Study examines real-world impact of ADHD medication shortages

Many par­ents and/or adults with ADHD report chal­lenges obtain­ing pre­scribed ADHD med­ica­tion. A 2022 report from the FDA sug­gest­ed that rough­ly 10% of Amer­i­cans pre­scribed com­mon ADHD med­ica­tions are impact­ed; a sur­vey by ADDi­tude mag­a­zine sug­gest­ed this fig­ure may be sub­stan­tial­ly higher.

What impact do chal­lenges obtain­ing pre­scribed med­ica­tion have on adults with ADHD and/or par­ents seek­ing to obtain it for their child? This impor­tant issue was exam­ined in a study pub­lished recent­ly in the Jour­nal of Atten­tion Dis­or­ders: “Every­thing’s a chal­lenge”: An inter­view study of ADHD indi­vid­u­als in the midst of the pre­scrip­tion stim­u­lant short­age.

The Study:

Par­tic­i­pants were 20 adults ‑10 men and 10 women- recruit­ed from online ADHD forums. To be includ­ed, they had to report hav­ing expe­ri­enced dif­fi­cul­ty obtain­ing ADHD med­ica­tion either them­selves or their child. All sub­jects par­tic­i­pat­ed in an online inter­view about their expe­ri­ence dur­ing 2024. Inter­views were tran­scribed and themes that were com­mon themes were identified.

The Results:

Four themes emerged across participants.

1. Access to med­ica­tion. All par­tic­i­pants indi­cat­ed that med­ica­tion was some­times out of stock at their phar­ma­cy. As a result, 80% had to call mul­ti­ple phar­ma­cies and/or dri­ve long dis­tances to obtain it (45%). Some (30%) could some­times only obtain par­tial pre­scrip­tions, and some had to switch to an alter­nate med­ica­tion (25%). Below are rep­re­sen­ta­tive quotes:

“I start­ed going to the phar­ma­cy think­ing I was pick­ing up my med­ica­tion only to be told, “We don’t have it. It’s on back order. And we don’t know when we will get more.”

“I actu­al­ly called every phar­ma­cy in my city and the city I work in; they were all out of stock or did­n’t have any stim­u­lants at all,”

“At one point, I drove an hour and a half out­side the city to get half of my prescription,”

2. Treat­ment bar­ri­ers. Prob­lems here includ­ed phar­ma­cists who often would not dis­close med­ica­tion stock lev­els (85%), restric­tive refill poli­cies (65%), and stig­ma from health care work­ers (50%). State­ments relat­ed to this theme includ­ed the following:

“…for the most part, phar­ma­cies were just like, “we can’t tell you whether we have it or not.”

“I can’t go pick it up until the day it is ready…they won’t release the med­i­cine until it is all gone. They won’t even give it to you even a few days ear­ly. So, once it’s emp­ty, I have to go right away to the phar­ma­cy to get it.”

“If I go to the phar­ma­cist to get a migraine med refill, I’m treat­ed fine. If I go to get an ADHD stim­u­lant the atti­tude changes. Ques­tions like do you real­ly need this? Is this a habit for me? People’s stig­ma of ADHD real­ly came up dur­ing that time.”

3. Impact of the short­age. A vari­ety of adverse effects attrib­uted to med­ica­tion short­ages were report­ed by par­tic­i­pants. These includ­ed a relapse of symp­toms (85%), reduced per­for­mance at work (65%), prob­lems reg­u­lat­ing emo­tions (55%), rela­tion­ship prob­lems (45%), and with­draw­al from social­iz­ing (20%). Below is what some had to say.

“I couldn’t keep up with all the require­ments of my job. I just couldn’t func­tion in an office envi­ron­ment. I need­ed to work from home, because I had so much rest­less ener­gy and would con­stant­ly get distracted”

“I strug­gled with my emo­tion­al regulation…without med­ica­tion I def­i­nite­ly became more irritable”

“I cut out almost all my social things, because I was absolute­ly overwhelmed.”

Par­ents report­ed dete­ri­o­ra­tion in their child’s aca­d­e­m­ic per­for­mance, emo­tion reg­u­la­tion and social inter­ac­tions. Not sur­pris­ing­ly, these had adverse effects on par­ents as well:

“It took a lot of time out of my sched­ule to focus on this and I was real­ly wor­ried that he wouldn’t have it. For him, this med­i­cine, it’s almost like it’s life or death because he can be so unsafe and so impul­sive when he’s not pay­ing attention.”

4. Cop­ing strate­gies. Com­mon­ly used strate­gies for cop­ing with the adverse impact of med­ica­tion short­ages includ­ed increas­ing phys­i­cal activ­i­ty, med­i­ta­tion, and con­sum­ing ener­gy drinks/caffeine. Some indi­vid­u­als resort­ed to acquir­ing stim­u­lants through non-med­ical channels.

Summary and implications:

This small study rep­re­sents an ini­tial effort to under­stand how trou­ble obtain­ing pre­scribed ADHD med­ica­tion impacts adults and parents.

The results make clear that short­ages can com­pli­cate the effec­tive man­age­ment of ADHD symp­toms and can sig­nif­i­cant­ly dis­rupt the lives of those affect­ed. It was not uncom­mon for par­tic­i­pants to report symp­tom relapse, dimin­ished work per­for­mance, prob­lems reg­u­lat­ing affect, and rela­tion­ship dif­fi­cul­ties when meds were not avail­able to them.

It should be not­ed that rules relat­ed to fill­ing and refill­ing pre­scrip­tions for ADHD meds ‑and that con­tribute to chal­lenges report­ed here- are in place to curb the non-med­ical use of drugs clas­si­fied as a con­trolled sub­stance. And research has clear­ly doc­u­ment­ed that mis­use, non-med­ical use, and diver­sion of stim­u­lant med­ica­tions is not uncom­mon; this is one rea­son that many col­lege men­tal health cen­ters do not pre­scribe these meds for stu­dents even though they may pre­scribe oth­er psy­chi­atric medications.

Clas­si­fi­ca­tion as a con­trolled sub­stance is also why the vol­ume of stim­u­lant med­ica­tion that can be pro­duced is reg­u­lat­ed by the Drug Enforce­ment Agency, anoth­er fac­tor that has con­tributed to shortages.

Results from this study high­light impor­tant chal­lenges that many indi­vid­u­als with ADHD expe­ri­ence in obtain­ing stim­u­lant med­ica­tion for them­selves or their child. How­ev­er, because this was a small study and with­out a nation­al­ly rep­re­sen­ta­tive sam­ple, it is not pos­si­ble to deter­mine how wide­spread the chal­lenges report­ed actu­al­ly are. Deter­min­ing this will require addi­tion­al research with a large, nation­al­ly rep­re­sen­ta­tive sam­ple. Giv­en the sig­nif­i­cant adverse impact on their lives that many par­tic­i­pants report­ed, this would be impor­tant work to do.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context:

• Sur­vey of 2500 fam­i­lies finds what ADHD treat­ments seem to work/ not work as applied in the real world
• What are cog­ni­tive abil­i­ties and how to boost them?