There's Not Enough Adderall
Below is a complimentary Demography Unplugged research note written on 12/1/22 by Hedgeye Demography analyst Neil Howe. Click here to learn more.
- There’s a nationwide Adderall shortage. Total prescriptions in the U.S. have risen +28% since 2017, with Millennials seeing a particularly sharp spike in 2020 and 2021. (Axios)
- NH: In October, the FDA announced a nationwide shortage of Adderall, which is expected to be in short supply through at least early 2023. The drugmakers that manufacture Adderall have given various pandemic-related explanations for the shortage, including supply chain issues and labor shortages. There are nine manufacturers in all, with Teva (TEVA) making up the largest share of the market (30%).
- But this isn’t the first time that there’s been an Adderall shortage. Though this one has lasted the longest, the industry has been dealing with this issue repeatedly since 2015. And the reason is surging demand. Because Adderall is regulated as a Schedule II substance, manufacturers cannot simply ramp up production to meet it. The FDA limits how much of the drug can be produced each year.
- Between 1997 and 2016, the share of U.S. school-age children diagnosed with ADHD rose from 6.1% to 10.2%, or by about +67%. The share of U.S. adults diagnosed with ADHD has increased even more sharply. Estimates vary: One 2019 study reported that prevalence among adults has gone from 0.43% in 2007 to 0.96% in 2016, or by +123%. Other studies put the current rate among adults at between 2.5% and 4.4%.
- As the number of people diagnosed with ADHD has soared, the number of Adderall prescriptions has followed, climbing steadily over the past two decades. In the first year of the pandemic, prescriptions saw their biggest YoY growth in at least four years. An estimated 41.4M Adderall prescriptions were dispensed in 2021, up +10.4% from 2020 and +14.8% from 2019.
- The pandemic-era spike in Adderall prescriptions was concentrated among one group in particular: Millennials. According to an analysis by Trilliant Health of its national all-payer claims database, the number of patients under age 21 with prescriptions declined between 2019 and 2020 before stabilizing between 2020 and 2021. Among those over age 44, the number of prescriptions saw little change throughout this period. But among those ages 22 to 44, prescriptions kept rising: +7.4% from 2019-20, and another +15.1% from 2020-21.
- Why are Adderall prescriptions continuing to increase among Millennials, but not other groups? Adderall use has always been particularly high among early-wave Millennials. They were the children who received it when childhood ADHD diagnoses began rising in the 1990s, the college students who sought it out as a "smart drug," and now the adults who are still taking it. (See “Attention Deficit, or Something Else?”) The largest increase in ADHD prescriptions since the early 2000s has been among women ages 25-29 (+700% from 2003 to 2015). The rising figures reflect both the cohort replacement effect caused by longtime Adderall users entering older age brackets and an increase in newly diagnosed adults.
- Some doctors have speculated that more patients may have requested ADHD medication during the pandemic to deal with increased stress levels and lack of focus. Even before Covid-19 hit, young women were struggling with higher levels of burnout than young men. (See "Would Better Jobs Solve Millennial Burnout?") This coincided with the launch of several new telehealth startups, which touted their ability to prescribe Adderall and other drugs quickly and took off after advertising heavily on platforms like TikTok and Instagram.
- Health officials are urging those whose prescriptions have run out not to turn to counterfeit pills, which could be laced with other dangerous substances, including fentanyl. (See "Fear of Fentanyl Going Into Moral Panic Mode.") Some are warning that desperate patients may end up turning to alternative stimulants like methamphetamine. So far, for the most part, those affected appear to be handling the shortage by attempting to switch to different drugs like Ritalin or by splitting their remaining pills into smaller pieces.