At the end of every month, Josh Jackson's anxiety takes over at the thought that pharmacies might not have his medication.
The 44-year-old middle school teacher has been taking his prescription for attention deficit hyperactivity disorder, or ADHD, for more than a decade. There's been a growing frustration among patients who have gone weeks to months without their ADHD medication.
Jackson said he can't imagine going two months without it.
“Having my medicine became a really big deal for me,” he said. “As much as it can be scary to think that you rely on something, if something is working, you want to protect it.”
Stimulant drugs are a common treatment for ADHD. But there's been a nationwide shortage of those medications since 2022. The shortage has affected Adderall and variations of methylphenidate, commonly known under brand names Ritalin or Concerta.
While the Drug Enforcement Administration increased the production limit of the stimulant drugs, there's still a high demand.
The problem is complicated. Manufacturing delays, strict federal substance regulations, increased access to telehealth, and a surge of ADHD diagnoses have contributed to the more than three-year long shortage.
Dr. Helen Blaisdell-Brennan, a local psychiatrist, said there could be thousands of patients who were diagnosed with ADHD who might not have that condition flooding the market.
“The problem is not only are there more people being diagnosed with ADHD, but the patients who have an attention deficit disorder are having great difficulty finding their medications,” she said. “They’re stressed.”
People struggled before the pandemic
ADHD is a mental disorder that makes people restless and affects concentration and impulsivity. There's a link between ADHD and issues with generating dopamine — the hormone that regulates motivation, memory and mood.
Stimulant medications like Adderall and Ritalin can help people focus and reduce impulsive behavior.
More than 15 million adults and about 7 million children in the U.S. have been diagnosed with ADHD, according to data from the Centers for Disease Control and Prevention.
People on the medication have described the feeling as their brain being quiet.
“People will say that those who have ADHD can't pay attention to anything,” Jackson said. “It's 180 degrees, the opposite of that. We are paying attention to everything all the time. It’s overstimulating.”
Here's an example: while talking with HPR for this story, Jackson said he was simultaneously honing in on the sound of zebra doves overhead and car engines revving down the road.
Jackson takes a generic form of methylphenidate three times a day to help with his symptoms. But he said getting ADHD medications has been a challenge even before the COVID-19 pandemic.
In the past, he's driven to five pharmacies on O‘ahu searching for his medication before the pandemic.
“I’ve been sent on some wild goose chases,” he said.
Who's to blame for the shortage?
Blaisdell-Brennan, the former president of the Hawaiʻi Psychiatric Medical Association, said one reason is the rise of telehealth.
“The stimulant shortage isn't just a manufacturing issue,” she said. “It's a result of rapid overprescribing that started during the pandemic, followed by abrupt regulatory enforcement. The demand didn't vanish. It shifted onto local psychiatrists even as the DEA production quotas have increased.”
The DEA strictly limits the amount of stimulant medications that can circulate on the market at any given time. However, as demand has risen, those quotas have stagnated. From 2012 to 2023, overall dispensing of stimulants in the U.S. has increased by 60%, according to a report produced for the DEA.
Then, in 2020, Congress loosened telehealth restrictions due to government lockdowns, opening the door for more people being able to gain access to mental health services as well as prescriptions.
The Department of Justice has cracked down on telehealth companies for fraudulent prescription practices involving the drug Adderall.
But those patients who were prescribed ADHD medications didn't go away, Blaisdell-Brennan said. She gets three calls a week from people who have little or no documentation of their condition from their telehealth providers, something she never saw before the pandemic.
“Many cannot provide their telehealth prescriber's name, or contact information,” she said. “Collaborative record documentation is part of the framework for safe prescribing by board-certified physicians.”
Almost half of adults with ADHD have received telehealth services for their condition, according to the CDC. About 1 in 11 adults were diagnosed through telehealth.
One of the worries is that people will turn to illegal means to get the prescription drugs they need.
For patients like Jackson who rely on their medications, he said he just wants to be his best self for his students.
“What's best for the kids in any classroom is having a teacher who feels mentally healthy, relaxed and patient,” he said. “All of these things that I'm capable of doing, but the medicine is a coping skill for me, among others, that allows me to be excellent in the classroom. If I can't get that medicine, it's going to be harder for me to be like the person that everybody's come to expect.”
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