Adderall Shortage Led to More Alternative Stimulant Prescriptions for US Children
Researchers analyzed overall prescription stimulant dispensing trends among US children from 2017 to 2023.
Following the US Food and Drug Administration’s (FDA) October 2022 announcement of an Adderall shortage, the subsequent decrease in Adderall dispensing was offset by a rise in alternative stimulants dispensed to treat children with attention-deficit hyperactivity disorder (ADHD). Researchers believe that the initial Adderall shortage led parents to seek out alternative medications to treat their children’s ADHD, according to data published in Pediatrics.1
“ADHD is the most diagnosed neurobehavioral condition among US children, with a lifetime prevalence of 11.4%,” wrote authors of the study. “Prescription stimulants are the first-line treatment for ADHD in children when pharmacotherapy is required. Due to the prevalence of ADHD and the importance of stimulant therapy in its management, stimulants are the most commonly prescribed controlled substance to US children.”
Adderall is a mixture of immediate-release amphetamine salts commonly used to treat ADHD. | image credit: Colin Temple / stock.adobe.com
Study authors presented their hypotheses on what led to current trends in pediatric stimulant dispensing and the rationale behind patient choices when seeking a necessary drug that is under shortage. Indeed, they owed it to 2 specific events that significantly impacted stimulant dispensing. With the first event being the COVID-19 pandemic’s effect on children and their need to treat ADHD in the classroom, the second was Adderall—one of the most commonly prescribed stimulants—entering a shortage in October 2022.
Adderall is a mixture of immediate-release amphetamine salts commonly used to treat ADHD. In 2021, prior to it entering a shortage, a total of 41.4 million Adderall prescriptions were dispensed globally, showing a 10%-20% increase from the year before, according to authors of a study published in BioMed Central Psychiatry.2
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The steady increase in Adderall dispensing leading directly into the pandemic could be an indicator of why the drug entered a shortage soon after. And while researchers believe the shortage led to a decrease in Adderall dispensing for children with ADHD, they think patients seeking alternative stimulant options offset the overall decrease in dispensing. To test the hypotheses, researchers agreed to “evaluate changes in prescription stimulant dispensing to children aged 5 to 17 years associated with the COVID-19 pandemic” and the Adderall shortage.1
Using the IQVIA Longitudinal Prescription Database—which contains 92% of US retail pharmacy prescription data—researchers measured the full extent of immediate-release and extended-release stimulant dispensing for children 5 to 17 from January 2017 through December 2023. Within this study’s inclusion criteria, the stimulants considered in the final study design were amphetamine, dexmethylphenidate, dextroamphetamine, lisdexamfetamine, methamphetamine, methylphenidate, and serdexmethylphenidate. The main outcome researchers sought was the study population’s monthly stimulant-dispensing rate.
“First, the stimulant-dispensing rate to children in December 2023 was 6.6% lower than the rate predicted by pre-pandemic trends because this rate never fully recovered after the large decline in March 2020,” continued the authors.1 “Second, the monthly stimulant-dispensing rate changed in a heterogeneous fashion by age and sex, with a particularly large decrease among adolescent boys. Finally, the shortage of immediate-release mixed amphetamine salts was associated with a decline in dispensing of this medication but not with a decline in the overall stimulant-dispensing rate, partly because dispensing of other stimulants increased.”
When it comes to Adderall dispensing among children, recent history has shown some unprecedented hurdles in making the drug accessible. Whether it was a drug shortage or a global pandemic, this research shows the increasing demand for ADHD medications and the importance of Adderall being universally accessible.
While this research may help shine a light on the overall importance of Adderall and other stimulants in treating children’s ADHD, study authors believe future research can inform policymakers. As Adderall continues to prove its importance within the entirety of the pharmaceutical supply chain, not just for children or patients with ADHD, researchers hope that their data can help health care industry leaders avoid future drug shortages.1
“Our findings indirectly demonstrate how increased demand for a medication class in adults may adversely affect access to these treatments for children,” concluded Kao-Ping Chua, MD, PhD, senior author of the study, according to a University of Michigan Medicine news release.3 “It’s crucial to address the shortage of stimulant medications because so many kids rely on them. Untreated ADHD symptoms can harm children’s health and learning.”
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