DEA scrutinizes telemedicine as Adderall shortage continues
Jessee Perry was able to get her Adderall prescriptions filled at her small pharmacy in Richmond's Church Hill neighborhood until two weeks ago, she said. What Perry had only heard through online chatter, friends and family suddenly became far more personal.
Perry, owner of a Farmers Insurance agency, was diagnosed with attention-deficit/hyperactivity disorder in 2013, she said. She started taking Adderall in 2016 for ADHD and, apart from a brief period during the COVID-19 pandemic, has taken it continuously.
Her clients depend on her to keep up with and pay attention to their needs, Perry said.
“Those are all things that end up getting impacted any time that I have been off of that Adderall,” she said.
Perry struggles when unmedicated with everyday obligations such as cleaning her home, cooking and being present with others, she said.
“Something that might take somebody without ADHD five minutes with no thought on it, these are things that we’re really struggling and fighting with,” Perry said. “It might take me hours to get it done without my medication.”
Nationwide shortage enters fifth month
The Food and Drug Administration added Adderall to its drug shortage website in October 2022. Five of the eight listed drug manufacturers still report partial or complete shortages.
This is not the nation’s first Adderall shortage. The FDA announced a similar shortage in 2011, and some of the same concerns raised now were raised then. Doctors and patients alike are now finding other stimulant medications are in shortage too, according to the American Society of Health-System Pharmacists.
Dr. Kara Beatty, president of the Psychiatric Society of Virginia and practicing psychiatrist in Richmond, has coped with this shortage alongside her patients. Beatty spoke with a Capital News Service reporter in November 2022, one month after the shortage began. At that time, Beatty said she felt the nation was only “on the fringes” of this shortage.
“Now, we are getting hit so hard,” Beatty said. “Specifically January and February, which traditionally tend to be difficult months for individuals — it’s become so much more difficult this year.”
More than just new patients are affected by this shortage, Beatty said. Existing patients, like Perry, are now also struggling to get their prescriptions filled.
“So many of my patients that are on Adderall or other stimulants that have a confirmed diagnosis of ADHD, have been on these medications for a long time, are no longer able to get them,” Beatty said.
Regulating controlled substances in the age of telehealth
Beatty owns the small practice Resilience Health in North Chesterfield, where she offers a “hybrid model” to her patients, she said. Beatty schedules both in-person visits and televisits depending on patient needs, as it creates more flexibility for everyone involved, she said.
The U.S. Drug Enforcement Administration designates Adderall and other stimulant medications as Schedule II drugs, according to its website. That designation comes with many regulations in Virginia, including a six-month expiration date, a no refill policy, prescription tracking and strict guidelines for partial dispensing.
Schedule II prescriptions also cannot be transferred between pharmacies without a paper prescription, meaning patients searching for their medication at other pharmacies have to come back into the office for a new one, Beatty said. She usually sends all prescriptions electronically, but the shortage has made that much harder, she said.
The use of telemedicine spiked during the COVID-19 pandemic. Rates have since stabilized, but use of telemedicine in 2021 remained 38 times higher than pre-pandemic levels, according to a study by the consulting firm McKinsey & Company. Adderall prescription rates increased during this same period, especially for adults aged 22-44, according to health analytics company Trilliant Health.
COVID-19 lockdowns and isolation forced many to reflect more deeply on their mental health, Beatty said.
“We all just formed better relationships with ourselves and gave ourselves some compassion,” Beatty said. “So, I think that’s a big piece of it.”
The Drug Enforcement Agency released its proposed permanent guidelines for future telemedicine operations late last month. Patients would need to have an in-person visit with their medical practitioner before they can receive a prescription for any controlled medication, including for ADHD treatment.
“DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm,” DEA administrator Anne Milgram said in a press release.
The public has until March 31 to submit comments on the DEA proposals. These comments will be considered by the DEA in the final draft, according to the release.
New Resilience Health patients are already required to schedule an in-person visit, Beatty said.
“Ethically, as a physician, I am a firm believer in in-person visits,” Beatty said. “I think telehealth has its benefits, so I created a hybrid model.”
Patients utilized telemedicine during the COVID-19 pandemic and beyond it to access health care remotely. Physicians also saw the benefit of remote health care, Beatty said.
“I think a lot of [physicians] are gonna be in trouble, because a lot of people have given up their office leases,” Beatty said. “A lot of practitioners do not see people in-person, and I think it’s gonna be very challenging.”
Beatty spends only two days a week in-office, she said. It creates a “jigsaw puzzle” to schedule all patients prescribed a controlled substance into those two days.
Shortage cause remains unclear
Telemedicine alone cannot be blamed for the shortage, Beatty said.
“In reality, it’s so complex,” Beatty said.
The root cause of the shortage is difficult to identify, but Perry said some of it has to do with education and new access to the care needed to get medication. Social media has helped people become more aware of ADHD symptoms, she said. And women, she said, have been “historically” underdiagnosed with ADHD.
“Females don't show the same symptoms and signs as our male cohorts, who tend to be more hyperactive, and it gets caught at a young age,” Beatty said.
There is a stigma associated with stimulant medication that Perry said leads people to think it is being abused.
“That people are abusing these medications and people are being overdiagnosed, but ignoring the fact that maybe we’ve been underdiagnosing a lot of different marginalized populations,” Perry said.
More Adderall prescriptions were dispensed than there were individuals with a formal ADHD diagnosis, according to a Trilliant Health study. The discrepancy could indicate patients were using a direct-to-consumer platform with a self-pay option, rather than insurance, it stated.
Drug abuse is always something to consider with controlled substances, but Beatty trusts the many regulations in place to prevent it, she said. The Prescription Monitoring Program, which came out of the opioid epidemic, is one of many systems in place to help curb drug abuse, she said.
Beatty has not seen any data indicating drug abuse is a factor driving the shortage, but hesitates to rule anything out at this time, she said.
“No matter whose fault … people are suffering,” Beatty said. “When I see that my patients are struggling to work — I don’t know why our society would want this. This is really detrimental to peoples’ well-being.”
U.S. House Rep. Abigail Spanberger (D–Va.) last December urged leadership across the country to respond in force to the shortage.
“Patients who rely on Adderall to function daily deserve a comprehensive federal response to ensure access to their medications,” Spanberger stated in a press release. “Given the complicated regulatory framework around controlled substances and the incentives in the drug industry, addressing the shortage of Adderall will require coordination between FDA, DEA and industry.”
Perry is prescribed both short and extended-release Adderall to manage her ADHD symptoms, she said. She is currently rationing what stock she has left, after multiple pharmacy searches have come up short.
“This is getting really bad,” Perry stated in a follow-up email.
The struggles are not simply a lack of focus, or not listening, she said.
“These are things that are absolutely essential daily tasks that we’re trying to get done,” Perry said. “We just aren’t able to do them in an effective manner at all unless we’re medicated.”
Capital News Service is a program of Virginia Commonwealth University’s Robertson School of Media and Culture. Students in the program provide state government coverage for a variety of media outlets in Virginia.