22.💊 Why is the Adderall Shortage happening in 2023? 2 of 2
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Don’t forget to read part 1 here!
Faati sits on the city bus. He stares out of the window while listening to music in his headphones. With his work uniform folded neatly in the seat next to him. Hairnet, apron, black pants, and white dress shirt. He has one stop to make before he starts his shift at the cafeteria.
Faati pulls the line above his head to signal the driver that it's his turn to get off the bus. The brakes on the bus release a high-pitched squeal briefly as it comes to a stop. The bus lowers closer to the ground as air escapes the hydraulic suspension with an exasperated hiss. Faati stands up now and exits onto the street. He's outside of a pharmacy that he frequents to refill his meds.
He walks to the back of the pharmacy and stands in a long line. It's taking forever. He only has twenty minutes to catch the next bus and worries he will be late for work if he waits much longer. Being on time is something he's worked on for years, and he hasn't had to put much effort into being on time for things now that he has medication to help him. Faati has ADHD; without a car, timing his bus commute is essential to keeping his job.
When it's his turn in line at the pharmacy, he walks up to the counter. He gives his name and I.D. but receives terrible news. The pharmacy tells him that due to the amphetamine shortage, he cannot fill the prescription for his meds. He asked when he could return to pick them up, but there was no answer. They didn't know when the medication would be back in stock.
Faati began to struggle at his job. The first month without his meds was hard. He knew the bus schedule like the back of his hand, but the problem was getting ready for work. He didn't consider getting up at his usual time worked because he took his meds right when he woke up. He should've gotten up a little earlier because without focus drugs, getting all of his things together was very difficult. He was late to work the second day without meds.
The next day he made sure to get up early. The days grew longer than he remembers, and now he finds himself spacing out when people give him important verbal instructions. He used to be great at multitasking, which is an essential skill in the food service industry since everything moves at such a quick pace. He burns orders because he can't keep track of time enough to remember to return to the grill while standing at the oven.
After two months, Faati's boss at the cafeteria warns him about his slip in performance. He wants to explain, "I'm trying to be on time; I'm trying to pay better attention, but I can't!" but he knows how people see ADHD; it doesn't matter. Instead, he stands there feeling ashamed and anxious and takes a verbal beating from his boss. He agrees he will try better. Finally, after three months without his meds, the prescription was filled but too late. Faati is fired for his lack of performance the same day his prescription is filled.
This painful moment replays in his mind whenever he gets low on his prescription, even though it was several years ago. That's why when he looked at the last tablet of Ritalin rattling in the plastic vial, Faati became reminded of his troubles in the past. His mind flashes to the car he just purchased. It was great not to rely on public transportation for the first time in his life, but now he fears he won't be able to keep up with the payments without his pills.
Unlike Sheila from the last episode, Faati works at a more neurotypical job that demands tasks get done and that they get done in a specific fashion overseen and enforced by management. A lot less flexible than working a writing job from home, which is still tricky with neurodivergence. Still, notice how different this affects someone who works at your local grocery store, bank, or restaurant. Not to mention the pain of withdrawals, the paranoia, the fatigue, and the inability to focus. Faati squeezes the near-empty prescription bottle in his hand and clenches his teeth. He'd do anything to keep his job. Anything.
'One of the most useful treatments in medicine.'
In part one, I established the history of clinical amphetamine usage and why the Adderall shortage is happening. Briefly, I discussed how it could affect the people who desperately need it. Even so, I want to dig deeper into the mental health of individuals who take stimulants to work and how the onset of the shortage back in the Fall of 2022 has been taking a toll on the collective minds of medicinal stimulant users.
People with ADHD have suffered more severely than those without the condition during the covid-19 pandemic. That's why doctors and other experts observed a surge in ADHD diagnosis and stimulant prescriptions during the pandemic. Tons of people who once relied on the structure of physically going to work or school like a crutch suddenly had it swept from under them and began to struggle. This caused many people who didn't need medication to suddenly seek evaluations and treatment.
Adults have overtaken children since the 2010s for prescription ADHD drugs. Stimulants offer irreplaceable relief to patients who suffer from neurodivergence. It improves their work and school performance, reducing their risk of anxiety, depression, drug abuse, and suicide. A 2017 study of millions of patient records observed adult ADHD patients who take stimulants are less likely to get into an auto accident. This is significant because one of the manifestations of adult ADHD is frequent auto accidents.
