When East Lyme resident Sarah Hannon tried getting her Adderall prescription filled earlier this year, her pharmacy first told her they had it but called a week later saying they didn’t. She estimated then calling more than 20 places around the state.

“It just took so much out of me, because I would spend hours trying to call different pharmacies, and they would all say the same thing, which is no,” Hannon said. It’s harder for her to focus without the stimulant, which treats attention-deficit/hyperactivity disorder.

The 25-year-old said she was diagnosed with ADHD in elementary school and prescribed Adderall in high school. Hannon is now doing clinical work for her graduate program in occupational therapy, and she has cut down on when she takes the medication, saving it for when she has to complete documentation at work.

Not knowing when the shortage will improve, Hannon wants to make sure she has medication to study for board examinations happening this summer.

She is not alone in feeling the effects of a shortage impacting adults and children alike. The Food & Drug Administration on Oct. 12, 2022 posted a shortage of the immediate release formulation ― a drug variety that acts quickly but for not as long ― of pharmaceuticals like Adderall, known as amphetamine mixed salts.

The agency said at the time that Teva Pharmaceuticals, the country’s largest Adderall supplier, was “experiencing ongoing intermittent manufacturing delays,” and there was insufficient supply from other manufacturers of amphetamine mixed salts to meet demand.

The FDA updated information for various manufacturers at different points in March and April. The agency lists “shortage of active ingredient” for products from USpharma Windlas and Epic Pharma, whereas the shortage reason for other manufacturers is an increase in demand. The estimated recovery date for different companies is listed as April, May and June.

The Washington Post found that Adderall prescriptions rose more than 30% over the past five years, driven by a 58% increase in prescriptions among those ages 22 to 44, according to a Trilliant Health analysis of insurance claims.

Citing increased telehealth uptake and the telehealth companies advertising on TikTok, Trilliant Health Chief Research Officer Sanjula Jain wrote last year, “In hindsight, it is clear that the emergence of digital mental health platforms enabled significant increases in prescribing, particularly for the Millennial generation.”

Niantic-based therapist Katie Ziskind noted, “We also see on TikTok people saying, ‘You have ADHD if these six things are occurring to you,’ which may or may not be the case.”

Depending on the dose, the FDA says brand-name Adderall is either available or has limited supply available, whereas generic doses are under allocation amid “unprecedented increase in demand.” The issue is that insurance companies often don’t cover brand-name Adderall.

The FDA estimates that generic drugs in general are sold for 80 to 85% less than their branded equivalents, due to fewer upfront research costs, despite having the same therapeutic effect.

Nutmeg Pharmacy New London manager Ryan Vecchitto said brand-name Adderall is available, but a 30-day supply could cost $200, and the issue is with the generics.

“It’s been quite brutal. I get a lot of calls and I have to turn a lot of people away,” he said Monday afternoon. He estimated turning away at least six people already that day, “and it sucks because they really need it.”

Vecchitto said wholesalers only allow Nutmeg Pharmacy to purchase a certain amount, and the pharmacy prioritizes existing customers. He hasn’t had an issue getting Concerta and Vyvanse, which are extended-release ADHD medications.

Like other retail pharmacies, Stop & Shop has “experienced intermittent supply chain shortages impacting the availability of Adderall,” company spokesperson Maura O’Brien said in an email. She said while pharmacies place orders five days a week, this shortage continues to impact availability at pharmacies nationwide.

“For many of us working in prescribing these medications, there is a lot of chaos, families going pharmacy to pharmacy, multiple requests for medication, a lot of anxiety and fear,” said Dr. Javeed Sukhera, chair of psychiatry at Hartford Hospital.

People who can’t access medication may see their symptoms worsen and functioning deteriorate, with Sukhera pointing to slipping grades and impacted social relationships.

He said Hartford HealthCare is seeing a shortage not only in Adderall, but also in various doses of all types of stimulants. He said Concerta is backordered in various places, in part because it’s been prescribed as an alternative to Adderall.

Sukhera thinks the issue is not just about increasing prescriptions but also about use among people without prescriptions, which is problematic because it’s medically necessary for many.

ADHD is “one of the things that I treat that has the best track record for medications, even more so than things like depression,” Sukhera said, “where we know people with ADHD get significantly better and achieve symptom control with these stimulants.”

