A crisis in prescribing medications for ADHD and ADD is about to get a lot worse.
We’ve reported before about how people are having a hard time getting Adderall, Vyvanse, Concerta and similar medications for Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder. The reasons cited by earlier reporting included increased diagnoses and prescriptions for the medications, supply-chain problems, government regulation and other factors.
Now there’s a new problem: A telehealth company that blossomed early in the pandemic, making Adderall and similar prescriptions, was shut down last week. (Look at the end of this post for our “What you can do.”)
“A major telehealth company was accused of selling millions of Adderall pills without securely confirming an ADHD diagnosis, federal prosecutors announced Thursday,” USA Today reported. “Done Global Inc. sold more than 40 million pills of Adderall and other medicine since the start of the COVID-19 pandemic, according to a federal indictment charging the company’s founding CEO and clinical president, who were arrested Thursday in California.
“The company was struggling to make money until the pandemic hit, court records said. At that point it began taking advantage of the crisis by hastily subscribing patients to monthly auto-refills of medication after brief telehealth calls without conducting a proper assessment for ADHD or allowing follow-up visits, according to court documents.”
‘Exploited the pandemic’
“As alleged, these defendants exploited the COVID-19 pandemic to develop and carry out a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose,” said Attorney General Merrick Garland. “Those seeking to profit from addiction by illegally distributing controlled substances over the internet should know that they cannot hide their crimes and that the Justice Department will hold them accountable.”
Done paid doctors and nurse practitioners to do fast-track telehealth diagnoses and prescriptions, the indictment said, without examining patients or establishing a relationship.
This development certainly means that thousands of people who relied on Done for prescriptions will be looking for different ways to get their medication, putting stress on an already-stressed market.
The Centers for Disease Control issued a statement warning of the risk of injury and overdose because of the Done indictment.
Since 2010, the rates of ADHD have tripled overall, according to a study by the medical-records software company Epic.
Shortages started in 2022
The initial Adderall shortage began in 2022, partly because of demand and partly because of manufacturing. “Prescriptions for Adderall, a stimulant that is approved to treat ADHD, rose more than 30 percent over the past five years and accelerated during the pandemic, according to data reviewed by The Washington Post,” The Post wrote. Telemedicine during the pandemic drove demand, making it easier for patients to get prescriptions without actually seeing a doctor. Nearly 40 percent of all prescriptions for stimulants last year came via telemedicine, The Post reported.
Getting Adderall and similar medications has been challenging for some time. We posted this piece in 2021 by a pharmacy technician who has ADHD and wanted to make a handbook for people to make sure they get their ADHD medications. Since we posted this, the problem has gotten a lot worse.
On top of increased demand, and some supply-chain and labor shortage issues at manufacturers affecting some production lines, a secret 2021 settlement in an opioid case with three top U.S. drug distributors kicked in to make more limits on medications like Adderall and other controlled substances.
“In July, limits went into effect that flag and sometimes block pharmacies’ orders of controlled substances such as Adderall and Xanax when they exceed a certain threshold,” Ike Swetlitz writes over at Benefits Pro. “The requirement stems from a 2021 settlement with the US’s three largest drug distributors — AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp. But pharmacists said it curtails their ability to fill prescriptions for many different types of controlled substances — not just opioids. Independent pharmacists said the rules force them come up with creative workarounds. Sometimes, they must send patients on frustrating journeys to find pharmacies that haven’t yet exceeded their caps in order to buy prescribed medicines.”
That, plus lax enforcement, created the conditions for Done.
Telehealth prescribing exploded during the pandemic. While many millions of people benefited, by being able to get prescriptions without friction and without physically visiting their doctors, there were also widespread criticisms of such companies as Cerebral, which came under heavy criticism and is now under federal investigation for prescribing medications online. Patients said Cerebral had mishandled their cases, and the president of the company was removed a year ago.
What you can do
As always, we do not give medical advice. Here are some thoughts.
Contact your doctor and see if there’s a solution near to hand. Perhaps another medication would be helpful?
Maybe you usually use a 5 mg tablet, but can’t find it. Can you find 10 mg and buy a pill-splitter? Is there an extended release version that might work for you?
Contact pharmacies beyond your standard pharmacy. Some may have more supplies than others.
One person said she found a hospital pharmacy that was able to help her. Another said that while the big chains like CVS and Walgreen’s were not helpful, a smaller family pharmacy was able to help.
Earlier in the crisis, we noted that people were looking for substitutes outside of the legal supply chain, which can be very dangerous. Experts note that fentanyl is showing up in the illicit stimulant supply in the U.S., including in fake Adderall. An amount smaller than a grain of sand can easily kill a person. Anyone who actually takes that route should consider purchasing fentanyl test strips and testing their drug before ingesting it.
Reddit has a page with lots of advice titled “How to outrun the stimulant medication shortage.” Again, we do not give medical advice, but you should know: they have observations like this: “Use local independent pharmacies if you can, because they often don’t have the same stock issues or the same patient load as mainstream retail pharmacies.” or “Outpatient hospital pharmacies or hospital-linked pharmacies may not be as affected by shortages as normal retail pharmacies, so it may be worth trying them. Make sure to look for one that also serves as the inpatient pharmacy for a hospital (usually also serves as the central pharmacy) or serves as that hospital’s mail-order pharmacy. You should also know that these pharmacies often process unusual amounts of medication for hospital inpatients, so if you use them, you will often get partial fills with a weird number of pills like 43 or 18.” or “With CVS Caremark you can call them (at the phone tree, say “override”) and you can ask for a “drug shortage override.” Many states have an order where they have to cover weird drugs and brand names due to the shortage.” or “Be careful upping your dose if you have bipolar disorder, as it may increase the risk of mania.” Also there is a listing of obscure medications, both amphetamines and methylphenidates. Thoughts about updosing and off-label stimulants are included. We do not give medical advice.
Some people trying to get through to a drugstore on their automated phone-tree line have begun to choose the option “if you are a prescriber” because it’s impossible to get through on the other phone-tree option for a patient.
Reddit’s subreddit, r/ADHD, has information about this and other matters. They say: “We’re an inclusive, disability-oriented peer support group for people with ADHD with an emphasis on science-backed information.” Their megathread about drug shortage issues has many resources.
There are also other Reddit resources like the subreddit for ADHD women, r/ADHDwomen. As in anything else, peer-to-peer health information can be extremely valuable — and also, Dr. Internet can be completely wrong. Do your homework; talk with a professional.
Our page on how to save on prescriptions may have some useful advice.
Is an authorized generic drug a possibility? “The term ‘authorized generic’ drug is most commonly used to describe an approved brand name drug that is marketed without the brand name on its label,” the Food and Drug Administration wrote on its site. “Other than the fact that it does not have the brand name on its label, it is the exact same drug product as the branded product. An authorized generic may be marketed by the brand name drug company, or another company with the brand company’s permission. In some cases, even though it is the same as the brand name product, a company may choose to sell the authorized generic at a lower cost than the brand name drug. Here’s the FDA list of authorized generic drugs.