That's probably why Dr. David Goodman calls stimulants "One of the most effective treatments in all of medicine, for any condition." When people have heart disease or diabetes, taking a pill doesn't suddenly make them able to function the way a healthy person does. For example, suppose you have a heart problem requiring you to take drugs. In that case, once you take the medication, you can't be miraculously able to start running marathons.
Many of the drugs used to treat ailments are precisely that. Treatments. Band-aids. They don't fix the problem; they ease the symptoms enough to get by. The meds used to treat inattention are pretty much the same. The difference is, for those several hours that focus medication is coursing through our veins, there's no such thing as ADHD. It is actually a very, very effective treatment for inattention. I've said it before, taking that one small 15 mg capsule of Adderall is like putting on glasses for the first time, for me anyway. It's life-changing. I couldn't work a full-time job AND do this podcast without it. Maintaining a full-time job is almost impossible.
That's probably why Dr. David Goodman said this about taking meds for hyperactivity or inattention. "This can come down to the difference between stopping at the red light or running the red light because you got distracted." That sounds important.
All that said it's easier to see why not having drugs, for people who rely on them, can contribute to being a less attentive family member or parent at home. Or how it can lead to a drastic inability to regulate emotions and impulses. It may mean increased distractability and tardiness at work, making the person seem unreliable.
That's why people panic when they can't find their medication after calling 15 or 20 pharmacies. It's like a wheelchair for people who can't walk. Imagine if suddenly, using a wheelchair was illegal, or there was a shortage of them. You may be able to get around somehow, but it would be more difficult. Here are some first-hand accounts of people struggling right now without medication from a CNN article:
Without medication, Clara experiences something known as ADHD paralysis: She could have a list of things to do and knows it's essential to accomplish, but she struggles to stop whatever other activity she is doing.
"As a parent, I was surprised at how upset I felt," Rebekah said. "I was crying, and it caused me to be just exhausted. By the end of the day, I had just crashed. I was like, 'Wow, this has really taken a toll on me,' and I think I've realized I'm accustomed to being able to get medication when I have a prescription. I have never tried to fill a prescription and been told, 'you can't get this anywhere.' "
Ashley Jordan, 24, of Colorado, said she must save her pills for when she needs them most. She has taken Teva's version of Adderall for over seven years for ADHD. Ashley was surprised to find that her pharmacy had given her a different brand in August because it was all they had. Unaware of the medication substitute, she had adverse reactions to the unfamiliar formulation of the drug, which caused her to become sick with an upset stomach and headaches.
After the Panic
Looking at Adderall as the effective medication that it is, it's no surprise to see why people kind of panic when they don't have it. Not only that, but it could cause people to do things or behave out of character when there's limited access to it.
Likewise, people who cannot acquire relief from their symptoms may seek relief via alternative methods. Social media is full of shady accounts claiming to have the drug for sale. Some people reach out to friends who no longer use the meds that were previously prescribed to them.
This isn't good because of the legal aspects of the Schedule Two substance. Selling your own prescription medication an obvious felony, but you can't even share it with others. In short, you can become a felon seeking to alleviate your symptoms or help someone alleviate theirs.
23 people were charged for trafficking pills in October of 2022 after seizing over 74,000 counterfeit drugs, according to the U.S. Department of Justice – including counterfeit Adderall laced with meth. Amid the opioid crisis, fentanyl should be a growing concern for anyone considering buying weird pills on the street.
I feel like I came off as unaware of the importance of regulating this drug. That is not true, and though I believe in decriminalizing drugs for medicinal and recreational use, I think people need to be aware of the dangers surrounding dextroamphetamine usage.
It's reasonable that the feds and medical practitioners advise against sharing this drug. Say you have a friend struggling to get work done around the office, and you give them an Adderall. What if they take medication for high blood pressure, and stimulants raise it too much? Or do they take medication for a mental disorder and start having paranoia or panic attacks if they consume even a tiny dose of dextroamphetamine?
I can understand the feeling of not having medication. Outside of the shortage, I've had times when I forgot to take it or there was a problem at the pharmacy. Words to describe the feeling you get when you don't have it in clinical terminology are: irritable, anxious, uncomfortable, and having trouble focusing. That's all just dressed-up language to soften the fact that people who need the drug are dependent and experiencing withdrawal symptoms.
