As we face a national shortage of ADHD medications, some individuals are taking this as an opportunity to turn to alternative treatment options in complement or in place of medication therapy for ADHD.
Continue reading to learn about the medication shortage, and several strategies to manage through lifestyle, behaviors, and alternative medications.
Scroll to the bottom for a downloadable PDF.
The Perfect Storm
Supply and Demand Side Challenges Lead to National Shortage of ADHD Medications
In October 2022, the FDA announced a national shortage of Adderall
(amphetamine/dextroamphetamine), citing “ongoing intermittent manufacturing delays”. While this was indeed the case, unprecedented demand for ADHD medications was already consuming the full manufacturing capacity of the drug supply chain. As early as mid 2022, some manufacturers had noted that they were unable to fulfill all orders even on a full production schedule.
Most ADHD medications are central nervous system stimulants with abuse and addiction potential.
As such, FDA classifies them as controlled substances, which limits how many pills can be dispensed and how frequently prescriptions can be refilled.
Controlled substances also have tighter restrictions from a manufacturing perspective the government only allows certain amounts of controlled substances to be made each year. The DEA calculates how much of a given drug ingredient is needed to meet demand, then allocates that precise amount. Demand forecasts based on historical data couldn’t predict the sharp rise in ADHD diagnoses during the pandemic.
While the manufacturing issues seem to have largely affected Adderall, prescribers began switching patients to other medications like Focalin, Vyvanse, Concerta, Ritalin and their generics. This migration overwhelmed the already strained system.
Despite the drug production industry now being back on line, shortages continue for many different drugs, doses or formulations. We’re hearing from patients that ADHD medications remain unavailable.
Recently, Robert Califf , MD, the head of the FDA, blamed the ADHD supply shortage, at least in part, on the surge in stimulant use by people with ADHD, who he suggested may not truly need the drugs.
Specifically, he took aim at telehealth providers for driving a “tremendous” increase in ADHD diagnoses and prescriptions.
Per Dr. Califf, “if only the people that needed these drugs got them, there probably wouldn’t be a shortage.” He believes that at least part of the solution is “better clinical standards.”
In March 2020, DEA removed ‘in person’ requirements and allowed controlled substance prescribing via virtual appointments. This led to an explosion in telehealth prescribing. One study of utilization showed a 36% increase in ADHD medication use among 12th graders from 2021 to 2022 (JAMA).
What to Do?
Aside from medication therapy, what are the treatment options?
The solution to the problem likely entails a combination of both ensuring ample supply of needed medications and improving clinical standards to incorporate a holistic approach to the management of ADHD.
Medications can play a significant role in ADHD therapy; however, some individuals may benefit from exploring alternative treatment strategies that are less invasive. It is crucial to collaborate with a trained specialist who can provide guidance and expertise in making informed therapy decisions.
For those impacted by supply shortages, or those seeking non pharmacologic strategies to manage ADHD, we encourage the following alternative or complementary approaches with oversight from your provider.
COGNITIVE BEHAVIORAL STRATEGIES
Implementing cognitive behavioral strategies can help individuals with ADHD improve executive functioning skills and impulse control. Setting goals, breaking tasks into smaller steps, using visual reminders or checklists, and practicing self monitoring can enhance planning, organization, and time management.
Quick Tip
Learn how to incorporate these strategies by working through one of the following books:
- CBT Workbook for Adult ADHD: Proven Exercises and Strategies to Improve Focus and Productivity, Reduce Scattered Thinking, and Build Life Changing Habits to Achieve Your Goals
By Melanie Spencer
Buy Now on Amazon > - The CBT Workbook for Adult ADHD: Evidence Based Exercises to Improve Your Focus, Productivity, and Wellbeing
By Kristen Baird Goldman
Buy Now on Amazon >
ESTABLISH A STRUCTURED ROUTINE
Creating a structured daily routine can greatly benefit individuals with ADHD. Consistent sleep schedules, regular mealtimes, and dedicated blocks of time for work or study help reduce distractions, improve time management, and enhance overall organization and productivity.
Quick Tip
Set phone reminders/alarms to prompt activities for meals, bedtime, and breaks from study/work.
MINDFULNESS & MEDITATION
Practicing mindfulness and meditation techniques can help adults with ADHD enhance their ability to focus and reduce impulsivity. Mindfulness involves paying attention to the present moment without judgment. Meditation techniques, such as focused breathing or guided imagery, can promote a sense of calm and improve overall mental well-being.
Mind-body practices like yoga, or tai chi promote relaxation, reduce stress, and increase awareness of thoughts and emotions. These techniques can enhance attentional control and overall wellbeing.
Quick Tip
Consider joining a mindfulness or meditation class, or try using smartphone apps like Calm, Headspace, and 10% Happier that offer guided meditation sessions.
SLEEP HYGIENE
Getting enough quality sleep is crucial for individuals with ADHD. Establish a regular sleep routine by going to bed and waking up at consistent times. Create a relaxing bedtime routine, avoid electronic devices before bed, and ensure your sleep environment is comfortable and free from distractions.
Quick Tip
Set a phone reminder to start your wind-down routine before bed. This should include time to engage in a relaxing activity, such as reading, meditating, or taking a hot shower or bath.
NUTRITION & DIET
While there is no specific ADHD diet, making healthy dietary choices can support overall brain function. Some dietary recommendations for adults with ADHD include:
- Eat a well-balanced diet: Focus on whole foods such as fruits, vegetables, lean proteins, and whole grains.
- Include omega-3 fatty acids: These healthy fats are found in fish (such as salmon and sardines), flaxseeds, and walnuts, and may have a positive impact on brain health.
- Limit processed foods and sugar: Highly processed foods and excessive sugar intake may negatively affect attention and exacerbate ADHD symptoms.
Most importantly, establish a consistent eating schedule for meals and snacks to ensure your energy levels are steady throughout the day.
Quick Tip
One easy indication of a varied dietary intake is through color of fruits and vegetables– aim for a minimum of 3 colors in a meal and 2 in a snack.
ALTERNATIVE MEDICATIONS
In some cases, individuals with ADHD may benefit from non-stimulant medications to help with attention and symptom management. It is crucial to have an open and honest conversation with your medical provider about your treatment options.
Non-stimulant medications, such as atomoxetine (Strattera), guanfacine (Intuniv), and clonidine (Kapvay) can be considered alternative options to stimulant medications. These medications work differently in the brain but can still assist with improving focus, attention, and impulse control.
Your medical provider will assess your specific needs, medical history, and treatment goals to determine if non-stimulant medications are appropriate for you. He/she will provide guidance on the potential benefits, risks, and side effects associated with these medications, ensuring you can make an informed decision about your treatment plan.
Discussing medication options with a healthcare professional is essential for an individualized approach to managing ADHD symptoms.
Remember, the holistic approach to treating ADHD is a comprehensive and individualized process. Incorporating these strategies into your life should be done in collaboration with a healthcare professional or qualified practitioner.
Please Note
This handout is for informational purposes only and is not intended as medical advice. Always consult with a healthcare professional before making any changes to your treatment plan.
Written by:
Becca Rick, MS, RD(N), CD GBS Director of Health & Wellness Consulting
Catherine Van Tassell, LCSW, PA-C, DipACLM GBS Director of Behavioral Health Consulting
