Adderall shortage raises questions about widespread dependency on the drug

William Brangham:

There is a national shortage of the drug Adderall, which is used to treat attention-deficit disorders. Manufacturing delays, low supply, and rising demand has left those who rely on the drug every day unsure about how or when they will be able to get their medication.

We reached out to people across the country who have had trouble filling their prescriptions recently.

Elaine Pasinski Thomas, Wisconsin:

I'm Elaine Pasinski Thomas. I am retired. I live in Madison, Wisconsin.

I thought, for sure this little snafu that they were having at our pharmacy was going to be fine. I didn't know that it was like a national shortage. So — and it was gone.

Violet Kayaga, New York:

I'm Violet Kayaga. I live in Brooklyn, New York, and I am a freelance fashion designer.

I take my medication to literally just function, to be what society would consider a normal person. So that means I need my medication to do my laundry. I need my medication to complete my tasks. I need my medication to work. I need my medication just to get out of bed and shower and to feed my cat.

Katy Slater, Kansas:

My name is Katy Slater, and I live in Kansas, and I am a stay-at-home mom.

You have to almost pharmacy shop, and — to see who has the supply, the right dosage, the right supplies. And that definitely is hard, because it looks bad.

Elaine Pasinski Thomas:

The pharmacy doesn't have the dosage. I need 10 milligrams, and so I'm breaking the tablets in half and trying to stretch them out.

Violet Kayaga:

Right now, I'm looking for work. So, for me, that looks like me being terrified of applying for jobs because I know, without my medication, I'm not going to be able to keep my job.

Katy Slater:

There has been times where I wasn't able to get it. And I rely on that for things like driving. If I'm out of medicine, I can't. That would be way too dangerous for me to drive. My kids have certain activities going on in certain days. And if there's supply issues, it's definitely — I have got to come up with another plan. And it's hard. They're your kids. So…

Elaine Pasinski Thomas:

When I don't have it — I find life hard enough without it. And I don't think that people really understand what it does.

Violet Kayaga:

I would just like to consider — people to consider that children with ADHD grow into adults with ADHD. And there's a lot of us out there.

And, of course, the kids are struggling, but there's a lot of adults that rely on this medication, and we're struggling as well. And it's not just a small thing. Yes, I'm not going to die if I don't have my medication, but the life that I lead without my medication, to me, is not a life worth living.

William Brangham:

So, clearly, people are struggling amid this shortage.

So, let's discuss this further with Dr. Craig Surman. He's an associate professor of psychiatry at Harvard Medical School and the scientific coordinator of the adult ADHD research program at Massachusetts General Hospital.

Dr. Surman, very good to have you on the "NewsHour."

We just heard from women, who are clearly struggling not having their Adderall medication to treat their ADD disorders. For people who are not familiar with either the medication or the condition, could you just give us a quick primer on them?

Dr. Craig Surman, Massachusetts General Hospital:

Attention-deficit hyperactivity disorder syndrome, it's a recognized as a disability under federal law.

It's a hardwired pattern of brain function. And national data in the U.S. suggests that about one in 10 school-aged children meet criteria, while 4 percent of adults continue to have symptoms. And it manifests as challenges getting to, sticking with, and finishing tasks and organizing life activities.

Adderall is one of a few medications approved by the Food and Drug Administration that just reduces the overwhelm and reduces the challenges people have. And as applied as part of a treatment plan, it really does make a huge difference in people's lives.

William Brangham:

So, we heard a little bit from those women about what — the experiences they are feeling about not having these medications.

Can you just tell me a little bit more? What are the consequences for someone when they suddenly don't have access to that medication?

Dr. Craig Surman:

Withdrawal happens with some of the medications we use to treat ADHD in the stimulant class, which Adderall is in.

And Ritalin is a generic name for a generic product called methylphenidate, which is quite similar. That class of medicine often produces tiredness, fatigue, or, worse, in dependence scenarios, mood and personality changes in people.

And, ideally, treatment is sustainable, and not going to start and stop, but, as people have learned, unfortunately, recently, people need to have Plan B's.

William Brangham:

There is a conception out there and — that we as a society are overprescribing these medications, especially to young people.

That is a slightly separate issue to this shortage issue, but I wonder if you could take on that concept. Do you think that that is an issue that, we are, as a society, funneling too many of these drugs out there into the world?

Dr. Craig Surman:

What I can say is that it is harder to do less convenient things. Behavioral therapies are hard to come by. And people may have to self-guide their way through strategies, environmental accommodations, getting accommodation with their employer or at school.

And particular groups also seem to be more vulnerable to risk of overdiagnosis or treatment. For children, younger age within grade leads to higher rates of diagnosis. And there are some subgroups in society that seem to have less access to behavioral therapies, which may alleviate symptoms.

So the story is a complex one, where there's probably both over- and under-diagnosis, and it depends upon the particular circumstance. So, this is the challenge on a social level to understand how to allocate these resources, and people are left doing their own research to figure it out.

William Brangham:

One other thing that people have mentioned as a possible driver of these shortages is the growth of these sort of non-doctor prescribing Web sites where you can go and sign up and say, I have X, Y, and Z, and get medications prescribed for you.

Do you think that those sites are contributive to this, that there are — there's simply more people getting prescriptions that may not necessarily need them?

Dr. Craig Surman:

I think the biggest factor is awareness that ADHD exists.

And, as one of the interviewees mentioned, it's really only in the last 15 to 20 years that adult ADHD has been a concept that's diagnosable. So, we should be seeing rising rates of diagnosis and treatment. But I think it's really important that people know there's a way that they can figure out if the diagnosis is being done well, however it's being done, because access to care is a real problem that telemedicine can solve.

But I would recommend people use resources like NIH, CDC, or Children and Adults with ADD online to ask themselves, is this really fitting the bill? And do I really want to change my brain vs. some other strategies they might pursue?

William Brangham:

And do you have any sense — again, I know you're not a supply chain expert here — but any sense of — like, what do you tell your patients as far as how long it might be before this medication becomes available?

Dr. Craig Surman:

My main concern is that they minimize the anxiety and have Plan B's, whether it's other medications they might go to, that they have had some small stockpile that they can use, or that they're going to taper off of medication and be off for a while, while they figure out, what is the sustainable plan for them?

But, unfortunately, collaborating with the pharmacist, collaborating with the prescriber ends up being the work that it takes to get these treatments.

William Brangham:

All right, Dr. Craig Surman, Harvard Medical School and Massachusetts General, thank you so much for being here.

Dr. Craig Surman:

My pleasure.