Adderall withdrawal symptoms can include:
restlessness
insomnia
weight loss
fast heart rate
dizziness
fatigue
seizures
panic attacks
blurred vision
high blood pressure
paranoia
dry mouth
suicidal thoughts
depression
The language is misleading, and I think that's a marketing ploy not to associate patients with addicts and recreational users. But, people relying on the drug for a long time to maintain their usual level of competency in society will react similarly to an addict without it. An estimated 5.6 million people across the United States use Adderall or other stimulants to treat their ADHD. This doesn't include the people who are abusing it.
Only now that we are experiencing such an impactful shortage can we see the truth about so many Americans; many of us are drug dependent. I imagine how many must be just barely hanging on during these times. Of the 5.6 million Adderall (legitimate) users (1.69% of the U.S. population), if 15% of those people are having trouble getting their meds, that's 840,000 potential lives in danger.
People who suffer from neurodivergence enough to seek a prescription probably struggle with managing their symptoms. The symptoms are impulsiveness, poor emotional regulation, and frequent auto accidents. This is an extraordinary group of individuals to go off their meds because they are more likely to do something impulsive, like try meth for the first time.
As countless individuals are confronting having to rapidly taper or stop, we're facing a real possibility of a public health disaster on a scale not seen since the prescription opioid crisis- Instead of enduring withdrawal. Other individuals cut off from Adderall are likely to turn to alternative stimulants like crystal meth, fueling a much broader problem.
Catastrophic regulation failures contributed to widespread opioid dependence and addiction. The government response to the prescription opioid crisis focused on rapidly reducing supply: crackdowns on pill mills, tightened prescribing restrictions and reformulated products to make them harder to snort and inject. This approach backfired, pushing many users onto the illicit market. Heroin was widely available and far cheaper than its pharmaceutical cousins.
The recent rise in fentanyl contamination has further fueled the crisis. Overdose rates have continued to soar, spiking from 16,000 during the height of the prescription opioid crisis to more than 100,000 annually. The number of cases of blood-borne infections like HIV and hepatitis has spiked in tandem.
This is the sort of crisis that some fear could happen with stimulants if it persists much longer or worsens. Cardiac arrests involving stimulant drugs are already at an all-time high. Methamphetamine injection is helping to drive infectious disease cases. And there are also concerns about street stimulants, including counterfeit pills, being contaminated with fentanyl, creating the risk of opioid overdose. All that being said, the DEA stated it has no intention of increasing the amphetamine quotas for 2023, despite the possible onset of a stimulant crisis.
If you are listening to this and experiencing a problem getting your ADHD medication, you may be struggling. This next section is about how to cope without your prescription dextroamphetamine.
How to cope with the Adderall shortage
To understand how to cope, let's look at how Adderall works. I've done it before in previous episodes. Still, I've generated a more detailed and nuanced understanding of the neurochemistry involved in this context.
The two active ingredients in Adderall, dextroamphetamine and levoamphetamine, are amphetamine compounds that work by increasing the levels of dopamine and norepinephrine in the brain. Dopamine is a neurotransmitter involved in the brain's reward and pleasure centers. The release of dopamine is essential to starting tasks. Dopamine is the chemical that makes a person, makes you, chase the feeling of accomplishment.
In contrast, norepinephrine is involved in attention and arousal. When the body experiences stress, norepinephrine is released, leading to physiological changes such as increased heart rate, blood pressure, and breathing rate. It also helps to increase focus and attention, which can be helpful in certain situations.
For example, imagine walking in a park and suddenly seeing a snake on the path before you. In this situation, your body's stress response is triggered. Norepinephrine is released to help prepare you for a fight-or-flight. This surge of norepinephrine increases your heart rate and breathing rate, providing the energy you need to run away or fight off the snake if necessary. At the same time, norepinephrine helps to increase focus and attention, allowing you to quickly assess the situation and determine the best course of action.
When a person takes Adderall, the drug is absorbed into the bloodstream. It travels to the brain, stimulating the release of dopamine and norepinephrine from nerve terminals. The drug also inhibits the reuptake of these neurotransmitters, meaning that they stay in the synapse longer, leading to increased activation of the postsynaptic receptors. This increased activation leads to increased neuronal firing and communication between different brain parts, improving focus, attention, and cognitive function.
