By Katherine Taylor
Emma Ferguson’s spot on the worn green couch might as well have been spring-loaded. In the midst of a passionate monologue that included topics like the essentials of rabbit care, Lizzo being a “bad bitch,” voting patterns of suburban white women, and the best method for making a beaded lampshade, she popped up and walked into the kitchen several times, simply to open and close the fridge without taking anything out.
This is a regular occurrence with Ferguson, 21. Catch her in a conversation that excites her and just watch; chances are she’ll leap from her seat, subconsciously driven to her feet by sheer passion, then realize she didn’t actually have any reason to stand up so now she has to create one: move a charger from one outlet to another, fill a cup that wasn’t empty, check the fridge, pet the cat.
Being restless and talkative are commonly-known traits associated with ADHD, parts of Ferguson’s personality I’ve become very familiar with as her roommate. These are the things that anyone who meets her sees right away.
But these are only a few strands of the tangled web ADHD has woven around Ferguson’s life. When she has access to Adderall, her symptoms are manageable; when she’s unmedicated, they become overwhelming.
The Food and Drug Administration (FDA) announced a shortage of amphetamine and dextroamphetamine salts (the generic name for Adderall) in October 2022, with little explanation as to why. Almost a year later, it has yet to be resolved, an abundance of red tape blocking the path to any potential solutions. The shortage has created a myriad of both psychological and logistical problems for people across the country who rely on the medication in their daily lives.
For Ferguson, the “fun” side of her ADHD takes a backseat when she can’t get her prescription filled. She forgets things: where she put her car keys, meetings, homework assignments, commitments she’s made. Focus becomes elusive. Things get disorganized, jumbled up and confused, a frustrating barrier to success for a high-achieving student. True irritation creeps in and spills out as she fights the feeling that she isn’t in complete control of herself anymore.
Having her medication doesn’t just make it easier for Ferguson to focus. It makes it possible for her to function.
“When I don’t have my Adderall, it’s 75/25 if I brush my teeth and put on deodorant,” Ferguson said. “I have a hard time doing routine tasks. My impulse control goes out the window, so I drink a lot more and I binge eat. I don’t show up for obligations that I normally would never miss.”
Despite the enormous impact of the shortage, to those affected, it seems like very little is being done to find a solution. A potential explanation is that Adderall is a highly controlled substance. It’s classified as a Schedule II drug by the Drug Enforcement Administration (DEA), meaning it has a “high potential for abuse, with use potentially leading to severe psychological or physical dependence.” This is the same designation awarded to drugs like hydrocodone, fentanyl, and opium.
Despite the addiction risks, Adderall prescriptions are not rare. According to the Centers for Disease Control and Prevention (CDC), prescription fills amongst people aged 25-44 increased by roughly 10% from 2020 to 2021. From 2006 to 2016, amphetamine use (including Adderall and drugs like it) more than doubled. Data collected by Trilliant Health shows that Adderall prescriptions for people aged 22-44 is outpacing actual ADHD diagnoses amongst the same group.
Because millions of people are prescribed the drug, strict regulations are set to curb attempts to sell or use it illegally. This is a fair concern; while estimates vary, data collected by the National Institutes of Health showed that roughly 1 in 10 college students used Adderall without a prescription in 2019. An Ohio State study from the previous year had that number at almost 16%. As a “study drug,” many students turn to it during exam season, hoping to increase focus, stay awake longer, and improve performance on tests.
But for Ferguson and others like her—people who are prescribed Adderall for intense and sometimes debilitating symptoms—there is little comfort to be found in the idea that someone else might not be able to get it. She just wants her meds.
“I don’t love taking Adderall,” she said. “It makes me kind of irritable. But without it, I feel like a little kid because the people around me have to corral me. When I got to college freshman year, I went to my doctor hysterically crying because I thought I’d gotten stupid, when I really just needed a prescription. I can’t do things at the capacity I’m capable of without it.”
For those who are seeking an explanation for the shortage, there isn’t much out there. The drug industry higher-ups—manufacturers, distributors, the FDA, the DEA—are providing very few satisfactory answers about what is causing this problem or when it will end. Some politicians and legislative committees have called for answers, but the pharmaceutical supply chain does not seem to have much to say. It seems that Big Pharma and all its subsidiaries are shrugging a collective shoulder on this issue.
