As the national Adderall shortage enters its fifth month, people who rely on drugs to help manage attention-deficit/hyperactivity disorder find few if any alternatives available. There are still no signs of relief and no easy fix for the problem, pharmaceutical experts say.

Widespread shortages have also affected Adderall alternatives.

In January, the American Society of Health System Pharmacists, which tracks drug availability, reported shortages affecting nearly 40 different doses or formulations of generic Concerta, a long-acting form of methylphenidate, the drug in Ritalin. Takeda Pharmaceuticals, which makes Vyvanse, also known as lisdexamfetamineit’s generic, he says there’s no shortage of that drug, but according to dozens of pharmacies contacted by NBC News, Vyvanse has been on intermittent backorders for months.

Michael Ganio, ASHP’s senior director of pharmaceutical practice and quality, said an unexpected spike in demand was more to blame than quality issues with manufacturing equipment or drugs.

“Our entire infrastructure for drug shortages and everything we have in this country to mitigate the impact of shortages is based on potential supply disruptions,” Ganio said. «It’s been very unusual to have a shortage due to increased demand.»

In recent years, ADHD medication prescriptions have increased more than pharmaceutical companies or government agencies predicted. According to the health data company bright healthAdult Adderall prescriptions increased 15.1% during 2020, double the 7.4% increase seen the previous year.

In October, the Food and Drug Administration announced a nationwide shortage of Adderall, citing «intermittent manufacturing delays.»

Dr. Sarah Cheyette began switching patients to alternative ADHD medications like Focalin, Vyvanse, Concerta, and Ritalin when she learned that pharmacies were out of Adderall late last year. Alternative medications didn’t always work, but for many patients, switching prescriptions made more sense than going off ADHD medications altogether.

“There is an overflow of people who couldn’t get Adderall and turned to other medications,” said Cheyette, a pediatric neurologist who treats children and adults with ADHD at the Palo Alto Medical Foundation. «And it’s getting worse.»

Some drug companies now say supply problems could last well into spring. Alvogen, which makes generic Adderall, expects its shortage to last until mid-April, according to the FDA. database. Teva Pharmaceuticals, the nation’s largest supplier of Adderall, reports that problems with some of its Adderall dosages, particularly the more expensive brand-name versions of its fast-acting tablets, have now been resolved, but lists recall dates for others as TBD (to be determined).

Doing more ‘isn’t as easy as flipping a switch’

Most ADHD medications belong to a class of controlled substances called central nervous system stimulants. Because drugs have a well-documented history of abuse and addiction, the FDA and the Drug Enforcement Administration limit the number of pills a pharmacy can dispense at one time and how often patients can refill their prescriptions. The DEA also sets limits on the active ingredients that pharmaceutical companies use to make these drugs each year.

“DEA is involved if any manufacturer tries to increase production,” Ganio said. The DEA calculates how much of a given drug ingredient is needed to meet demand and then allocates that precise amount. The problem, according to Ganio, is how the DEA uses historical data, that is, prescription numbers from previous years, to establish these amounts.

Demand forecasts based on historical data could not predict the sharp rise in ADHD diagnoses during the pandemic, Ganio said. Now there is a mismatch between DEA quotas and prescription numbers.

The quotas have been problematic for companies like Novartis-owned Sandoz, which makes generic Adderall and Concerta.

“Since mid-2022, we found that when a customer asked us for more than they forecast, we were unable to fulfill those orders,” Leslie Pott, a Sandoz spokeswoman, told NBC News in an email. “We asked the DEA for an increase in volume, with some applications accepted and others denied.” According to Pott, these customers range from hospitals and institutions to retail pharmacies, specialty pharmacies and wholesalers.

«This is incredibly unprecedented.»

Pediatric Neurologist Dr. Sarah Cheyette, Palo Alto Medical Foundation

Ganio said the DEA is often willing to increase fees if there is a legitimate demand from patients. But it’s hard to measure an increase in demand while it’s happening. There is no coordinated, real-time system for tracking ADHD diagnoses nationwide like there is for Covid or the flu.

“Producing more drugs is not as easy as simply flipping a switch,” Ganio said. “The FDA and DEA are seeing more demand, but how much more?”

Covid, social networks and telehealth drive demand

Doctors can’t cite exact numbers either, but many say they’ve noticed a clear increase in patients seeking ADHD treatment since the pandemic lockdowns began.

“Like many crises, many factors came together to create a perfect storm,” said Cheyette, who recently saw many more ADHD patients than in the years before the pandemic. «This is incredibly unprecedented.»

As people began working from home or helping kids with virtual school, they began to recognize the symptoms of ADHD, said Dr. Max Wiznitzer, a pediatric neurologist at Rainbow Babies and Children’s Hospital and Case University. Western Reserve in Cleveland. This was especially true for adult women.

“Suddenly parents were seeing that their children were having a hard time staying focused, and we were identifying more children who had symptoms and needed intervention,” Wiznitzer said. “The parents of my patients have been asking about ADHD more often.” Since the pandemic began, Wiznitzer said he has prescribed ADHD medication to more adults.

Ashley Gandy, 39, who lives in Carrollton, Texas, takes Vyvanse for her ADHD, a prescription she got through a telehealth doctor. Her 6-year-old son takes Concerta, which is prescribed by her pediatrician. For several weeks in the fall, Gandy’s Vyvanse order was backordered, and now her regular pharmacy is out of her son’s Concerta.

“The CVS person told me they haven’t had any for a month and they don’t expect to get any anytime soon,” he said.

When will the Adderall shortage end?

In late December, Rep. Abigail Spanberger, whose Virginia constituency encompasses Fredericksburg and several other cities in the northeast region of the state, wrote a letter asking the FDA and DEA to coordinate a federal response to the shortage. ASHP’s advocacy branch has also been pushing the government to improve the way it addresses drug supply and demand problems.

The ADHD drug shortage also has addiction experts on high alert now.

According to Dr. Eric Kutscher, an addiction medicine specialist at NYU Grossman School of Medicine, the very reason these drugs are controlled substances in the first place—their potential for abuse—makes you fear continued shortages. Without access to prescription stimulants, Kutscher said people with substance use disorders could «turn to a supply of drugs that is more dangerous than ever.» Deaths from counterfeit Adderall mixed with fentanyl have already been reported.

“We have a limited safe supply and a very dangerous available supply that could harm many people,” Kutscher said. «From a public health perspective, this is an emergency.»

A quick fix is ​​unlikely, experts acknowledge.

From Ganio’s perspective, addressing the ADHD drug shortage will require much more transparency from drug companies and better coordinated systems for forecasting drug demand.

Cheyette worries that the solution won’t come soon enough.

“These are not Beanie Babies that people can’t find,” he said. “These are drugs that people depend on to function.”