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Prescriptions for attention-deficit/hyperactivity disorder (ADHD) drugs spiked during the COVID-19 pandemic, particularly among young women, a new report from the Centers for Disease Control and Prevention (CDC) shows.
The spike is part of a growing trend in the use of these prescribed stimulants — more than 45 million prescriptions for Adderall alone were dispensed last year.
The U.S. Food and Drug Administration (FDA) last October announced an Adderall shortage that is still ongoing and has left millions of Americans scared and scrambling — switching medications, rationing doses because they can’t fill prescriptions or seeking replacement drugs on the black market.
Many young women have taken to TikTok to share their suspicions that as a result of the shortage, the formula is being watered down. The New York Times reported earlier this month that videos related to the phrase “adhd meds not working” have been viewed more than 15 million times on the social media platform.
The FDA and drugmakers blamed the shortage on growing demand for the drugs. The CDC links this increased demand to increased stress during the COVID-19 pandemic, changes in guidelines for ADHD diagnosis, “increase in awareness” and increased access to prescriptions through telehealth, driven by ads placed on TikTok that target young adults.
But shifting cultural dynamics among young adults may also be at play in increased demand.
Compact Magazine contributor Katherine Dee links increased Adderall use to its wide range of potential users, beyond those people diagnosed with ADHD.
Adderall is an amphetamine, which can be used simply for its stimulant effects. It also can be used as a performance-enhancing drug, an off-label antidepressant or an emotional anesthetic.
There is also “a subsection of the population being fixated on what’s been called ‘toxic positivity,’ an excessive preoccupation with maintaining optimism no matter the situation,” Dee said. Stimulants like Adderall can provide that feeling.
Others point to supply-side issues. Wired reported last summer that Teva Pharmaceutical Industries, a major producer of ADHD drugs, faced a worker shortage. But now several other manufacturers also are reporting supply issues.
On the FDA’s website, some manufacturers blame the shortage on “demand increase” or “shortage of active ingredient,” while others list no reason.
Dr. Yoram Unguru is a pediatric hematologist and oncologist with joint faculty appointments at the Herman and Walter Samuelson Children’s Hospital at Sinai Hospital of Baltimore and the Johns Hopkins Berman Institute of Bioethics. Unguru, who studies drug shortages, told CNN the pharmaceutical companies’ lack of transparency about the shortage “hinders solutions.”
Bloomberg reported Monday that supply also is affected by new secret rules limiting pharmacies’ ability to distribute controlled substances. These rules were an outcome of an opioid crisis-related settlement with major drug distributors AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp., which capped the amount of controlled substances the drugmakers could distribute to pharmacies.
The amount of the caps themselves are kept secret as part of the settlement agreement, in part to stop pharmacies from being able to game the system.
But many pharmacists report that as prescriptions for controlled substances rise, the rules limit their ability to fill legitimate prescriptions.
Prescription stimulant use on the rise
Between 2006 and 2016, prescription stimulant use more than doubled in the U.S. While they can be prescribed for conditions such as narcolepsy, prescription stimulants primarily are used to treat ADHD, a neurodevelopmental disorder that can cause inattention and hyperactivity.
The CDC study, published March 31 in the Morbidity and Mortality Weekly Report, analyzed insurance claim data to determine the number of stimulant prescriptions filled from 2016 to 2021 for people ages 5 to 64.
People purchasing drugs out-of-pocket or with health plans not provided by an employer were not included in the data.
The CDC found the pandemic jump in prescriptions came after several years of increases going back to 2016. The trend coincides with rising rates of ADHD diagnoses in adolescents, adults and women, the report said.
Overall, the report found the percentage of enrollees with one or more prescriptions for stimulants increased from 3.6% in 2016 to 4.1% in 2021.
But a look at particular demographics is more revealing. The number of females ages 15-44 and males ages 25-44 filling stimulant prescriptions increased by more than 10% from 2020 to 2021.
