Adderall: Not your average party drug

Adderall is a two-faced drug. 

On one hand, it is a critical medication approved to treat symptoms of attention-deficit/hyperactivity disorder and narcolepsy, according to the Food and Drug Administration. 

On the other hand, Adderall is often viewed as a party drug because of how often it is misused recreationally, according to the National Institute of Health’s 2018 Monitoring the Future survey. 

An ongoing Adderall shortage was announced over half a year ago, according to the FDA. 

This means it’s been six months of many people struggling to fill their prescriptions or being unable to do so at all, according to a Feb. 18 NPR article. 

This shortage has many moving parts, but that is no excuse for limiting people’s access to their medication. It’s time for the restriction and stigma around prescription stimulants to end.

Adderall misuse

It’s estimated that about 11.1% of U.S. college students have misused Adderall, according to the 2018 survey. 

Although rates of Adderall and other amphetamine misuse declined during 2021 after the onset of the COVID-19 pandemic, they have since returned to pre-pandemic levels, according to the 2022 Monitoring the Future Survey.

Methamphetamine, minus the meth

A pervasive misconception surrounding stimulant medications is that they are like taking prescribed meth or cocaine. While also stimulant drugs, their effects greatly differ from those of responsibly-used prescription stimulants. 

Methamphetamine, also known as meth, is often compared to amphetamine because of their chemical similarity, as methamphetamine resembles the structure of amphetamine but with a methyl group attached to it, according to Healthline. 

The two also differ in their effects on the brain, specifically in terms of dopamine regulation. 

Methamphetamine has a much stronger effect on dopamine release and transporters, which may help to explain its intense high and addictive quality, according to a Jan. 30, 2009 Journal of Biological Chemistry article.

When taken as prescribed

In practice, the critical difference between these substances isn’t in any sort of chemical formula—it’s in the way prescription stimulants are administered. 

In fact, there is an FDA-approved ADHD medication containing methamphetamine, known as Desoxyn, according to Healthline. 

All prescription stimulants are classified as Schedule II drugs, which means they have medical use, but contain a high potential for misuse and addiction, according to the Drug Enforcement Administration.

Other Schedule II drugs include opiates like oxycodone, morphine, codeine and fentanyl, according to the DEA.

Prescription stimulants are also highly controlled and regulated, but only when they are obtained legally. When taken as prescribed, they’re taken at much lower doses and in capsule form, rather than possibly crushed up and snorted or injected intravenously. 

Stimulant medications have been shown to improve symptoms of ADHD, as well as prevent the negative outcomes associated with it, according to a Sept. 10, 2020 New England Journal of Medicine article.

One study in Sweden found that amongst individuals with ADHD, those taking ADHD medications had lower rates of criminality, according to a Nov. 22, 2012 New England Journal of Medicine study.

For people without ADHD, stimulants provide little benefit. One study found that in healthy college students, Adderall had little to no effect on their test-taking abilities, according to a June 27, 2018 Pharmacy article.

The never-ending shortage

The reasons for the current shortage are hard to pinpoint. Manufacturing delays are a key factor, according to the FDA.

However, supply-chain issues don’t account for the extent and duration of the shortage. 

The Drug Enforcement Administration’s method of regulating Adderall is also a significant contributing factor to the shortage, according to an April 10 Vox article. 

Because of Adderall’s status as a Schedule II drug, manufacturers are only allotted a limited quantity of raw materials for production per year, called the aggregate production quota, according to the Vox article.  

Pharmacies also face restrictions on the amount of controlled substance prescriptions they can fill, according to an April 3 Bloomberg article. These constraints are the result of certain settlements regarding the prescription opioid crisis, but affect all controlled substances, including most ADHD medications, according to the article.

The shortage has also affected the supply of other ADHD medications, such as methylphenidate, which includes Ritalin and Concerta, and lisdexamfetamine, also known as Vyvanse, according to a Feb. 6 NBC article.

In addition, alternatives to Adderall aren’t always as affordable or accessible. 

For example, there aren’t currently any generic versions of Vyvanse available, meaning that, even with insurance, prices can be steep, according to a Feb. 7 Inflow article. 

There is some hope on the horizon for Vyvanse users—on August 24, the market exclusivity of Takeda, its parent company, will expire, opening up the opportunity for the production and distribution of generic lisdexamfetamine, according to the article.

Despite rising need as well as distribution and supply complications, the DEA has decided not to increase the aggregate production quota for ADHD medications for 2023, according to a December 2022 Federal Register notice.

The bottom line

Some argue that this shortage may lead to a reproduction of the opioid crisis and that people may be led to dangerous alternative stimulants, such as crystal meth, which are not regulated by the FDA, illustrated by a November 2022 column in the LATimes. 

While worries over the high potential for misuse motivate regulators like the DEA to restrict access to ADHD medications for those who need it, allowing an on-going shortage is counterintuitive. 

People with ADHD, like myself, deserve to have access to treatment. 

My ADHD meds allow me to get out of bed everyday. They’re a big part of the reason I and many others similar to myself are able to function in life without constant struggle and inner turmoil. 

We should not have to ration our medications.

We should not have to be looked at or treated with suspicion and distrust every time we ask for our meds at the pharmacy. 

Every day, I have to face others’ judgments and unwillingness to understand that I’m not just lazy, but that I’m trying my best—that with ADHD, simple tasks can feel impossible. 

My Vyvanse has a $120 copay. I went through almost every popular ADHD medication before reaching it. Sometimes it makes me irritable, sometimes it makes it hard to fall asleep, and I almost always lose my appetite for a few hours afterwards. 

I wouldn’t continue to take and fill my prescription if it didn’t immensely improve my quality of life in other areas—my focus, motivation, executive functioning and emotional regulation—so I can live my life how people without ADHD do everyday. 

For many with ADHD, Adderall is that medication for them. 

It’s imperative we do everything we can to urge lawmakers to lower the scheduling of prescription stimulants like Adderall.

We must call for government organizations, manufacturers and pharmacies to improve transparency with the people they serve, whether it be their constituents, consumers or their patients.