ADHD Patients' Increased Use of Stimulants Blamed for Adderall Shortage

The head of the Food and Drug Administration (FDA) is attributing the shortage of ADHD medication to an increase in stimulant use by individuals with ADHD who may not require the drugs. In an interview with WebMD’s John Whyte, the FDA commissioner, Robert M. Califf, M.D., contends that telehealth providers are responsible for an extensive rise in ADHD diagnoses and stimulant prescriptions over the last few years. Califf suggests that not all of these diagnoses are warranted, and better clinical standards are required. Maggie Sibley, Ph.D. and Ann Childress, M.D. are working with the American Professional Society of ADHD and Related Disorders (APSARD) to develop guidelines for diagnosing and treating ADHD in adults.

Califf’s suggestion that ADHD medication use may be unnecessary and inadvisable for some diagnosed individuals contradicts decades of research into short- and long-term ADHD medication use. Stimulants are considered safe and effective for the majority of children and adults with ADHD. William Dodson, M.D. cites research that indicates the risks associated with not using ADHD stimulants outweigh the risks of taking them.

JAMA Network’s recent study shows that treatment rates for children with ADHD are generally low, with only 12.9 percent of 9- and 10-year-olds with reported symptoms taking ADHD medication. Similarly, only about 4.1% of adults with diagnosed ADHD take a stimulant medication, and evidence of medication misuse among adults is limited.

The National Institute on Drug Abuse reported a 36% increase in ADHD medication use among 12th graders in 2022 compared to 2021. The pandemic’s remote learning exacerbated attention issues, leading to more stress and increased use of ADHD medication. However, high schoolers’ stimulant misuse is unlikely to explain the ongoing Adderall shortage that has affected ADDitude readers' lives for almost a year.

The DEA allowed virtual appointments for evaluations and prescription of Schedule-II controlled substance like Adderall in March 2020. The move led to a surge of new ADHD diagnoses, especially among women seeking telehealth care from 2020 to 2021. The most common ADHD stimulant prescribed through telehealth providers like Cerebral has been Adderall. Califf’s suggestion that “a large amount” of individuals are unnecessarily or irresponsibly using stimulant medication is at odds with the evidence.

In 2022, Cerebral and other telehealth companies came under federal investigation following news reports that questioned their prescribing practices. There were concerns among ADHD specialists that telehealth providers had contributed to the overprescription of stimulants. In an interview, Califf acknowledged the increase in prescribing, particularly related to virtual prescribing, but there is no research yet to confirm or deny the validity of ADHD diagnoses made by telehealth providers during the pandemic.

It remains unclear whether telehealth providers over-diagnosed ADHD and over-prescribed stimulants, or simply met pent-up demand from a population of adult patients who had struggled to access in-person health care prior to the pandemic. Women, in particular, have been under-diagnosed due to outdated stereotypes and societal stigma.

Patient advocates and legislators are working to solve the Adderall shortage with different approaches. Rep. Abigail Spanberger is calling on the FDA to coordinate a response with the DEA that addresses artificially low production quotas for stimulant medication, as well as other roadblocks to accessing care. Meanwhile, twenty other members of Congress wrote a letter to the DEA urging new telemedicine and prescription rules, better mapping of supply chains, and taking seriously increases in demand when setting production quotas. Additionally, Maia Szalavitz has suggested that oversight of ADHD medication should be shifted from the DEA to the FDA.

Califf's statements regarding the ongoing ADHD medication shortage and efforts to mitigate it could be seen as troubling. Although the FDA cannot solve the shortage on its own, it has missed an opportunity to assure millions of Americans with ADHD that it takes the condition and treatment seriously.