The A.D.H.D. Drug Shortage Is Causing Real Pain

Edward Krumpotich, a drug policy consultant based in Minnesota, was diagnosed with severe attention deficit hyperactivity disorder at age 15 — but he didn’t get help for it until he was 37. In the interim years he suffered from methamphetamine addiction, which he later realized was driven by attempts to self-medicate his untreated A.D.H.D. He attended more than 30 rehabs before one finally prescribed stimulant medication for him.

Today, a nationwide shortage of the A.D.H.D. medications he relies on threatens his recovery. This drought of drugs like Adderall, Vyvanse and Ritalin — which has now stretched on for a year — is causing widespread suffering and increasing levels of disability among families across the United States.

Policymakers must end this shortfall, which is due primarily to counterproductive attempts to fight drug misuse by restricting medical access to controlled substances. Current government quotas on stimulant manufacturers are interfering with, instead of promoting, health and recovery.

While some other factors, including manufacturing and supply chain issues, have also contributed to the shortage, the stimulant drought is linked to a dispute between the Drug Enforcement Administration and drug companies over the effects of manufacturing quotas. Each manufacturer has a specific limit and the D.E.A. claims that some have extra doses that they could sell. Individual companies, in turn, say that the issue is that the D.E.A. won’t raise their particular quota and they don’t have enough to meet demand.

As a society, we tend to trivialize the impact of psychiatric disorders. If the problem isn’t something that is clearly physical, it’s often seen as conquerable by force of will. Those who suffer from mental illness and disabilities that aren’t visible are told to suck it up; their medications are sometimes dismissed as unnecessary or attacked as performance enhancers used by people who just are too lazy or entitled to do hard work unassisted.

But few people without personal experience can appreciate how transformative appropriate medication can be. Even fewer realize that effective early treatment of conditions like A.D.H.D. and childhood depression may actually help to prevent addiction, or be critical to successfully overcoming it.

“This is life or death for me,” said Mr. Krumpotich, emphasizing how much of a difference A.D.H.D. treatment makes for him and how it aids his recovery. But because of the current shortage, he spends hours contacting pharmacies, switching between medications when the ones he takes aren’t available and taking lower doses of what he can get. All of this puts him at risk for relapse.

When I reached out to doctors and patients about the A.D.H.D. medication shortage, it yielded an inbox full of pain. Dozens of people contacted me, describing lost jobs, difficulty working, elementary school meltdowns, failing grades in children and suicidal thoughts. Many people said they were struggling financially because their insurance wouldn’t cover the medications that are available — and alternatives can cost dozens to hundreds of dollars more per month.

Dr. David Rettew, a child psychiatrist and the medical director of Lane County Behavioral Health, in Eugene, Ore., told me that “many, many families are struggling with their pharmacy not having a supply of various kinds of stimulants.” His patients and their parents often spend hours or days calling different stores. Sometimes one store said they have stock, but it was out by the time they arrived to pick the medication up.

For some children, the shortage is leading to academic problems. They “can’t pay attention at school and can’t stay in their seats and are more distractible,” said Dr. Rettew. “So they’re not getting their work done and they’re not learning as effectively.” This may seem minor, but it can put a child’s future at risk if it is prolonged, occurs at the time of a major test or causes the child to be labeled a troublemaker. That can lead to feelings of self-hatred and ultimately, even disorders like depression and addiction.

Children with A.D.H.D. have at least twice the risk of addiction compared with those without it. Among people with addiction, around 20 percent have A.D.H.D., compared to around 5 percent of the general adult population. While medication doesn’t seem to reduce or elevate this risk, leaving A.D.H.D. untreated may lower the odds of addiction recovery.

For people with both addiction and A.D.H.D., there’s also a high risk of turning to street drugs — of which there is no shortage — for relief. Several harm reduction workers I interviewed said they knew people who have turned to illegal methamphetamine because they couldn’t get A.D.H.D. medications.

The consequences of the drug shortage also affects adults. Taleed El-Sabawi, an assistant professor of law at Florida International University, ran out of medication as she planned a move to St. Louis for a visiting professorship. “It was extremely stressful,” she said. “My productivity just tanked. I got nothing done.”

Her drive from Miami to St. Louis was difficult, as she missed signals from other cars, so her partner took over driving. Research shows that people with A.D.H.D. tend to be more likely than drivers without it to have car accidents. But when people with A.D.H.D are medicated, they are around 40 percent less likely to have car accidents.

Dr. Rettew described having to spend extra hours — which few doctors have in abundance — rewriting prescriptions, since electronic prescriptions cannot be transferred and must be re-sent if a store is out of stock. For one patient, he had to write and send prescriptions five times before one of them could finally be filled by a pharmacy.

While other medications, like some chemotherapies, are in short supply right now because of manufacturing and supply chain issues, shortages of controlled substances are exacerbated by the war on drugs. Medications for physical pain are also currently scarce largely because of restrictions on drug distributors stemming from a legal settlement related to the opioid crisis. Since these restrictions apply to controlled substances more broadly, the settlement has also contributed to the A.D.H.D medication shortage. For many, these drugs are critical to patients’ survival and quality of life.

People tend to assume that at baseline, everyone’s emotional and sensory experiences are the same, when in fact they vary widely. What is a minor distraction or minimal effort for many people can be an overwhelming hurdle for people with A.D.H.D. or other brain disorders.

From the inside, A.D.H.D. is often a battle with overwhelming sensory experiences that feel impossible to ignore and constant self-criticism for being unable to do what others seem to achieve easily. This is demoralizing and can lead to self-destructive behavior.

It’s also why so many describe the experience of effective medication as finally understanding what it’s like to function normally. It’s cruel to have it snatched it away.

The D.E.A. is probably being especially strict on A.D.H.D. drug availability because it raised quotas during the opioid crisis — and was blamed for increased overprescribing. Now, it may be overcorrecting and worsening shortages. As I’ve argued, the D.E.A. simply should not be in the business of regulating medicine, which it has never been able to do effectively.

Illegal drugs should not be easier to get than legitimate medications. Policymakers must act, as the United States cannot continue torturing people who rely on controlled substances to function. Causing or contributing to medication shortages is not an effective way to prevent or treat addiction, but it does make living with conditions like A.D.H.D. far more painful and difficult.

Maia Szalavitz (@maiasz) is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”

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