On October 12th, the US Food and Drug Administration declared a shortage of amphetamine mixed salts, commonly referred to by the brand name Adderall, after manufacturing delays at one of the largest providers, Teva Pharmaceuticals. Adderall is an FDA-approved treatment for attention deficit hyperactivity disorder and narcolepsy and is a crucial tool to help patients maintain focus and stability throughout the day. However, the drug also has high addiction risk, especially for high school and college students due to its nature as a stimulant drug. In 2021, there were over 40 million prescriptions for Adderall. This growing demand contributes to the current shortage of Adderall and follows a recent controversy in May where the telehealth startups Done Health and Cerebral were blocked from filling Adderall prescriptions. These startups were restricted due to concerns that they were potentially overprescribing the drug and had minimal screening requirements in place to properly diagnose patients. These telehealth companies have since transitioned away from remotely prescribing controlled substances, but the question remains on how to properly regulate these types of medications while still ensuring that those who need the medication can receive it.
Telehealth companies have filled the demand for more accessible healthcare, especially during the pandemic. Patients can avoid transportation costs, wait times, and prevent the spread of infectious diseases while still receiving their required treatment. Mental health services are in high demand, with a majority of patients preferring remote mental health counseling over in-person. Thus, the higher demand for stimulant prescriptions corresponds to a higher demand for mental health services overall.
While telehealth companies have reignited the conversation regarding the overprescription of stimulants and overdiagnosis of ADHD in the United States, this debate is far from new. Currently, the US contributes over 80% of the worldwide demand for ADHD medication, and 42% of those diagnosed with ADHD are American. This implies that ADHD is both overdiagnosed and overtreated with medication, especially when some telehealth companies only require one online consultation to diagnose patients. However, even if patients are later told that they were misdiagnosed or mistreated, the use of stimulant medication cannot be easily stopped. Patients can develop a tolerance to amphetamines and experience withdrawal that lasts up to 3 weeks.
Ultimately, Adderall misuse should not be disregarded, but those already using stimulants should have access to other mental health resources to prevent possible misuse and addiction. While telehealth companies may be increasing the strain on stimulant manufacturers, their faults in overprescription are a symptom of an existing traditional system that struggles to provide adequate mental health counseling to those in need. While issues with telemedicine care have emerged, telehealth will likely maintain its popularity, as it provides more convenient mental health services.
*For more resources on substance abuse treatment and support, please visit SAMHSA’s National Helpline.