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A few months back, when Sheila McClear called up her pharmacy to refill her Adderall prescription, the people on the other end of the line were not exactly happy to hear from her. “They said, ‘We don’t have a single pill left to give anyone in the pharmacy.’ ”
This is how she learned there is an Adderall shortage at the moment. When I say shortage, I mean McClear’s got a friend who actually bought some Adderall on the street rather than calling up pharmacies one by one.
Just for context: Adderall is a common drug, used to treat ADHD in kids and adults—nearly 20 million of them each year. McClear is a writer who lives in New York. Without this drug, the basics of her life—hitting deadlines, getting things done—they get much harder.
Which is why she spent weeks looking for her supply. In the meantime, she tried to use other drugs to help her focus. She experimented with 5-Hour Energy drinks. She hates 5-Hour Energy drinks. McClear says that between her provider and her, they probably called 18 different pharmacies trying to track down some pills. Eventually, she found a place that would refill her prescription. Now, she keeps her remaining Adderall in a little glass vial next to her stove. She’s been watching it dwindle day by day. She’s a little worried about what’s going to happen when she starts calling pharmacies again.
“People don’t really take Adderall seriously always, but try telling someone, ‘You can’t have your blood pressure medication for eight days,’ ” McClear said. “If you want to exist in the modern world, you have to be able to get stuff done. And that’s what Adderall does. Otherwise, you’re just not functioning.”
On a recent episode of What Next, I looked into why pharmacies across the U.S. are struggling to fill one of the most common prescriptions in the country. A transcript of the episode, which has been condensed and edited for clarity, is below.
Mary Harris: Ike Swetlitz has been tracking the Adderall shortage since it began last summer; he covers health for Bloomberg News. I called him up to explain how patients like Sheila McClear got to the point where they are hoarding their psychiatric drugs.
Swetlitz told me this shortage is curious for a bunch of reasons, starting with how he got wind of it a few months back. He was working on a completely different story about ADHD, and the people he was interviewing kept mentioning how hard it was for them to get their meds.
Ike Swetlitz: And I thought, well that sounds a little strange. Maybe it’s something going on with the pharmacy. So I started calling other patients’ pharmacies, looking online for what people were saying about it, and stumbled upon a post on Reddit with a number of people who were writing about their difficulty filling Adderall prescriptions. And one of them said he had reached out to the FDA to see what was going on and that the FDA had shared with that person that there were some delays with Teva, which is the pharmaceutical company that makes most of the Adderall in the United States.
It’s almost like this news came out by accident, but it doesn’t seem like something that should be known by accident. It seems like there should be a statement. People should know that there’s a shortage of a pretty popular medication.
At that point, over the summer, the FDA had not issued any sort of announcement. The FDA has said they don’t want to alarm the public when they’re working to try and prevent a shortage because then everyone’s going to go try to stock up on it and make the situation worse.
Eventually, in October, the FDA did acknowledge what was going on. But there were still lingering questions about why pharmacies were coming up short.
Teva, the company that manufactures Adderall, they have tried to explain the shortage a little bit. What have they said?
They said that there was a labor shortage on the packaging line. It’s still a little bit unclear what the specifics of the labor shortage were. They’ve said that they were resolved by the summer, but that that caused a backlog that led to the shortage that we saw in the months after that.
Why did it last?
They’ve said it just takes time to catch up. And while Teva’s doing that, customers—the pharmacies, wholesalers that are buying the medications from the manufacturers and then giving them to their patients—would turn to other drug manufacturers to buy Adderall. And those drug manufacturers hadn’t anticipated that increase in demand from those customers who had previously gotten it from Teva. So it spiraled throughout the market.
As one manufacturer after another tried to make up for Teva’s labor shortages, there was something else going on: a dramatic rise in the number of people looking for ADHD drugs. The Washington Post has estimated prescriptions for Adderall have soared 30 percent in the past five years.
That’s a problem because the government tightly controls how much Adderall can be manufactured in the first place. It is classified as a “Schedule II” controlled substance, in the same category as opioids like oxycodone. The Drug Enforcement Agency sets an industrywide cap—a “quota”—on the raw amphetamine needed to manufacture Adderall. Without DEA approval, no one is allowed to make any more.
So the federal government will set the total quota for the total amount of the raw ingredient that can be produced by everyone combined. And then within that, each of the manufacturers would apply to the government and say, “OK, we want to make this much.” The government would evaluate those applications and divide up the total quota amongst all the manufacturers. Now, both the federal government and the manufacturers can request and make adjustments to those numbers throughout the year if they think that they really need more in order to meet the needs of people. So it’s not set in stone. Those adjustments could be made.
So when Teva realized that they didn’t really have enough Adderall to go around, did they go to the DEA and say, “Hey, we need to adjust our quotas here because we’re not going to be able to supply all the people who need this drug with what we have right now.”?
I’ve asked Teva that question, and they haven’t answered it. One other large generic drugmaker said that they did request more. Some of that request was granted; some of it was denied. But that’s a question that I haven’t gotten an answer from from Teva—and also from the DEA.
So what does the DEA say about this excuse that “Well, our quotas weren’t working this year, and so that’s resulting in this shorter supply.” Do they just say that’s not so?
The DEA has given me some numbers about this. They get reports from companies at the end of the year. And the DEA has told me that there was a lot of the amphetamine raw material that the companies still had at the end of last year.
