The company has stopped prescribing Adderall to new patients. For months, those with ADHD struggle to get their medications filled. Federal regulators claim that the aggressive marketing of telehealth startups has exacerbated the shortage. Rolfe Winkler of the WSJ, who has investigated two companies, explains how an impending rule could affect the deficit.
a person under the Biden plan
Startups make it easier to get ADHD drugs. This caused some workers to be anxious.
An online transcription service prepared this transcription. This version is not final and could be updated.
Kate Linebaugh, do you remember your first time taking it?
Matt Lindberg: I do. I do. I have focused, I believe, on cleaning out my closet that day.
Kate Linebaugh, Has cleaning up your closet been on your mind for some time now?
Matt Lindberg: Oh, you can bet. Yeah.
Kate Linebaugh: Matt Lindberg, 27 years old. Matt Lindberg lives outside Madison, Wisconsin, with his wife and their dog and takes Adderall for his ADHD.
Matt Lindberg: Adderall helps me function. It helps me focus, stay organized, and complete each task. I struggle to do that when I am not taking Adderall.
Kate Linebaugh Kate Linebaugh, Matt could not obtain his medication for a couple of days last week. He could not find a store that sold Adderall, and Matt was not the only one.
Speaker 1: We first reported the Adderall shortage last fall. It isn’t good right now. The situation is at a fever pitch.
I’m not on Adderall. I’m not able to focus and not paying attention. I can’t sit still, and fidgeting is a constant. I must go four or five days a month without medication because I cannot find my medicine. It isn’t perfect.
Kate Linebaugh Kate Linebaugh, Federal regulators claim that the Adderall shortage has been exacerbated by an increase in demand driven by telehealth startup companies and their aggressive marketing. The Journal is our show on money, power, and business. Kate Linebaugh. Kate Linebaugh. What’s the story behind the Adderall scarcity? Adderall improves focus for people with ADHD by increasing brain chemicals such as dopamine. The Drug Enforcement Administration regulates it because of its amphetamine content and the potential for addiction and abuse.
Kate Linebaugh, that’s Rolfe Winkler, our colleague.
Rolfe Winkler: There are a lot of people who chase those prescriptions. The DEA regulates this because of it. Part of their regulation is a quote for the total amount of drugs that can be produced. There is a fixed amount.
Kate Linebaugh Kate Linebaugh says the DEA limits the amount of Adderall produced yearly. A 2008 law known as the Ryan Haight Act has also set strict guidelines for how Adderall can be prescribed. The law is named after a young boy who died of an overdose from a medication prescribed to him online. According to this law, controlled drugs like Adderall are only prescribed following an in-person consultation.
Rolfe: You have to go in person to your doctor. You can only renew your prescription for a few months, not just when you first get one. The drug must be continued every three months. This could be more pleasant for some people.
Kate Linebaugh Matt was diagnosed with ADHD in his sophomore year of high school. He said he tried several medications but could not find the right one. In college, Adderall was prescribed to him. Was it a difficult decision?
Matt Lindberg: Absolutely, yes. It wasn’t like I just heard about Adderall and wanted to take Adderall. My doctor and I discussed it in detail.
Kate Linebaugh, did you hesitate to take Adderall at first?
Matt Lindberg: I did. I was a college student then, and the hesitation stemmed primarily from stereotypes. Adderall is often associated with college students who use it to help them study. My only delay was that I wouldn’t say I liked how people viewed me.
Kate Linebaugh Kate Linebaugh says that Matt is going through a lot to get an Adderall prescription because of this abuse.
Matt Lindberg: Normally, I’d go to the city. I would go at least once a week. I attend ADHD therapy regularly. Every time I visit the doctor, I give them a urine sample to… Check that it is within what’s needed.
Kate Linebaugh Kate Linebaugh says that some people without prescriptions can obtain Adderall by avoiding the rules.
Georgia Maddox: I remember first taking just one pill from my brother. He knew I would try it, and that day would change my life.
Kate Linebaugh Georgia Maddox, 24 years old, lives in Seattle. She told Rolfe she began abusing Adderall several years ago and that it was used to suppress her appetite. She has struggled with eating disorders since she was 17.
Rolfe Winkler: What did you feel when you took Adderall?
Georgia Maddox: “I felt like a Superwoman or a Heroine.” It was only a change. I could do anything. Not only could I do it all, but I was able to do it perfectly. My brain felt great because I didn’t need to eat. It’s difficult to admit, but the lack of appetite I experienced from Adderall was a huge motivator.
