A surge in Adderall use

Adderall and other stimulants are used to treat ADHD and narcolepsy. Because stimulants can be addictive and abused, they are considered controlled substances, and the federal government limits how they can be produced, prescribed, and distributed.

During the COVID-19 pandemic, telehealth became more popular and led to a significant increase in Adderall prescriptions. In 2023, there were 45 million prescriptions for Adderall, compared to 35.5 million in 2019.

In 2022, several large U.S. pharmacies, including Walmart, CVS Health, and Walgreens Boots Alliance, reported delaying or blocking prescriptions of Adderall and other stimulants due to concerns of overprescribing from telehealth start-ups.

An investigation from Bloomberg News also found that the telehealth company Cerebral was inappropriately pushing prescriptions for Adderall. Shortly after, the company's clinicians stopped prescribing controlled substances, and it faced federal investigations. So far, Cerebral has settled with multiple state and federal agencies and continues to cooperate with the Department of Justice.

According to David Goodman, a psychiatrist and assistant professor at the Johns Hopkins University School of Medicine, people who legitimately need prescription stimulants typically don't get addicted to them, but there are also people getting these drugs who don't actually need them.

"The crisis, if you will, is not in the prescription of the medication," Goodman said. "The crisis is in the accuracy of the diagnosis." Currently, there are no standard guidelines for diagnosing and treating ADHD in adults, although specialists have been working on developing specific standards for years.

The high demand for Adderall and other stimulants has also impacted supplies of the drugs. Many prescription stimulants, including generic Adderall, Concerta, and Vyvanse, have all been facing shortages since 2022.

According to drugmakers, some of the current shortages may be partly due to new manufacturing limits set by the U.S. Drug Enforcement Agency (DEA). Last August, DEA issued quota changes for controlled substances, moving from annual amounts to quarterly amounts and reducing the amount of medication that a manufacturer is required to have in its inventory.

Currently, DEA and HHS are working to set up a "control tower" to ensure that manufacturers can buy enough materials to produce drugs that are in short supply.    

Amid the ongoing shortages, Matthew Strait, deputy assistant administrator in DEA's diversion control division, said people who are looking for stimulants should avoid buying them online. "We see fake pills that look like Adderall that are being sold on the open net and the dark net," he said. Instead of Adderall, these drugs may be fentanyl or methamphetamine.

Could Adderall abuse lead to another drug crisis?

According to Strait, the current situation with stimulants is comparable to the beginning of the opioid crisis.

The health concern that originally drove opioid use was the "fundamental belief" that pain is undertreated, Strait said. Now, with stimulants, a "mental health crisis" stemming from the pandemic could be spurring their use.

In addition, Strait noted that both opioids and stimulants have been exploited by unscrupulous people online. Ads on sites like TikTok promote stimulants, and telehealth companies "facilitate that prescribing function after short telemedicine encounters," he said.

The United States is also seeing an increase in the number of drugmakers selling stimulants, much like more drugmakers began to sell opioids during the start of the opioid epidemic. Increased competition for opioids was "a hallmark of the epidemic," Strait said.

"I'm not trying to be a doomsday-er here," he said, but "… it makes me feel like we're at the precipice of our next drug crisis in the United States." (Swetlitz, Bloomberg, 4/19; Morrison, Daily Mail, 4/19)

The lack of standardized, evidence-based practice in behavioral health care particularly impacts the treatment of substance use disorders (SUD). The lack of care standardization can perpetuate disparities in who receives quality care and who does not. Learn how Shatterproof fostered industry consensus to promote consistent and accountable substance use treatment.