ADHD Medication: The Shortage Is Getting Worse

Stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) has been in short supply since at least October 2022. ADHD is one of the most common neurodevelopmental disorders of childhood that often persists into adulthood. The estimated prevalence of adult ADHD in the United States is at least 3.5 percent. A common misconception is that stimulants are only used by college students who want to study more effectively. This is not true in most cases. The prolonged medication shortage without explanation has led to severe consequences for children and adults appropriately diagnosed with ADHD.

Individuals with ADHD experience an ongoing pattern of inattention, impulsivity, and, sometimes, hyperactivity. This causes problems staying on task, sustaining focus, and remaining organized. The impulsivity can cause them to act without thinking, take dangerous chances, and make poor decisions. Because stimulant discontinuation (due to unavailability) can lead to transient withdrawal symptoms, they often experience fatigue, mood swings, increased anxiety, disrupted sleep, irritability, and lack of motivation.

One of the primary arenas in which adults and teens with ADHD face challenges is driving. Adults with ADHD tend to be at greater risk of having accidents, receiving traffic tickets, and driving without a license. In 2021, over 3,500 people died in distraction-affected crashes caused by texting or answering a phone call while driving.

Several weeks ago, the CDC issued an official warning about a “potential disrupted access to care among individuals taking prescription stimulant medications and possible increased risks for injury and overdose.”

What is the reason for the new warning?

The U.S. Department of Justice announced a federal fraud indictment against two executives from a digital health company, Done Global. The indictment against this company could impact as many as 50,000 patients over 18 in all 50 states.

The arrest of the founder and CEO, as well as the company’s clinical president (a psychiatrist), is based on the assertion they generated more than 100 million dollars in revenue by writing prescriptions for more than 40 million pills to individuals who were targeted as “drug seekers.”

According to Merrick Garland, "This telehealth company exploited the COVID pandemic to carry out a scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate purpose."

Done’s online posts frequently featured young people “discovering” on camera that they had ADHD. One video, posted on TikTok the day before the arrests, portrayed the point of view of a Done client: “You started seeing a Done provider for your ADHD and became a whole new person who uses her ADHD as a superpower.”

Telehealth companies that sprang up during the pandemic were a lifeline for some patients who could not access medical care due to distance from providers or the need to quarantine. However, it was also a time for less-than-legitimate companies to take advantage of patients by providing a means of obtaining sometimes unnecessary prescription drugs.

Last year, a CDC study found that prescriptions for stimulants used to treat attention-deficit hyperactivity disorder surged during the pandemic, especially among adults. Between 2016 and 2020, the share of the population that had filled a prescription for a stimulant drug held relatively steady. However, there was a significant increase in 2021, with prescriptions surging more than 10 percent across most age groups. The General Accounting Office looked at telehealth services used by Medicaid participants during the pandemic and found an increase of 15 times the pre-pandemic level. Some of their practitioners were prescribing stimulants without ever conducting an in-person evaluation.

As the world rebounded from the COVID-19 pandemic, research shows that more people are taking their healthcare into their own hands, and the internet makes it easy to do so. Telehealth companies that provide direct-to-consumer medications and related services witnessed their profits rise swiftly during the pandemic. However, even as in-person medical visits have become the norm again, these companies have continued to thrive.

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Dr. Adrianne Fugh-Berman, a pharmacology researcher at Georgetown University, believes “there’s real telehealth and there’s fake telehealth.” She said real telehealth was an asset during the worst parts of the pandemic. However, the fake telehealth companies are, in her view, “companies who are just bypassing clinicians to provide drugs to patients.” This is a scary phenomenon. Fugh-Berman runs Georgetown’s PharmedOut program, a project to educate healthcare professionals on pharmaceutical marketing practices. According to PharmedOut’s resources, companies that use direct-to-consumer advertising are not subject to FDA regulations if they provide “disease awareness,” even though these campaigns can “lead to the overuse of marginally effective or potentially dangerous drugs for minor conditions.” PharmedOut warns that this practice can harm public health, mainly as more companies rely on social media.

In 2022, the telehealth platform Cerebral began offering virtual treatment for multiple mental health conditions, including anxiety, depression, insomnia, and attention deficit disorder. They are currently facing legal proceedings stemming from the company’s policies of prescribing controlled medications such as Adderall. A subpoena by the DOJ resulted from an investigation into Cerebral due to possible violations of the Controlled Substances Act. It followed a report published in The Wall Street Journal citing concerns by a former employee who reported feeling “pressured to prescribe Adderall and other drugs used to treat ADHD.” Last week, the Justice Department and the Federal Trade Commission filed an amended complaint against Cerebral and its former executives.

Why is this situation going to get worse?

The continued shortage of medication to treat ADHD is going to get worse. The CDC’s advisory states, “Patients who rely on prescription stimulant medications to treat their ADHD and have been using this or other similar subscription-based telehealth platforms could experience a disruption to their treatment and disrupted access to care.” There is legitimate concern by the CDC that patients whose care or access to prescription stimulant medications is disrupted might seek medicines outside of the regulated healthcare system. This might significantly increase their risk of overdose due to the prevalence of counterfeit pills in the illegal drug market that could contain unexpected substances like fentanyl. They, therefore, recommend that clinicians prescribe naloxone, an overdose-reversal drug, to any patient who obtains ADHD medications outside of the health care system.