(Tuesday Hadden | Student Life)

The FDA declared a shortage of the ingredients used to produce Adderall on October 12, 2022. Since then, many people with attention deficit hyperactivity disorder (ADHD) who take stimulant medications have experienced difficulty accessing their prescriptions. 

Over a year after the shortage began, members of the Washington University community with ADHD have seen improvements in their access to their medications. However, many still struggle to consistently access their medication to the detriment of their academic performance and mental health.

The shortage of stimulant medications, which is often referred to as the Adderall shortage, refers to a class of drugs used to treat ADHD and includes Vyvanse, Ritalin, Concerta, and other variations of Adderall. 

These medications are in shortage for a variety of reasons, including the fact that an increasing number of people have been diagnosed with ADHD after the Covid pandemic due to school closures and reductions in physical and social activity, according to a study from the National Institute of Health. 

The Drug Enforcement Administration (DEA) highly regulates the ingredients in ADHD medications, due to their high potential for abuse, which has exacerbated the national manufacturing delays of stimulants.

First-year Tally Feingold said that she has taken ADHD medication for about a year, but that she was unable to access Adderall until this semester. She said that she wanted to be prescribed Adderall, in particular, because it worked well for members of her family, who also have ADHD, but her doctor couldn’t prescribe it to her because it wasn’t available.

As a result, she had to test out various medications, such as Ritalin and Vyvanse, which have similar but often distinguishable effects depending on the person. 

“I was put on nine or ten medications over the course of a year, and I was never prescribed Adderall,” Feingold said. “Eventually I switched psychiatrists and my new psychiatrist was able to find Adderall. From the second I took it, it’s been the only medication that has worked for me so far.” 

Feingold said that the process of testing medications was draining and would have been avoidable had Adderall been accessible. 

She said that even since she was prescribed Adderall, she hasn’t had consistent access to it. Most recently, she said that her psychiatrist wasn’t able to access her prescription in October 2023.

“I went about two weeks with no medication at all,” Feingold said. “It was at that point that I realized how big of a difference it makes in my life.”

She said that focusing on academics without stimulants required significantly more energy.

“I would come home from class and fall sound asleep and then my whole day would be wasted,” Feingold said. 

Feingold also said that not having access to her medication brought back feelings she had before she was diagnosed with ADHD. 

“I feel the same way I felt in high school,” Feingold said. “What’s wrong with me? Why can’t I just do my work? Even though I know what’s wrong with me now and I’m on medication, I just had that same feeling. Why can’t I just do it? It’s so frustrating not being able to just act like everybody else.” 

Physician Paul Glaser, professor of child and adolescent psychiatry at the WashU School of Medicine, treats young people with ADHD and specializes in substance use. He said that he has occasionally been unable to access his patients’ prescriptions, even in recent months.

“It’s been a roller coaster for the last six months,” Glaser said. “Some months I’ll get a lot of trouble with the shortage and then it’ll go away for a month and then come back. It’s very unpredictable.”

Chris Stone, Director of Disability Resources (DR), said that when the shortage began last year, he and other DR employees were concerned about students not being able to access their ADHD medication. 

“A year ago there was a lot of concern nationally about production,” Stone said. “Not saying that there may not still be concerns, but we’re not getting the same news from the CDC and other areas that we were then. Production has not been having the same issues that it was a year ago.”

Although production has improved availability of medication across the board, some WashU students continue to have inconsistent access to their prescription. 

Junior Thomas, who only goes by their last name, said that they take ADHD medication and have had inconsistent access to their prescription for the past year. When the shortages began in the spring, they said they struggled to get their Adderall. 

“I had to call like seventeen different pharmacies,” Thomas said. “I was calling every single CVS and Walgreens before I found [my prescription].”

Thomas said that they have since found their prescription at a lower dosage than they usually take because regulations are looser on medications with lower dosages, making them less scarce. However, they said that there have been months where they couldn’t access their medication at all. 

They added that having inconsistent access to stimulants, and too low of a dosage even when they do have access to it, has made focusing on academics significantly more difficult. They said they have to lean on coping mechanisms other than medication, such as drinking “so much more caffeine.”

Glaser said that his patients have suffered academically from just a few days without their prescription. He said that many people report that it is significantly harder to focus on tasks, socialize, and that daily life is more exhausting. 

“If you go a couple days without your medicine and you really need it, it can hurt your grades,” Glaser said. “I had a student who flunked an Organic Chemistry test because she ran out of medicine two days before. I felt really bad for her.”

Beyond making academics more difficult, community members shared that having inconsistent access to their ADHD medication worsens their mental health. 