Kate Linebaugh, Georgia: Georgia claims she convinced a doctor she had ADHD. She was prescribed Adderall. However, she admits that the in-person consultations were nerve-wracking for her because she worried about being seen to lose weight and getting taken off of the drug. In 2020, pandemics changed the rules for prescribing Adderall. Congress passed the Ryan Haight Act, and the DEA decided controlled substances such as Adderall could be specified online. This meant Georgia could avoid facing the scrutiny of in-person appointments. She discovered that she could now get Adderall through a different source.
Georgia Maddox: It was through Instagram ads that I found it. Somehow, I kept getting ads for online ADHD treatments. It was like someone was holding a donut in front of my face that I wanted to grab. It was so trying.
Speaker 2: I’ll show you how to get ADHD treatment quickly. The three-step process of this company, Done, makes it easy. Take a 1-minute assessment to determine if Done will work for you. You can book an appointment the same day or the next day with one of their licensed ADHD clinical staff. They make it super easy…
Kate Linebaugh, tell me about Done. What is this company called?
Rolfe Winkler: Done is a company that jumped into this business, working with many nurse practitioners. They created the platform. They will advertise on social media. You’re directed to their website to fill out a few simple questions. Then, a nurse practitioner will diagnose ADHD, write you a script, and schedule a 30-minute appointment. You will be charged 80 dollars a month for them to continue writing you an Adderall prescription.
Kate Linebaugh, Done: The company says its questionnaires don’t replace comprehensive evaluations. The company claims practitioners will follow up with a further assessment and discussion. They also say the appointment length can vary.
Rolfe: What is the first-time experience like?
Yes. I answered about eight questions. I lose things a lot, but only sometimes. How often do you fail to complete a project? Quite often. In my mind, I answered those questions honestly. Looking back, I’m not sure I was. But I got a telehealth consultation with a physician.
Kate Linebaugh: January 2021.
Georgia made her first appointment. Georgia was given a prescription to take Ritalin, a different stimulant. Next month she will be prescribed Adderall.
Georgia Maddox: The whole appointment made me feel terrible. I knew that I had made a big mistake. It was incredible for my addict mind to be able to pick up Adderall the next day, and the appointment was only 10 minutes. But the sober part of me wondered how it could have happened. How did I get Adderall within 10 minutes?
Kate Linebaugh, Georgia, received Adderall in 2021 through Done. In August of that year, Georgia was using Adderall faster than was prescribed. She received a second prescription for the drug from Cerebral, another telehealth company. Both Cerebral & Done declined to comment about Georgia’s situation. Cerebral has said that it no longer prescribes controlled substances to its patients. Done has implemented procedures to reduce the risk of abuse.
You have no idea how different I was then. I made decisions I never would have made with a clear, sober mind and wanted Adderall. It was too easy.
Kate Linebaugh, last October, the FDA reported that Adderall was in shortage. Seven months after the FDA’s announcement, this shortage persists. Was telehealth a factor? This is coming. Adderall is in short supply.
That’s an excellent question. However, there isn’t a firm answer to it. Government regulators say that Adderall shortages are due to demand. Government regulators say that there are a lot more prescriptions written. This is true. In 2019, Adderall prescriptions grew by about 5% a year. This continued in 2020. In 2021, the number of drugs increased by 10%. They rose another 11% from October to November of last year. The market is booming.
Kate Linebaugh Kate Linebaugh, the government quotas are preventing supply from keeping up with demand. The DEA says that Adderall manufacturers have not used up their quotas over the last few years, so it does not need to increase the percentages. The DEA wrote to manufacturers, expressing concern about the rising demand.
The DEA is concern that many of the prescriptions being written are invalid. One doctor we interviewed for a story boasted about making $20,000 per month by renewing prescriptions at a rate of two per minute for 2,300 patients. Many of these people probably do have ADHD, but others may not. The DEA is worried that a subset of people is receiving this medication when the quota should go to those diagnose.
Kate Linebaugh, The DEA has also informed Adderall manufacturers of its concern that “aggressive advertising practices by companies including Telehealth providers could drive excessive prescriptions.” Federal investigators are looking into the prescribing practices of both Done and Cerebral. Done has said that it is aware of the possibility of abuse when obtaining prescriptions and has strict procedures to minimize this risk. The company claims to comply with all laws and regulations. Cerebral said that it is cooperating with the investigations.