Becky McCoy of East Lyme said when her 10-year-old son began taking Concerta after being diagnosed with ADHD last year, it was “like night and day. He said his brain feels calm for the first time.”

And it wasn’t just her son: McCoy was also diagnosed last year. She could retroactively see symptoms starting early in childhood, but she was a child in the 1990s, when ADHD in girls was more overlooked. McCoy said when she and her son were assessed, their therapists really wanted to make sure symptoms were ADHD-related and not linked to their history of grief and trauma.

The two are on different doses of Concerta, and McCoy said she has had less of an issue getting Concerta for her son than for herself.

No one-size-fits-all approach

The ability to get ADHD medications varies person to person. New London resident Angelica Powell said she once experienced a delay in getting a refill of generic Adderall for her third-grade son, who gets a one-month supply at a time, but it was no more than a couple days.

She said her son has been on medication for about a year and a half. She first had suspicions about ADHD amid distance learning in 2020.

“I know there’s a big stigma with the kids being on the medication, and that's mainly because of people who abuse it, but with this kid, it’s really helped him,” Powell said. “We were against it in the beginning; we didn’t want to do the medication, but once we saw a gradual difference, it’s really worked for him.”

Mitchell College is a leader in supporting neurodivergent learners, including those with ADHD. Gizelle Tircuit, director of health and wellness, said she and medical staff from Yale New Haven Health haven’t had students come in to say they’re short on prescriptions. Mitchell doesn’t monitor students’ medications.

Dr. Shanthi Mogali, chair of psychiatry at Lawrence + Memorial Hospital, said she has seen a spike since the pandemic began “in people coming in requesting for treatment of concentration and focus problems.”

She has seen people with no evidence of childhood ADHD and no neuropsychological evaluation saying they have ADHD and need a stimulant. She said stimulants have a place in the treatment of mental health disorders but “are likely being prescribed inappropriately in a lot of different areas” and questions the huge increase in diagnoses.

Mogali doesn’t think there should be this much Adderall being prescribed and is training staff to explore non-stimulant medications ― such as Wellbutrin, Strattera and Intuniv ― even if patients may not like to hear that. Another concern she has is that tension and concentration issues are also related to anxiety and depressive disorders, and so a stimulant may not be treating the underlying disorder.

Mogali has been getting frantic calls from people who have been prescribed stimulants for years, who are now crashing from being off medication.

“They’re having so much fatigue that they can’t get up and go to work,” she said. “They’re not able to focus. They have increased irritability.”

Mogali said responding to the shortage is “extremely time-consuming for staff” who have other emergency psychiatric situations to handle, considering they’re getting extra calls from patients and pharmacists, and trying to find pharmacies that can fill prescriptions.

For various reasons, medication might not be the right answer for everyone. New London High School junior Serenity Essence Montalvo said she was on Vyvanse for a year when she was nine, but had bad side effects. She said she became aggressive and lost weight. She went off medication and was doing cognitive behavioral therapy, learning coping skills.

She talked about how something in her body is always moving, and how she can “bounce off the walls.”

“My friends get tired of it, and sometimes we’re hanging out and I’m jumping and I scream randomly and I sing and I dance. I definitely know that’s a toll on my mom,” she said. “Your mind just races. It will never stop.”

At her Niantic-based holistic therapy practice Wisdom Within Counseling, Katie Ziskind sees some of what others have mentioned: more frequent prescribing of stimulants, insurance not covering non-generics, appetite changes, mood swings and fatigue among people coming off medication.

Like what Mogali said about depression and anxiety, Ziskind noted that concentration and memory issues can also be symptoms for people with post-traumatic stress disorder. Prescribing them a stimulant can mean “there’s even more hypervigilance, they’re much more sensitive to sound, their appetite’s been suppressed.”

Ziskind also sees a domino effect with medications, where someone on an ADHD drug is so overstimulated they’re also on a sleeping medication, and then they have anxiety in the morning so now they’re on a benzodiazepine, a class of depressant drugs used to treat anxiety and insomnia.

“We don’t do enough education on side effects,” she said. “A lot of times we just look at what works for the general population.”

e.moser@theday.com