I felt like the guy from the movie Limitless when I re-introduced myself to prescription stimulants again as an adult a few years ago. It's an incredible feeling, but there is an equal and opposite reaction for every reaction. What goes up must come down. When you don't have the meds, it can feel just as bad as it initially felt a relief to have them. You can take a few steps to cope if you're feeling the adverse effects of not having your medication because of an Adderall shortage.
Call your doctor.
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Call your doctor and let them know you are experiencing a shortage. They probably can't do much, but letting them know is still good. Suppose you use an app to request a refill for your meds. In that case, the doctor's office probably sends a notification to your doctor for him or her to write a 'script and send it to the pharmacy. Your doctor probably has yet to determine whether or not that particular location can fill it or not.
Because ADHD medication is a controlled substance, they would have to write a new prescription and send it over again to switch to a different pharmacy. Notifying the doctor's office will at least alert the doctor to be on standby to write a new one quickly. The last thing your primary healthcare provider should want is for you to end up hospitalized because you don't have what you need from them.
You might even discuss the possibility of switching to different medications.
3. Relax, and call the pharmacy.
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It might be hard to focus and feel motivated to do much, but before you freak out, call pharmacies in your area. If you live in a larger city, there are many pharmacies, which increases the chances that there's a place that can fill the prescription.
Go to Google, and search "pharmacies near me." Then, start calling places close to you. If you can't find one close, keep looking outside your area until you do. Doing it this way ensures you're not calling places listed randomly. Hopefully, you can find one even closer than you're the regular place.
4. Try other meds or supplements.
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Knowing how Adderall works in the brain and nervous system, you can try other vitamins or supplements, like nootropics, that arouse similar chemical reactions in the nervous system.
Alpha Brain is something that I always talk about. It's a nootropic that I've used for about a decade. Some of the ingredients in Alpha Brain, such as L-tyrosine and L-theanine, are believed to increase dopamine levels in the brain. Chemical trials, like double-blind placebo studies, have supported its effectiveness.
L-tyrosine and L-theanine can be purchased as oral supplements alone as well. I've taken them both and have found them to be beneficial.
5. Ration medication
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The medication is effective on the days it is taken, even if it is not taken every day. In this way, stimulant medication differs from many other psychiatric medications, which must be taken daily to be effective. However, when patients skip stimulant medication doses, it can disrupt their routines and functioning. One way to ration medication that many patients employ is to take the medication Monday through Friday and not on the weekend or when on vacation.
6. Caffeine
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I didn't know caffeine was called the poor man's Ritalin. I call it "the working man's, make me jittery and anxious. I'm still sleepy and un-motivated, but I can't stop drinking it because I'm addicted" juice. It could work for you, though.
7. Exercise
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During exercise, the brain releases dopamine in response to the physical exertion and the feelings of accomplishment that come with completing a workout. This can help to improve mood and reduce stress levels.
Studies have also shown that regular exercise can increase the number of dopamine receptors in the brain, which can help to improve the brain's response to dopamine over time. This may contribute to the mood-boosting and stress-reducing effects of exercise.
8. Meditation
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Meditation practices such as mindfulness meditation have increased dopamine release in certain brain areas, such as the striatum, which is involved in motivation and reward processing.
Studies have also shown that regular meditation can increase the density of dopamine receptors in the brain. This means that the brain becomes more sensitive to dopamine over time, which can lead to increased feelings of pleasure and reward.
Additionally, meditation has been found to be effective in reducing stress and anxiety, which can positively impact dopamine levels. Chronic stress has been shown to decrease dopamine levels in the brain, and reducing stress through meditation may help to restore healthy dopamine function.
And with that, we can finally finish up this two-part article.
Conclusion
This has officially been the most research-intensive project. Knowing what I know now about the shortage, I'm definitely concerned. I'm not concerned for myself, but I am truly worried about what many people would do if we couldn't get any more focus medication. If you are experiencing difficulties, talk to a medical professional, or pharmacist, and if you’re experiencing mental health difficulties, talk to a professional.
References:
https://www.theguardian.com/society/2023/jan/29/adderall-shortage-us-adhd-ritalin-drugs