The company has stopped prescribing Adderall to new patients. We made a series last year called Uncontrolled Substances about cerebral that showed how it grew its business through prescribing Adderall. Cerebral claims to have provided high-quality care for thousands of patients that would not otherwise be able to access it. The shortage is frustrating right now. Patients like Matt need Adderall. Matt says that filling the prescription for Adderall 30mg slow release has become more complex than just a simple trip to the pharmacist.
I had my first experience with out-of-stock medication about five months ago. I called many pharmacies around Madison to see if they could fill a prescription and was finally able to get my 30mg through the sixth or fifth pharmacy that I tried.
Kate Linebaugh Kate Linebaugh says that Matt has had to be creative every month to obtain his medication. He’s called several pharmacies and his doctor to find the right medicine.
My doctor suggested I switch to a 25-milligram and five-milligram release. The pharmacy only had 30 milligrams in stock, which is still the same as my usual dose.
Kate Linebaugh – A workaround
Matt Lindberg: A solution. That’s what it is. It’s something I don’t enjoy. This can be a real challenge for someone with ADHD. It just feels wrong. I need to call ahead to the pharmacy to ask, “Okay, do you have thirty milligrams?” No. What is 25 plus five? The answer was no.
Kate Linebaugh Kate Linebaugh, Matt’s Adderall, ran out last week because he answered no. What was that like?
I found it frustrating to do what I felt was… It’s as if I do everything correctly. I received the diagnosis. I have a diagnosis and was prescribe medication. It was frustrating to have gone through all that and run out of medicine.
Kate Linebaugh says that next week, on May 11, the pandemic-related public health emergency is ending. The rules requiring a doctor’s in-person visit to obtain Adderall will return to effect. However, the DEA requested a temporary delay. Could this help ease the Adderall supply?
In theory, making it harder to obtain the prescription may reduce the number of written drugs. This could bring up supply to meet demand.
Kate Linebaugh, right. It would also mean that some people currently taking Adderall won’t be able to continue receiving it.
Rolfe: It’s possible. That’s possible, yes. Some people may not seek treatment when needed, while others refuse because they do not have ADHD. They are just looking for pills. It’s not easy to answer.
It made me feel a bit guilty knowing that, in some way, I contributed to the Adderall shortage.
Kate Linebaugh, Georgia: Georgia claims she hasn’t used Adderall since 2021. She told Rolfe she went to a rehab center a few months after receiving the overlapping prescriptions. She claims to have also become addicted both to cocaine and alcohol.
What do you think about that time?
Georgia Maddox: I couldn’t see any way out at that time. I was unable to live without drugs. I now work in a psychiatric hospital and get to help others who are in the same situation as myself. Am so happy and content now that I don’t use drugs. I also do good for others. I have been clean from alcohol and other substances for about a year.
Rolfe: Do you have any long-term side effects from Adderall?
Georgia Maddox: Yes. I must be conscious of it all the time. Adderall has incredible power and is helpful to so many people. Adderall? I don’t think we realize how addictive Adderall can be. Chemically, it is very similar to meth and yet has become so common. While trying to balance the need to remove barriers for those with ADHD to get Adderall and protect those addicted is a difficult task. It’s a tricky balance.
Kate Linebaugh Kate Linebaugh Matt was able to fill his Adderall prescription. Do you worry about running out of Adderall again?
Matt Lindberg: Yeah. It’s a constant worry, and I now have a calendar reminder. I will move the date to two weeks before my medication runs out. Want to start with a good head. I am worry about this situation continuing and affecting my ability to obtain the prescription.
Kate Linebaugh: Do you feel other emotions?
I get angry when I think, as I mentioned earlier, that I have done everything right. What else must I do to get the treatment I need? That makes me angry.
Kate Linebaugh, do you feel helpless?
Matt Lindberg: Yeah. Oh, absolutely. It’s an excellent word. I’m going to give up and hope for the best.
Kate Linebaugh: Today, Friday, May 5, that’s it. Gimlet produces the Journal in collaboration with The Wall Street Journal. Kate Linebaugh, Jade Abdul-Malik, and Annie Baxter are the creators of The Journal. Griffin Tanner, Nathan Singapore, and Peter Leonard are our engineers. So Wiley is the composer of our theme song. This week, we have music from Katherine Anderson and Peter Leonard. We also have Nathan Singapore’s Blue Dot Sessions and Emma Munger’s Nathan Singapok. Nicole Pasulka, Najwa Jamal, and Nicole Pasulka fact check.