So they’re saying, “Use your leftovers.”
Yeah. And it’s complicated because it’s a little unclear exactly who has these leftovers. There are the companies that manufacture the active pharmaceutical ingredient that’s in Adderall that makes it Adderall. And then there are the companies that actually manufacture the pills that you swallow. So we don’t know where exactly that ingredient is and who has it. But the DEA is saying that there’s a lot of the raw ingredient on the market somewhere. And therefore, the shortage we’re seeing is not a shortage caused by the quotas.
Hmm. This sounds confusing. Like I’m not sure who’s right or what the truth is.
Yeah, I agree. It’s definitely confusing. These things are not necessarily mutually exclusive, right? It’s possible that a certain company has run out of a quota and another company has a bunch left over. We don’t have the numbers on the amount of quota allocated to each company to know whether that’s happening.
When you started reporting the story, did you feel like you were going to figure it out?
Well, I would always like to. When I started reporting the story, I found out this isn’t the first time that something like this has happened. Back in 2011 and 2012, there were Adderall shortages. And the FDA at the time said that these DEA quotas were contributing to the situation. The DEA said that the drug companies had enough, and people should look at what they were choosing to manufacture with it. So this wasn’t a completely new situation. I’m always hopeful that I’m going to be able to get to the bottom of something. But, it seemed like this was pointing toward a deeper issue.
What’s the deeper issue? Is it just the tangled relationship between the government and these manufacturers of a substance that they’ve put on Schedule II, which means it’s a controlled substance?
That situation makes it challenging to get some of this information that would help figure out what’s really going on here. It’s not like the government’s just saying, “Well, you can only make 10 units, and you can only make 20 pills, and you can only make 30 capsules because we think that’s the optimal way that this should work.” There are civil and criminal penalties for doing this wrong. And, if these drugs are diverted or abused, and someone’s found to be at fault for that, you can get barred from being able to make these. We’re seeing a lot of that with prescription opioids. There’s a lot on the line here.
In recent months, the ADHD medication shortage has spread beyond Adderall. The University of Utah’s drug information service recently reported shortages of Ritalin and Concerta, which use a completely different base ingredient. And once again, the “why” is mostly a guessing game.
The FDA has not declared an official shortage of those drugs. And so there’s less hard information about why exactly it’s been challenging to fill those prescriptions. But that started happening as a lot of people had trouble getting prescriptions for Adderall and some of the advice that patients and doctors were getting was, “Maybe you should try a different medication if we can’t get Adderall.” So, it looks like those Adderall shortages have spread to the other medications that people might be advised to take instead. But it’s also important to remember that these medicines are not exact substitutes for each other. Adderall is an amphetamine-based medication. Ritalin and Concerta are methylphenidate-based medications. Those are two different chemicals. For some people, one of those types of drugs might work really well and the other one might not work well at all.
One of the other frustrating things that’s come up is that lots of people are taking the generic versions. The generic version might be harder to find. So if you can get the brand but insurance doesn’t cover it, you all of a sudden owe more money on this prescription.
What would you say to someone who looks at this shortage and thinks it’s not really a big deal.
It’s important to remember that while this is a popular drug for ADHD, it’s also a medication for narcolepsy. And there are a lot of people who are taking the drug for narcolepsy and need that to be able to stay awake and go about their lives in a normal way.
But for people who have ADHD too, this is a medicine that has enabled them to do things they otherwise couldn’t have—to maintain a level of mental organization and clarity that otherwise wouldn’t have been possible without the medication. People may be worried about losing their jobs if you can’t show up to the meeting or remember to do and complete the tasks that you need to do.
I keep hearing this language when the Adderall shortage is discussed of doctors saying, “We don’t want a repeat of what happened with opioids.” And I’m curious what you think of that language and why it’s being used.
I know that there are doctors who are concerned when people lump opioids and Adderall together. Both are Schedule II controlled substances. With opioids, there was a lot of inappropriate prescribing, a lot of inappropriate marketing, a lot of people taking the drugs at doses that shouldn’t have been prescribed, people ending up addicted to the drugs after going in for surgery and getting a prescription for something. You weren’t going out looking for something to abuse.
I’m curious if you think it’s the right analogy. What are people hoping to prevent by not making Adderall more available in some way?
Adderall is a drug that is misused, right? People do take it when they’re in college trying to stay up late, writing a paper. There’s actually very interesting research on whether it actually improves someone’s ability to do that or just makes them think that they have more of an ability to do that. But regardless, there are people who take Adderall when they don’t need it. That isn’t good.
I read this Los Angeles Times op-ed that basically argued that the current Adderall shortage might create an opioid-like crisis situation by driving people who would have gotten Adderall from their doctors to a gray market. And in fact, I spoke to a woman who said she’s having trouble getting Adderall and she had a friend who bought some Adderall on the street because there was this shortage.
I would be really interested in some data or information on how frequent that is. I definitely talked to people when this was starting to happen back over the summer and into the fall who—that thought had crossed their minds. And that was really scary for a lot of people because you don’t know what you’re buying on the black market. And there have been a lot of reports of people buying pills that say they’re Adderall but are laced with fentanyl or something like that.
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Is there any timetable for when the shortage might end?
On the FDA’s website, some of the companies say when they think their back orders or supply constraints will end. But globally, the FDA has not given a prediction. The short answer is we don’t know.