The numbers also rose nearly 20% among females in an even narrower age range, 20-24.
Historically, ADHD has been defined as a childhood disorder more common among boys, according to the study, but during the study period stimulant prescriptions dipped slightly among kids.
The medications tracked in the analysis were stimulants sold under the brands Dexedrine and Adderall, methamphetamine under the brand Desoxyn and methylphenidate, known as Ritalin.
Telehealth, TikTok and Adderall
The CDC’s report comes on the heels of a series of recent articles reporting similar numbers.
The Washington Post reported prescriptions for ADHD medications rose 19% on average between 2018 and 2022, and Adderall prescriptions in particular increased more than 30% over that time.
Healthcare analytics firm Trilliant Health similarly reported a 22% increase in prescription stimulants from 2019 to 2021, for people between the ages of 22 and 44, according to its analysis of insurance data.
Epic Research, a health analytics firm in Verona Wisconsin, reported that ADHD diagnoses of women ages 23-49 nearly doubled between 2020 and 2022.
Adderall gained particular popularity among adults who recognized their ADHD symptoms later in life, including those who self-diagnosed online, often using online tools created by telehealth providers.
Telemedicine exploded during the pandemic when people could not access regular doctor visits. A slew of mental health startups seized on the relaxed regulations and flooded social media, namely TikTok and Instagram, with advertisements encouraging young users with symptoms like being “spacey, forgetful or chatty” to seek ADHD treatment online.
The ads were successful and diagnoses shot up.
Telehealth providers like Cerebral — a startup whose valuation grew to $4.8 billion in 2021 — and Done were blasted for making it “scary easy” for young people to access the drugs.
The backlash, including investigations into the marketing practices of these providers by Bloomberg, The Wall Street Journal and the Drug Enforcement Administration (DEA) last year led some of them to scale back advertising, some pharmacy chains to stop filling prescriptions from some telehealth providers and some of them to stop prescribing those meds to new patients.
But Dee reported that they weren’t the only companies engaging in questionable practices. She investigated other telehealth providers, like Circle Medical that have received less media attention but continue to provide such prescription services and yet “offer only a thin veneer of legitimacy to their ADHD diagnoses.”
“The two providers just wanted to make sure I finished the survey,” Dee said. “Say ‘Yes’ the magic number of times, and you will get an Adderall prescription. Or, if you prefer and have the gumption to ask, a prescription for Vyvanse or Ritalin.”
These telehealth prescribers don’t just offer ADHD treatment to troubled young people. They also offer consultations for “gender-affirming” hormone therapy, anxiety and depression treatment and sleep studies, Dee wrote.
In the shortage, has the medication stopped working?
But it isn’t only pharmaceutical companies making ADHD meds content on social media. A large community of users discussing their various psychological or “neurodivergent” conditions has sprouted on social media.
Peer-reviewed research found that user-generated content about ADHD is one of the most popular health topics on TikTok.
Recently, a slew of people posting on TikTok that their Adderall was no longer working swept the social media platform.
According to the Times:
“Videos of people who claim that their medication is no longer effective have recently catapulted through TikTok. In one, someone clutches a prescription bottle, rattling the pills as she shakes her fist. ‘They’re giving us ‘fake’ Adderall during the shortage,’ the caption reads. ‘The adderall isn’t adderalling,’ another user claims in a video.”
Some psychologists reported their patients feel the medicine is less effective. Users are concerned the composition of the medication is changing. The FDA and pharmaceutical company Teva say nothing has changed.
Instead, the Times offered several other possible theories for the change people are experiencing: tolerance buildup; starting and stopping which many people have been forced to do when they couldn’t access drugs during the shortage; life disruptions such as other mental health conditions or changes in sleep; cognitive bias — hearing from others that their meds aren’t working and thinking the same is happening to them; and changing medications.
As the shortage drags on, many people have had to switch drugs altogether or switch to generics. While the drugs are meant to be the same, they have different components that people may respond to differently.