In 2019, less than 2% of all stimulant prescriptions — drugs that are commonly used to treat ADHD — were prescribed via telehealth visits, according to Trilliant Health. By 2022, this figure multiplied, leaving telehealth visits to account for nearly half of all stimulant prescriptions in the United States. Further, the data analytics company reported that the amount of stimulant prescriptions is outpacing the amount of ADHD diagnoses.

In August 2022, adderall users began to experience difficulty obtaining their medications. That October, the FDA declared an adderall shortage. TEVA Pharmaceuticals — the largest adderall manufacturer in the U.S. — reported delays, in addition to other generic manufacturers of the drug. 

The lack of adderall caused a disruption in the pharmaceutical industry, forcing medical providers to prescribe alternative medications. The adderall shortage triggered a scarcity of several other ADHD medications, including Ritalin and Concerta.

As the shortage persists, numerous collegiate newspapers have published articles divulging personal testimonies from students who say the shortage has taken a toll on their academic performance and mental health.

Dario Bayardo, director of the Goldman Center for Student Accessibility at Tulane University, said the shortage has not posed major challenges to the center’s operations. “But there have been a few students that have expressed to us some of the challenges that they are facing,” Bayardo said. 

The American Psychiatry Association describes ADHD as “a chronic and debilitating disorder” that “is known to impact the individual in many aspects of their life including academic and professional achievements, interpersonal relationships, and daily functioning.” 

Individuals with untreated ADHD report significantly poorer self-esteem and social function outcomes than individuals without ADHD or with treated ADHD, according to a 2013 study.

 Although the cause of the shortage is disputed, several factors have contributed to the deficiency of these products. 

First and foremost is the increase in demand for these drugs. From 2018 to 2022, there has been a 58.2% increase in adderall prescriptions alone for individuals aged 22-44. 

This prescription augmentation may, in part, be attributed to the growth of the telehealth industry, which was necessitated by the spread of COVID-19. In light of the pandemic, the Drug Enforcement Agency implemented Public Health Emergency laws that temporarily waived regulations requiring individuals to attain prescriptions for controlled substances in person. As a result, telehealth startups like Cerebral began prescribing stimulants over the phone at substantial rates, sometimes within 30 minutes.  

These startups conducted widespread marketing campaigns over social media platforms such as Instagram and TikTok to amass clients. In January 2022, Instagram removed certain Cerebral ads for violating community guidelines. 

“We don’t allow content that attempts to generate negative self-perception in order to promote health-related products,” a Meta spokesperson told Forbes in response to a Cerebral advertisement that suggested ADHD medications could curb overeating. 

These short assessments and promotion tactics have raised ethical concerns amongst physicians and politicians regarding the integrity of lucrative telehealth companies. Mounting apprehension has prompted government agencies to further review the legality of their business operations. 

Pharmaceutical companies say they have not been able to keep up with the abrupt increase in demand for these drugs. Some companies blame manufacturing delays, while others blame regulatory measures enforced by the DEA.

ADHD medications like adderall are categorized under the Controlled Substances Act into schedules based on their interpreted potential for abuse. Stimulants used to treat ADHD fall under Schedule II. Due to their high-risk classification, the DEA sustains a quota system that limits the amount of raw materials manufacturing companies have access to in a given calendar year. 

In a statement to CNN, the DEA responded to these allegations and said they “are aware that the pharmaceutical industry is claiming that there is a quota shortage for the active ingredients in ADHD drugs,” however, “based on DEA information — which is provided by drug manufacturers — this is not true.”

While some suggest the DEA should loosen its regulations or cede oversight of controlled substances altogether, others believe the solution lies in more restrictive telehealth policies. 

 This February, the DEA announced its intention to reinstate former policies regarding telehealth and controlled substance prescriptions. This comes as provisional COVID-19 Public Health Emergency laws are set to expire on May 11. 

Effectually, it would mean the end of lax regulations that allowed telehealth companies to thrive. That is, patients will no longer be able to obtain prescriptions for controlled substances via telehealth appointments without visiting their provider in person at least once. 

The proposal provides an exception for Schedule III-V non-narcotic controlled substances — like anabolic steroids — and Buprenorphine, which is used to treat opioid use disorder. However, patients would be limited to a 30-day supply of these drugs. 

While this course of action may appeal to long-term ADHD medication users whose access to stimulants has been disrupted in light of the shortage, critics fear these restrictions will implicate vulnerable populations who have benefitted from the Public Health Emergency laws and even expedite the opioid crisis. 

Brigham Walker, an assistant professor in the Department of Health Policy and Management at Tulane’s School of Public Health and Tropical Medicine, conducted research with colleagues indicating that telehealth removed barriers for Louisiana Medicaid beneficiaries and provided them with better access to medical care. 

Further, he and his colleagues determined that “a significant pre-pandemic racial disparity” that existed within the medication-assisted treatment of substance abuse has tapered, “likely in part due to the lifted restrictions on in-person only access and prior authorization requirements.”

 On the other hand, just as many opioid users turned to illicit drug markets when they were no longer able to obtain legitimate prescriptions, doctors fear that stimulant users may be tempted to do the same. 

Fentanyl-laced adderall has already claimed the lives of college students, and according to a 2018 study, approximately 20% of college students misuse prescription stimulants to begin with. 

 “Balancing access and safety is an important dual aim for health policy makers,” Walker said. “A few things to consider are the magnitudes of gains in access compared with magnitudes of adverse outcomes stemming from that increased access, as well as the effectiveness of policies in addressing both.” He added that “policymakers should be mindful of these potential trade-offs.”

The FDA and the American Society of Health-System Pharmacists estimate that shortages will be resolved sometime between now and June. 

In the meantime, Bayardo said he encourages any Tulane students who need disability-related support to contact the Goldman Center or visit accessibility.tulane.edu.