Senior Ryan Ricks, who also takes stimulants to treat their ADHD, said that they have been unable to access their prescription for weeks at a time this semester. They said that the uncertainty of when they can access their medication is anxiety inducing. 

“I remember having one pill left and just freaking out,” Ricks said. “I was like, ‘oh my god, what am I going to do?’ I did two weeks worth of work because I had no idea how long I was going to go without my medication, so I got it all done then.”

Ricks said that they don’t think people understand how difficult withdrawals from ADHD medication are.

“I call it brain flaying,” Ricks said. 

Ricks said that if they stop taking their medication for even a few days, their ADHD symptoms present more aggressively than they would before they would before they had started taking stimulants.

Glaser explained that withdrawal symptoms are more aggressive than normal symptoms because a person’s brain chemistry acclimates to the effects of stimulants.

“Those first days [without medication] are really hard because there’s a rebound, which worsens ADHD for a day or two,” Glaser said. “Without the medicine you’re more scattered, maybe tired, forgetful, and definitely have concentration troubles.”

Thomas said that withdrawals from stimulants not only make their ADHD symptoms worse, but also affect their other mental health conditions. They said that they have anxiety and autism, which are highly comorbid with ADHD, meaning that people who have ADHD have these disorders at higher rates than the rest of the population. 

They said that taking too low a dosage not only worsens their ADHD symptoms, but also makes it more difficult to handle the symptoms of their anxiety and autism. 

An employee of Habif Health and Wellness Center, who was required by her employer to remain anonymous, said that she is prescribed stimulants to treat ADHD and has struggled to access her medication in recent months. 

Similar to Thomas, she has anxiety and depression. She said that the symptoms of all three disorders have been exacerbated by not taking stimulants for periods of time, and she has relied on coping strategies to mitigate the symptoms of her ADHD to focus on her job and school. 

“I’ve tried using noise canceling headphones, but that only does so much,” she said. “I need a break every twenty five minutes in order for my brain to focus. I’ve also just been consulting my therapist more.”

Not only is the shortage affecting people’s academics and mental health, but Ricks said that they have also been burdened financially. 

“Adderall usually runs at about thirty five or forty dollars for me,” Ricks said. “At some points it was about a hundred and fifty dollars.”

The shortage has also driven some people to buy their prescription from illegal sources, an issue that has been flagged by the FDA.

Feingold said that she has never considered seeking out ADHD medication from illegal sources, but she said that she is worried that peers who can’t access their ADHD medications might do so. 

She said that people have approached her asking to buy her Adderall but she doesn’t sell it. 

“Kids getting desperate and having to resort to that makes me nervous,” Feingold said. 

Glaser said that he has seen people seek out stimulants from illegal sources, such as online vendors or from other people who are not medical professionals. He warns students who can’t access their prescription not to resort to these options. 

“You don’t know if what you’re buying is what you’re really getting,” Glaser said. “There have been people who have had really bad outcomes because they got laced…and they end up either having a really bad trip or dying.”

Students interviewed for this article said that they have generally not consulted Disability Resources for help accessing their ADHD medications or for other disability accommodations. 

Ricks said they thought about working with Disability Resources, but that they were dissuaded because of the amount of documentation they require to grant accommodations.

Glaser said that he believes WashU Disability Resources and Habif do a generally good job of advocating for students and providing them necessary resources. However, he shared Ricks’ sentiment that the process of receiving accommodations poses a barrier to students. 

“The only barrier is that some colleges require psychological testing for ADHD,” Glaser said. “That can be very expensive and not covered by the basic insurance plans that colleges have.” 

Ricks said that WashU’s requirement of psychiatric testing has dissuaded them from seeking out help from Disability Resources.

“I literally have a psychiatrist who will tell you right here right now that I have ADHD,” Ricks said. “What more do you need from me?”

Although these students did not seek help from Disability Resources, Director of Disability Resources Chris Stone said that some students with ADHD have done so and have largely seen success in accessing their prescription. He also said that Disability Resources prefers to help students on an individual basis because there is not a one-size-fits-all solution for students struggling with the shortage.

“There are a lot of avenues to get medications,” Stone said. “It just may not be the pharmacy or the resource that the person has used previously. So sometimes it’s more about exploring where am I able to get this?” 

Stone encourages students struggling to access their medication to visit Disability Resources to seek help navigating the process. 

According to Glaser, the future of the shortages are difficult to predict. Students are hopeful that it will end soon, but they remain anxious about their access to stimulants. 

Ricks said that they have had more consistent access to their prescription this semester, but that not knowing when they could lose access remains a looming fear for them. 

“I get anxious every time it’s near time to refill my prescription,” Ricks said. “But I think it should be ok. My psychiatrist thinks that it’s stopping and I’m hoping that it will because I really don’t want to deal with this again.”