Telehealth made America’s ADHD crisis worse
Attention Deficit Hyperactivity Disorder (ADHD) is an American disease: Out of the estimated 85 million people diagnosed with it in the world, 42% are American. About 11% of people in the US (pdf), and up to 20% of American adolescents are diagnosed with it, compared to 5% of the populations of Europe, China, or Brazil.
There are many reasons behind this discrepancy. In order to be diagnosed in Europe, for instance, a patient needs to show more symptoms (pdf), making it three times more likely people will fit the diagnosis in the US. The US also makes up more than 80% (pdf) of the global ADHD medication market, and growth has been steady for many years.
In a decade, the number of prescriptions in the US for Adderall, the most common drug to treat the disorder, have more than doubled, from 15.5 million a year in 2009 to 35.3 million in 2019.
Since then, prescriptions have gone up at an even faster pace, contributing to an ongoing shortage of Adderall in the US. One of the causes is the growth in prescriptions obtained via telehealth services, made possible by pandemic-era changes in regulations to the prescription of controlled substances—to which amphetamines, the main ingredient of Adderall, belong.
Adderall prescriptions went up 10% during in 2021
The debate over whether stimulant drugs like Adderall are overprescribed for the treatment of ADHD in the US is old. In some countries, such as European nations, medications to treat the disorder are only used as a last resort, after behavioral and psychological therapy, while in the US they are the preferred intervention.
Proponents of pharmacological intervention note that therapeutic doses of amphetamines improve a patient’s life, are well tolerated long-term, and not addictive—some even suggest the world is underprescribing medications for ADHD. Opponents highlight the ease with which ADHD diagnoses can be abused to get access to stimulants, noting that even when taken correctly these drugs only manage, and don’t solve, the symptoms, which reappear as soon as treatment is interrupted.
But if prescriptions for Adderall had been rising at a fast pace before the pandemic, they have gone up drastically since. In 2021, 10.4% more prescriptions for Adderall were filled compared to a year prior. In many cases, this reflects legitimate diagnoses—people who had never before noticed certain symptoms were more likely to experience them during lockdown, periods of isolation, and changes in routines.
Before the pandemic, the prescription of controlled substances—for instance amphetamines, or opioids—required at least one in-person visit, but in order to allow new patients to be treated without risk of contracting covid, the US government allowed purely remote prescriptions starting in the March 2020. For specialized telehealth startups, more prescriptions mean more business, and reporting has found many of their employees were under pressure to overprescribe Adderall or other stimulants, which can easily be abused.
The volume of prescriptions from these companies was such that many large pharmacies—including Walmart, Walgreens, and CVS—stopped filling them, out of concerns about shortages. Supplies of Adderall are coming in short, even though the drug has been removed from the official list of medications in shortage in the US, where it had been from September of 2019 until May of 2022.
However, the makers of the drug don’t blame excess prescriptions for the short supply. According to Teva, the US’s biggest producer of Adderall, the problem is due to labor shortages, which have caused delays in production and packaging. The US government also limits the amount of drugs each company can produce, and the pharmaceutical firms are advocating for an increased allowance.