You may have heard back in October of 2022 that there was a shortage of the ADHD medication Adderall.

But that shortage is ongoing, all the way in early 2024 as we’re posting this video And it’s been a tough year for the millions of people who take this kind of medicine. Yeah, no kidding!

Oh, hello! It’s Jessica McCabe, from How To ADHD! Hi there, Hank!

Hello Brains Today we thought we’d hand over this particular topic to someone who specializes in it. So Jessica is gonna explain the real reasons behind this medication shortage. Take it away, Jessica!

Let’s do it! Over the last year, the Adderall shortage has raised questions about how tightly regulated stimulant medications are, and whether those regulations work to prevent drug misuse. But the thing is, the reason these pharmaceuticals are hard to find right now isn’t just regulations, and certainly not misuse.

There’s another perfectly good reason this is happening. So let’s get into the real story behind the Adderall shortage. [Intro music] When people talk about the shortage of stimulant medications for ADHD in the U. S., they often point a finger at Food And Drug Administration quotas first The FDA limits the maximum amount of these drugs each manufacturer is allowed to make, so if we don’t have enough, that seems like a logical place for the problem to start.

But according to the FDA, the manufacturers aren’t even hitting those numbers, and are currently only making about 70% of what they could be. So while the quotas may have made pharmaceutical companies less nimble in reacting to shortages, they’re not the only cause. Why do quotas even exist?

Primarily, due to concerns about the potential for misuse. But despite how often stimulant misuse ends up in the news, it’s a lot more complicated than you might think. To start, let’s get into how Adderall and similar medicines work.

ADHD is believed to involve two neurotransmitters: dopamine and norepinephrine. Neurotransmitter systems can’t really be simplified to “this neurotransmitter does this one thing”. They’re more like multi-tools than a key and a lock.

But we do know there are a lot of dopamine receptors in the areas of the brain involved in reward, learning, memory, and movement. And norepinephrine can impact working memory. All of those systems are affected by ADHD.

Stimulants like Adderall increase the amount of dopamine and norepinephrine available for neurons by slowing down how quickly the neurons suck them up. In people with ADHD, the right type and dose of stimulants can improve focus and attention and reduce hyperactivity and impulsivity. In people without ADHD, who don't need this additional dopamine and norepinephrine the effect is… different.

Stimulants can make them feel euphoric, energetic, and confident that they’re crushing it, smarts-wise. Combine that with a drug that impacts dopamine and the reward system, and yeah, Adderall definitely has the potential to be addictive and abused by people without an associated condition. So as demand for Adderall increases, the next question is, how much of that demand is coming from misuse?

Estimates of stimulant misuse vary widely, but studies suggest about 3.5 million people in the U. S., have misused stimulant prescriptions. And around 1.5 million have met the criteria for prescription stimulant disorder in the last year.

So it is a problem that exists, especially among college students. One meta-analysis found that up to 17% of college students misuse stimulants at some point during their academic career. Most of the students that report misusing stimulants use them to do better in school, concentrate better, study longer, and improve their skills.

But studies show that college students who misuse stimulants tend to spend less time studying than their peers, and overall have either similar or lower GPAs. And importantly, we haven’t seen a rise in misuse rates as the number of prescriptions has gone up. In 2019, 5.8% of young adults reported prescription stimulant misuse in the last year.

In 2021, that dropped to 3.7%. That seems to suggest that newly diagnosed people are taking their drugs themselves, not selling them to others for misuse. So if the quotas aren’t the primary problem, and misuse isn’t going up, what is leading to this debilitating shortage of meds?

It turns out, there has been a major uptick in legitimate ADHD diagnoses in the last several years. And the main demographic getting these diagnoses is a group of people who often got overlooked in the past: Adults. For one thing, as we learn more about ADHD the diagnostic criteria was revised in a way that it became broader in 2013, which meant more people qualified for a diagnosis.

On top of that, more adults began seeking out diagnoses for something they likely struggled with for their whole lives. Even though the traditional view was that people grew out of ADHD as they aged out of childhood, up to 90% of people diagnosed with ADHD as kids continue to show symptoms in adulthood. And one study showed that 75% of people with ADHD received their diagnosis as adults.

It’s also important to consider that there are major systemic problems with who gets diagnosed with ADHD as a child in the first place. The diagnosis rate for males versus females in childhood is 3 to 1. But in adults, it’s closer to 1 to 1.

Which suggests that there are a whole lot of young girls who aren’t being diagnosed when they should be. And as you might expect, the increase in ADHD diagnoses has also led to an increase In prescriptions meant to treat this condition Prescriptions for stimulant meds jumped 10% during the COVID pandemic, between 2020 and 2021 and have nearly doubled overall since 2011. Part of this may be due to more awareness as people recognize themselves in conversations about ADHD on social media.

The pandemic itself also seems to have played a role. Telehealth made it more convenient to see a doctor about these issues. So in a weird way, COVID may have provided a sort of breakthrough in getting people access to treatment— only for this shortage to take it away again.

Regulations are a real factor in the current shortage of ADHD medications. But a bigger one is the rise in legitimate diagnoses. The system wasn't prepared to handle the influx, and we're seeing growing pains as it struggles to catch up with the real prevalence of this condition.

Whatever solutions governments and pharma companies pursue, they should keep that in mind. Unfortunately, many of the policies targeted at avoiding misuse make it disproportionately harder to obtain medication for those who actually need them. As the Adderall shortage continues to unfold, it’s worth making sure that the quest to keep stimulants out of the hands of people who don’t need them isn’t coming at the expense of the people who do.

Thank you Jessica for getting into all the nitty-gritty here with us. You should definitely check out her channel How To ADHD for more of her content which is very awesome - I’ve been following it for years the link down below. I also want to give a big thank-you to our patrons We only get to do fun, out-of-the-box videos like this thanks to their support, and it means a lot.

So, to all of them. Thank you for supporting And to everybody else thank you for watching. [ OUTRO ]