According to the American Society of Health System Pharmacists, seven of 11 listed manufacturers have provided no explanation for the shortage, or refused to disclose how much of the drug they have available. Of the four remaining on that list, two have discontinued the product, and two are prioritizing existing customers.
Right now, many with ADHD are simply trying to ride the shortage out, doing their best to navigate a myriad of bureaucratic and logistical issues to get their medication. Through a combination of phone calls, pharmacy cooperation, psychiatrist assistance, and sheer luck, some people have found a path to getting their prescription filled.
Callie Barnett, 22, is a student at the University of Arkansas studying abroad in Rome last spring. For her, going abroad has made it easier to take her medication consistently. She was able to request a full four months’ supply before she left, though it wasn’t easy to acquire.
“Before January, I was already having trouble getting my normal prescription, but for four months[’ worth] I had to travel five hours away to my hometown to get enough,” Barnett said in an email from Rome. “I have friends who didn’t have that luxury.”
Were Barnett without her medication, though, things could get dark quickly. As part of her diagnosis, she deals with racing thoughts, inability to focus, and suicidal ideation.
“When I don’t have my meds it is almost impossible to get out of bed,” she said. “My thoughts race and all I can think about is everything I need to be doing, but it feels like I can’t. It sends me into a depressive spiral that makes it extremely difficult for me to get up and join the world.”
Dealing with such serious symptoms means that people who are left without their medication are forced to try and solve the problem on their own. Ferguson, who is prescribed the generic versions of both extended release and instant release Adderall, is supposed to get a month’s worth of both every time her prescription is filled. Recently, though, that hasn’t been the case—especially for the extended release, which she relies on the most.
“Twice now it’s been 20,” she said. “One time I got ten of each type. I’m on this fucked schedule where I don’t have them at the same time. It’s been about six months that I haven’t gotten my two prescriptions on the same day.”
In order to carefully control the amount of Adderall and other Schedule II drugs on the market, the DEA sets specific quotas at the beginning of every year. Manufacturers are only allowed to produce based on those quotas. Thus, production is limited by estimates derived from data collected in previous years, rather than as a response to actual demand. Producers can’t simply make more to match prescription needs—and individual recipients are saddled with the consequences.
“When they run out of Adderall, it’s all on me to call my doctor and have her call in more,” Ferguson said. “And I have to call the pharmacy to see if they have it so she can send the script over. I can only have three pharmacies on file, so if none of them have it, I just can’t get my meds. Plus I have to wait until I’ve run out of whatever they gave me initially before I can get the rest of the month filled. You expect me to do all that without my Adderall?”
Because of the strict regulations on the drug, any potential solutions that could be executed lower down the food chain are out of the question. Pharmacists can’t substitute similar drugs; insurance companies have their own rules about what they cover. Once, a pharmacy had Adderall on hand, but Ferguson is only insured for the generic version, not the name brand. She would have to pay $300 if she wanted it.
“That’s unacceptable,” Ferguson said. “I should not be paying the same amount for a medicine I’m prescribed as I would to get it on the black market.”
Without consistent access to her medication, Ferguson and others like her have had to learn to cope. Because the extended release pills have been harder for her to get, she has been relying on taking multiple instant releases in a day. When she runs out of her measly ration of those, she asks friends who have a prescription to loan her some until she can get hers filled and repay them. More often than not, though, she simply goes without. And the inconsistency has serious side effects.
“When I stop taking my meds suddenly, I can’t even get to class,” Ferguson said. “It’s difficult to slow my mind down enough to focus on one thought, so things slip through the cracks.
“It’s hard to maintain relationships. Due dates become really impossible because my procrastination gets worse. It’s not that I’m intentionally being a shit student or coworker or whatever it is, I just don’t have the capacity to do things in a timely manner.”
No timeline. No answers. No solutions. No meds. The Adderall shortage is affecting people diagnosed with ADHD across the country, and there is little that individuals are able to do to solve the problem. Without the medication, performing the tasks necessary to get more becomes increasingly difficult, and daily life becomes a struggle.