Here's how my day begins: I wake up at 6 A.M. with a list of tasks I’ve written down and reminders I’ve emailed myself. I sit down to work, knowing my entire day is planned. Nothing is going to stop me today . . .
Oh, look! A hawk outside my window has seen a rat scurrying on the ground. My wife just woke up—I need to tell her a joke. Instagram! I should check Instagram. What’s up with the way my books are stacked? You know what? I should go for a walk and get a breakfast burrito. Yes, that sounds good. Also, orange juice and a coffee. Actually—the diner is open. Should I get pancakes? No, wait—wait! I have a schedule. It’s written down. I am supposed to be writing this thing for Esquire . . .
Welcome to year 43 of ADHD. I am a middle-aged man with a neurodevelopmental disorder for which I take medication to get through the day. I’m embarrassed to admit this, even though some people show off their ADHD like a guy making sure you notice the Cartier Tank on his wrist. Look at Instagram, TikTok, or YouTube and you’ll find glib confessionals about life with ADHD, testimonials on how to be productive, and claims of “cures” through diet and exercise. All of these attract hundreds if not thousands of likes. Call it the memeification of attention deficit hyperactivity disorder.
I was diagnosed with ADD in 1985 at the age of five. Doctors swore I’d grow out of it. School administrators suggested to my parents that having ADD—a diagnosis later upgraded with the addition of hyperactivity (in the late ’80s, the Diagnostic and Statistical Manual of Mental Disorders finally added the H)—was like wearing a scarlet letter. One authority figure said I was bound for prison because I couldn’t sit still and pay attention. Going to college or learning a trade was out of the question. My divorced parents fought over how to treat my ADHD: One was pro medication; the other thought pills would turn me into a zombie and tried to enroll me in military school. When I was eight, the parent who wanted me on meds won and I started taking Ritalin. It was the first of many medications. In retrospect, the pills seemed less about helping me and more about shutting me up. By 18, with the decision left up to me, I’d stopped taking medicine altogether. I did not go to prison, nor did I grow out of ADHD. In fact, I also have an anxiety and obsessive-compulsive personality disorder to top it off. This has led to more than a few Tony Soprano panic attacks. My brain moves fast and I’m unable to process thoughts or emotions. Then things get backed up. Sooner or later my heart is pounding, I’m sweating, and I feel like death. That’s not a great way to live. And so, in 2018, after two decades of living without it and with a host of mixed feelings after an overprescribed childhood, I went back on medication for my ADHD. Combined with meditation, exercise, and meds for my anxiety, the Adderall I’ve been prescribed has improved my life. I read hundreds of books a year and write thousands of words every day. I’ve published two books of my own and write for myriad publications. (It is not lost on me that my chosen career is one that requires sitting still for hours and turning my thoughts into words.)
Which is to say, I am a high-functioning mess. I had managed without the help of prescription drugs, but the medications made my head a calmer, more focused place. Then the world ran out of Adderall.
In October of 2022, the FDA announced there was a shortage of amphetamine mixed salts—better known by the brand name Adderall. The agency didn’t offer any solutions or timelines but promised it would “continue to monitor and assist manufacturers with anything needed to resolve the shortage.” The shortage not only continued but also made it even more difficult for people to get other medications. Doctors, hoping for a short-term solution, started prescribing Vyvanse, Focalin, and Ritalin. By mid-2023, those meds also faced supply issues.
A month later, I was on the phone with a pharmacist, pleading, saying I’ve been dealing with ADHD nearly my entire life and I’ve never had this problem before. “I’ve called five other pharmacies, and I don’t get why I can’t just get the medication I take to function close to normal,” I said. All the pharmacist could do was apologize and tell me they had no idea what was going on. I am hardly alone in my desperation. I have a friend in Philadelphia whose teenager takes Adderall, the search for which they call their “Kafka story.” Another person told me he drives 40 minutes from his home in Wisconsin to a less affluent town in Illinois where he never has trouble getting it. Pharmacies in low-income communities, where there are high rates of uninsured people who can’t afford the out-of-pocket costs, fill fewer prescriptions and, the story goes, tend to have more of the drug on hand. It’s a bleak indictment of our country’s health-care system.
Sooner or later my heart is pounding, I'm sweating, and I feel like death. That’s not a great way to live.“My husband has ADHD, so the task of where to find it became a tag-team effort,” Mary (not her real name) told me. I started talking to Mary late last year through DMs on Instagram after she saw me posting about my own struggles getting my prescription filled. She messaged me a tip about a pharmacy that was out of my way but either had Adderall in stock or would dole out a few pills to hold me over. Mary and her family live near the wealthy suburb of Scarsdale, just north of New York City. She said she’d called a pharmacy in Scarsdale and was told by the pharmacist that they would only fill prescriptions for people who lived within a five-mile radius. Mary couldn’t believe it: “It was implied that Adderall was only for the well-heeled children of Scarsdale who needed it for their SATs or whatever and not for interlopers.”
Should we have anticipated the shortage? The amount of ADHD content on social media and the way people casually say, “I have such ADHD,” then mention they’ve never actually been tested for it suggest that having an attention deficit is now trendy. It’s true that concentration is all but impossible in our overworked, overstimulated world, whether or not you have a diagnosis. When I read in May 2022—nearly six months before the FDA announced the shortage—that the Department of Justice was investigating the mental- health start-up Cerebral for allegations that it was overprescribing controlled substances like Adderall, my skepticism about the number of people claiming to suffer from ADHD felt validated.
In search of answers about the Adderall shortage, I spoke with dozens of doctors and pharmacists. Howard Deutsch, a principal at the consulting firm ZS Associates who focuses on commercial strategy in the pharmaceutical industry, offered the analysis that made the most sense. It mostly boils down to dollars and cents. The patent for Adderall has lapsed, which means patients can buy generic versions of the drug for a fraction of the original cost. That’s good for consumers in theory, but the thinner profit margins reduce the incentive for manufacturers to scale production. Plus, since Adderall is a controlled substance, the government is careful about how much capacity can be supplied. “That’s gumming up the works as well,” said Deutsch.
I avoided Adderall for two decades. I spent tens of thousands of dollars working on myself, tackling my mental health with shrinks, meditation, and other remedies. Then I realized Adderall was necessary. I did everything right and put my faith in medicine. Now I have trouble finding my medication because the drug isn’t profitable enough for Big Pharma.
The week leading up to refill time is usually when I’m unhappiest. My pulse quickens when I notice I’m running low. I need to stop what I’m doing, concentrate on my breath, and prepare for the tidal wave of adrenaline that’s about to crash through my body. Once I center myself, I start calling pharmacies and emailing my shrink about where Adderall is in stock, hoping he sees the message before every pharmacy runs out. This has happened before, and I was reduced to asking a family member if they could ration off a few pills. Otherwise, I’d need to buy the drug I’m legally prescribed through illegal means. Trying to feel better shouldn’t be humiliating. A few months ago, I found what one friend called “a low-key gift-from-God hookup,” a place that always has Adderall in stock but is cash-only. I don’t ask questions. I went there and paid more than double what I normally pay with my insurance. As I walked out, the guy gleefully said, “See you next month.” He’s right. I’ve got no other choice, and he knows it.
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