The health crisis nobody talks about

“How do you get an ADHD person to clean their house? Give them homework.”

“What does ADHD stand for? Attention Deficit HEY DOUGHNUTS!”

“Why didn’t the ADHDer cross the street? He does not know. He was about to cross the street and suddenly the day was over.”

For millions of Americans who suffer from Attention Deficit Hyperactivity Disorder (ADHD), these jokes will bring lopsided smiles, but they also reflect a painful reality of struggling with ADHD — a reality made worse by a nearly nine-month-long lack of Adderall much worse is the country that seems to have no end in sight.

According to Matt Ford, a staff writer at The new republic its tweets last month about the challenge of tracking adderall meds went viral, it’s really hard to explain to people who don’t have ADHD. “It just makes things more difficult,” said Ford. “That sounds easy. But I have a harder time remembering to do things, process things, and get things done. And things are slipping.” When confronted with the prospect of not having to fill his Adderall prescription, a drug he’s been on since childhood, he worried: “Could I think about doing chores? Could I think of doing simple tasks like paying bills, answering emails and text messages, or even “getting my job done”?

These are not hypothetical concerns. Like Ford, I took Adderall and other stimulants after being diagnosed as an adult. Last December and January, when I saw the pill count go down and it became a struggle to get a prescription for Adderall or its generic equivalent, the effect was profound and debilitating. (Perhaps the most gruesome is the fact that so many ADHD sufferers have had to undertake the tedious task of calling pharmacies and finding out who stocked Adderall, and then contacting doctors to ensure new scripts are written Joke of national shortage. We are, without a doubt, the people least equipped for such a job.)

Ask anyone with ADHD and they will tell you that even on a good day, completing and checking the boxes on a to-do list can be a serious challenge. The more tasks there are to complete, the more overwhelming it feels and the harder it can be to even get started. And paradoxically, the attention required for one thing can be so exhausting that it becomes harder to move on to the next task. Adderall or other ADHD medications have a chemical reaction in the brain that allows users to focus and focus in ways that would be impossible without them.

like dr Richard Friedman, professor of clinical psychiatry and director of the Department of Psychopharmacology at Weill Cornell Medical Center, said to me, “If you suddenly stop taking stimulants, you not only lose the effects of the drug, you have withdrawal symptoms. You have withdrawal syndrome, which is even more debilitating… Your brain was flooded with a drug that increases dopamine, and now it’s not.”

On a practical level, the periods of being off medication this past winter made me rummage around my apartment looking for anything that would distract me from having to focus, which will seem easy to the non-ADHD sufferer, but for those of us affected by it, it’s a deep struggle. But not only did I feel inattentive, I was literally exhausted the whole time.

ADHD has traditionally been associated with children and an estimated six million children suffer from it. For children whose parents could not get prescriptions for Adderall, this has resulted in trouble sleeping, being unable to concentrate at school, not being able to finish schoolwork, and other behavioral problems that can lead to intervention and even suspension.

Since the mid-2010s, however, adults have been more likely to be diagnosed and prescribed with stimulants — although it’s likely millions will remain undiagnosed. According to a recent study, 4.1 percent of Americans in employer-based health plans take stimulants. That would represent more than six million Americans, although the actual number is likely higher, reaching as high as 16 million by some estimates). The number of Americans taking stimulants has increased 30 percent over the past five years and has increased even more dramatically during the pandemic.

But although patients have been reporting for months not being able to fill their prescriptions, the issue has received limited media focus and even less regulatory or political attention. Things got so bad, Friedman said, that he seriously considered the idea of ​​importing drugs from Canada to help his patients.

Paradoxically, one of the problems in solving the problem is finding a single explanation as to why this deficiency occurs.

Certainly part of the problem is the increase in prescriptions mentioned above. During the pandemic, rules were changed to allow prescriptions to be filled out after a telemedicine session (previously they were limited to in-person appointments). As a result, by one estimate, nearly 40 percent of all stimulant prescriptions now come from online visits.

Another hurdle is what the FDA described as “intermittent production delays” last October, exacerbated by the supply chain issues that have rocked the global economy for more than two years.

To make matters worse, Adderall and other ADHD stimulants are Schedule II controlled substances, meaning they have “high potential for abuse” and are therefore tightly regulated. As a result, the Drug Enforcement Administration, and not the Food and Drug Administration, decides the amount of drug that is manufactured annually and how much each dispensary can purchase. The DEA refused to increase those quotas in January.

Rep. Abigail Spanberger (D-VA), who is one of the few members of Congress to raise concerns about Adderall deficiency, has confronted the DEA and FDA with questions about Adderall deficiency. However, she still hasn’t received a “full explanation of why this is happening,” she told me in an interview last month. We, according to Spanberger, “do not yet know how [the shortage] ends or when it ends.”

But the bigger problem, she says, is that “no one rang the bell that we were headed for a shortage.” With the lack of media and political attention to the problem, the problem only got worse and ADHD sufferers were abandoned and forced to fend for themselves or find a solution on their own.

As Spanberger ruefully noted, “Part of the problem is that people don’t see these drugs as essential,” and because Adderall can be abused, it creates a stigma around the drug and means that “people don’t look at it in the same way” as they would with any other disease. In our conversation, she hinted that one of the challenges of getting her housemates to join her in addressing the issue is the stigma surrounding ADHD, and members don’t want to be seen advocating an issue that is so easily stereotyped and dismissed.

As Friedman remarked to me, “There has long been a suspicion that ADHD has been dramatically overdiagnosed.” Certainly, the image of college students taking Adderall to cram for a test or finish an assignment has become dominant in popular culture . A telemedicine company, Cerebral, which is now under federal investigation, has been pushing an advertising campaign that has linked ADHD to obesity and vaguely linked symptoms to the condition. Perhaps unsurprisingly, the company issued prescriptions for 97 percent of users — and sometimes after online consultations as short as 30 minutes.

Those stories, Friedman says, “nurtured a public perception [ADHD] It’s either a mild problem or a fabricated one, or worse, the people diagnosed are just plain lazy.” For ADHD sufferers, these attitudes are frustrating, but perhaps understandable. For people who don’t have ADHD, it’s hard to explain why this condition makes seemingly ordinary and everyday tasks so difficult, or how simply popping a pill can mean the difference between a productive day and an unproductive day. People who take stimulants aren’t lazy, but they become lazy without them.

Another common myth about ADHD and prescription stimulants is that those of us who take these drugs are addicted to them. But as Fridman pointed out, this is “a common misconception. Addiction is taking increasing amounts of a drug to get high.” But if you take stimulants, “you don’t get tolerant. You don’t need more of it.” People don’t take Adderall to feel euphoric, they take Adderall to function.

This is one of the enduring frustrations of reporting the Adderall shortage. ADHD isn’t well understood or appreciated, but as Ford told me, for those of us who use it, it’s “life-changing. My quality of life would be dramatically worse,” he added, and “I wouldn’t have the career I have” if it weren’t for Adderall.

He jokingly said tackling ADHD ignorance is important, but “all the people who complain would [it] I can’t focus enough to get the hell out of my head.” As long as there is stigma and misconceptions about mental health, those who suffer from ADHD will struggle to help others understand why this condition can be so debilitating — and how a simple pill can make such a difference. Because how do you explain why tasks that seem so easy to others can be so challenging for us?

And perhaps that’s also the best explanation for why, after nine months of a national shortage that has impacted the lives of millions, there still seems to be no end in sight – and such a muted urgency to fix it.