

If you run out of ADHD meds, contact your local pharmacy to explore supply options or request prescription transfers. If unsuccessful, reach out to your GP or ADHD service for guidance. Avoid self-substituting medications or self-medicating with drugs, alcohol or too much caffeine, as this will likely worsen your ADHD symptoms. 

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8. Through Trial And Error, You Can Get  Through The Shortage 

As we don't know for sure how long this ADHD medication shortage will last, it's crucial to make a contingency plan and take control of our own situation where possible. The uncertainty can be overwhelming, but there are strategies to manage your treatment and keep things as consistent as possible while you wait out the shortage. 💕

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Please remember, these tips aren't official medical advice but are some strategies that have worked for me while navigating the medication shortage.

How To Manage When ADHD Medication Options Are Limited

• Chain stores might run out of stock faster. Local, independent pharmacies may have supplies when others don't, so building a relationship with these pharmacies and asking them to call you as soon as they get a shipment can be helpful.
  
  
• If you can't find your medication nearby, try calling pharmacies a little further away. It might mean some travel with every prescription refill, but staying consistent with your preferred brand could be worth the effort. Many pharmacies will reserve medication for you if you provide a digital prescription.
  
  
• Incorporate magnesium supplements or a bit of caffeine to manage medication crashes. Matcha tea is another alternative that can help with focus and stress.
  
  
• Double down on non-medication tools like executive function coaching or daily exercise. Nutritious diets also support overall brain health and function.
  
  
• Prepare for end-of-day energy dips by adjusting your schedule, like meal-prepping on the days you have medication available or having a small late-afternoon coffee on days that require more focus.
  
  
• Connect with your insurance company to explore coverage for alternative medications.
  
  
• Stay informed about production updates and lean on support networks, including ADHD groups and counseling, for additional coping strategies.
  
  
• Discuss with your doctor about switching to similar stimulants that have fewer disruptions in production or even non-stimulant options, if appropriate.
  
  
• If possible, start the refill request process about three-and-a-half weeks after your last prescription to navigate shortages effectively. This depends on your provider's policy but could help you plan ahead.
  
  
• Being open about your struggles, especially regarding work, school, or personal commitments, is vital. Sharing your situation can lower expectations and invite empathy from others who understand the impact of being unmedicated, potentially easing some of the pressure on you.

Managing this shortage is all about being persistent, flexible, and creative. Trying different strategies and staying in touch with your healthcare team can help you find your way through this tough time. 🥰

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Just remember, if you're thinking about adjusting your ADHD treatment plan in any way, always talk it over with your doctor first to keep things safe and effective. With some teamwork, you can keep on top of your ADHD management with as little disruption as possible. 💪

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You asked us….

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Is it possible to live with ADHD without meds?

Yes, living with ADHD without meds is possible, even though it might be  tough. Many manage symptoms through therapy, lifestyle changes, and support. Despite the ADHD medication shortage, alternatives like non-stimulant medications and strategies for ADHD symptoms can offer effective relief.

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Key Takeaways

• The Situation: The shortage, starting in 2022 with Adderall, has expanded to affect various ADHD medications globally, including Concerta, Ritalin, and Vyvanse. Countries like the US, UK, and Australia are experiencing significant impacts, with patients facing challenges accessing regular medications.
  
  
• The Reasons: Factors contributing to the situation include DEA manufacturing quotas, manufacturing delays, increased demand for stimulants, misuse by individuals without ADHD, and a domino effect from medication switches. These combined factors have created a complex situation with no single cause or easy solution.
  
  
• The Impact: The shortage should be considered as a global mental health crisis, affecting employment, education, and personal relationships. It has led to increased anxiety, skipped medication doses, and heightened suicide risks.
  
  
• The (Temporary) Solution: As there's no clear end in sight, we need to rely on a backup plan until the supply issues are resolved.

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Strategies for managing this include:

• Staying in touch with your ADHD management team or clinician. Given the personalized nature of ADHD treatment, this step is critical. They can provide alternative strategies or help ease the anxiety stemming from these shortages.
  
  
• Checking drug shortage databases, exploring different medications or formulations, and trying out non-medication strategies for ADHD management.
  
  
• Connecting with smaller, local pharmacies and checking with pharmacies further away for stock updates.
  
  
• Building open communication with employers, educators, and loved ones is essential for getting the right support. Effective planning and communication can ease some of the pressure on people with ADHD when they're feeling less productive and regulated.

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The ADHD medication shortage has certainly put us to the test, but it's also shown just how strong and united the ADHD community can be. 🤩 It's a reminder that together, we can push for the solutions we need. 

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Your health and happiness are paramount, so adjusting your treatment plan should always be a team decision with expert support. Remember, you're not alone in this; we're all in it together, and the ADHD community continues to fight for the change and support we deserve. ✊

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What’s Next?

Want to learn more about the different options available to treat ADHD beyond taking ADHD medication? We’ve got you covered. 👇 

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The Positive Effects of Exercise For ADHD

How to Prioritize Self-Care When You Have ADHD

The Intriguing Relationship Between ADHD and Coffee

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