Right before the holiday break, the Biden Administration attempted to relieve what it called a nationwide drug shortage through a raft of executive orders that was mostly paperwork and monitoring requirements. Most of the administration’s actions are aimed at “essential medicines,” and few will do anything to counter the 15-month shortage of attention-deficit/hyperactivity disorder (ADHD) medications, which has affected millions of Americans. Let’s dive into the reasons behind this shortage and potential solutions below.

ADHD (formerly known as attention deficit disorder) is a medical disorder that causes issues with focusing attention, hyperactivity, impulse control, mood swings, and general executive dysfunction in both children and adults. ADHD is treated through a variety of methods, including behavioral therapy and medications such as Adderall, Vyvanse, and Ritalin. It will not surprise readers that the COVID-19 pandemic was an extremely difficult time for those with ADHD, with both remote school and work drastically exacerbating executive dysfunction issues. As people’s symptoms worsened, and more Americans received ADHD diagnoses, prescriptions of ADHD medications skyrocketed 27 percent between 2019 and 2022. In October 2022, after a labor crunch at Teva Pharmaceutical Industries (the manufacturer of Adderall), the Food and Drug Administration announced a shortage of Adderall, which then turned into a shortage of other ADHD medications as patients tried to find something else to treat their ADHD.

The issue is two-fold: pandemic-related supply chain problems that continue in varying degrees today and Drug Enforcement Agency (DEA) regulations that simultaneously helped boost demand and access to medicines during the pandemic while restricting their supply. Adderall, Vyvanse, Ritalin, and other ADHD medicines are Schedule II drugs, meaning they are treated similar to Oxycodone and fentanyl in terms of strict controls around their production and sale. During the pandemic, the DEA allowed telehealth prescribing of ADHD medications, creating greater access and increased demand. Yet the DEA has not increased its limits on production, which it bases off past production levels and future sales commitments. The DEA claimed in a November 2023 letter that quotas have not been increased because manufacturers failed to produce the fully allotted amount of ADHD medications in 2022, and that trends for 2023 have been similar. A November 2023 letter sent to the DEA from the Association for Accessible Medicines, an industry group representing generic drugmakers, stated that DEA restrictions on obtaining raw material for generic Vyvanse have caused serious production limitations. Essentially, we have a chicken-egg problem: New generic manufacturers have no past production history and are hesitant to make many sales commitments before the DEA provides reasonable quotas – which the DEA won’t provide without production history or sales commitments. Brand manufacturers are in a similar pickle: Pandemic supply-chain issues caused production to drop, so quotas haven’t changed to meet new demand, and new sales commitments can’t be made without increased quotas.

As a result, many ADHD patients have had to resort to scouring pharmacies looking for available medicines – a rather difficult task when executive dysfunction is one of the most notorious symptoms of ADHD. This isn’t a small problem; executive dysfunction can cause students to fall behind in school (as if pandemic learning loss wasn’t already bad enough) and adults to underperform and even be fired from jobs. As we’ve seen with chronic pain patients during the opioid crackdowns, patients will go to great lengths, which could even include illicit means, to acquire medication they need to function and make a living. With 40 percent of all fake pills seized by the DEA containing fentanyl and increasing reports of overdoses and deaths from counterfeit ADHD meds laced with the dangerous chemical compound, we could be looking at another potential avenue for America’s opioid crisis to expand.

How do we prevent this? Congress can pressure the DEA to increase quotas, better factor in increased demand when determining those quotas, and ensure those quotas don’t punish manufacturers facing supply issues. Congress can also work with manufacturers to strengthen and improve supply chains in the long term. Inaction will leave millions of ADHD patients high and dry, struggling to function in a world that demands their constant attention to live and work.