The Great Adderall Shortage of 2011, noted last spring by Mike Riggs, continues to frustrate millions of Americans who depend on the stimulant, a combination of amphetamine and dextroamphetamine, to focus and function. It's the generic, immediate-release version of the drug, which comes in tablets, that is hardest to find. Shire, the company that developed Adderall, no longer makes the tablets, but it does sell extended-release capsules (Adderall XR), and it says "current inventories of all strengths of ADDERALL XR® are sufficient to meet patient demand." That brand-name version is more expensive, however, and may not be covered by insurance plans. Other possible substitutes, such as Vyvanse, Provigil, and Focalin, are also more expensive, because they are relatively new and still under patent, and may be less effective. The upshot is people desperately scrambling to find Adderall tablets for themselves or their ADHD-diagnosed kids, calling one drugstore after another, and bursting into tears at pharmacists' counters. Advice columnist Amy Alkon writes:
That was me, boohooing like a baby on and off on Tuesday afternoon, because just as my writing life has changed so substantially in such positive ways, those gains are likely going to be taken away from me if those shortages don't end….
The drug I was taking for many years for ADHD, Ritalin, never worked that well on me, but I only discovered that after I started seeing this doctor that I came to feel I could trust on science. I finally confessed to him that it had become almost physically painful for me in struggling to concentrate throughout my writing day, and that I was contemplating taking Ritalin with Mucinex to boost my focus. Bad idea, he said, and prescribed me Adderall to see how it worked.
Like Ritalin, Adderall is a dopamine reuptake inhibitor, but it also pushes a little dopamine out into the brain, and apparently, I really need that D. The first day I took my first Adderall was the best writing day I've had in 20 years. I used to have a tornado of shit whirling around my head at all times, and it stopped and put itself neatly away in cabinets when I took this drug. After years of struggling to pay attention, suddenly, all I had to do to focus was decide to focus, and I found creative decision-making and managing a lot of information, if not easy, tasks I could manage if I worked at them.
The supply of Adderall is ultimately controlled by the Drug Enforcement Administration, which allocates amphetamine quotas to pharmaceutical companies. But the DEA insists it is not responsible for the shortage:
"We've given them quota sufficient to meet the needs and then it's up to them how they manufacture their product," said Gary Boggs, a supervisory special agent for the Office of Diversion for the federal Drug Enforcement Agency.
Company business decisions surrounding competition, marketing — and profit margins — are behind many of the troubles that patients have encountered, Boggs added. Manufacturers might make more of an expensive brand-name drug and not enough of a generic version. Or they may distribute too much product in one place, causing a shortage somewhere else.
"This isn't just a clean there is either product or not product," Boggs said. "There's a whole lot of different dynamics in here."
Meanwhile, manufacturers of generic Adderall, a.k.a. "amphetamine mixed salts immediate-release tablets," cite "increase in demand" (Sandoz and CorePharma) or "API [active pharmaceutical ingredient] supply issues" (Teva) as explanations for the shortage. Those are two ways of saying the same thing: Demand exceeds supply—i.e., there's a shortage. Why is there a shortage? Because there's a shortage! Duh.
Notwithstanding the DEA's denials, it should be obvious that if the government did not insist on getting between people and the drugs they want, supply would meet demand, as it tends to do in a free market. Trying to figure out why there is a shortage of a government-controlled substance is like trying to figure out why the Soviet Union did not have enough windshield wiper blades to replace ones that wore out. At some point, a central planner miscalculated, as they tend to do. According to MSNBC, manufacturers "say that as they receive their new DEA allocations in the new year, the shortages may subside."
For the sake of Alkon and all the others whose lives have been senselessly disrupted by the government's pharmacological edicts, I hope that's true. But this episode highlights the arbitrariness of the distinctions at the root of the war on drugs. A recent story in the Tampa Bay Times suggests a few explanations for the Adderall shortage:
Doctors blame the shortage of generic Adderall (which is also known as mixed amphetamine salts) on the fact that more kids and adults are being diagnosed with ADHD. Estimates for ADHD patients range from 5 million to 15 million, with the number increasing about 5 percent a year.
But others say it's also because more people than ever are abusing the drug, including students who use it to stay awake and cram for tests.
Another category of abuse: If an addict can't get oxycodone, Adderall is viewed by some as a reasonable alternative, said Dan Fucarino, owner of Carrollwood Pharmacy.
Whether or not people really do view a stimulant like amphetamine/dextroamphetamine as interchangeable with a narcotic like oxycodone, Adderall used for unapproved purposes comes mainly from legitimate prescriptions. The implication is that doctors are overdiagnosing and/or overprescribing, a pretty tricky call to make when dealing with an objectively unverifiable psychiatric condition like attention deficit hyperactivity disorder. Notice that the Tampa Bay Times, hewing to prohibitionist orthodoxy, describes using Adderall to study for an exam as "abusing the drug"—unless, of course, the student has jumped through the requisite hoops, saying the right things to qualify for a diagnosis and earn the magical slip of paper that transforms abuse into medicine. Why empower doctors to decide who "really" needs Adderall when adults should be able to decide that for themselves?