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The Adderall shortage: Exploring rates of prescription fills over time

by | Apr 2, 2024 | Research, Research Insights

Truveta Research explores the potential impact of Adderall shortage using EHR data to explore trends in prescription fills for patients with ADHD
  • There was a decrease in the rate of amphetamine/dextroamphetamine (Adderall) prescription fills per eligible population starting in the fall of 2022; prescription fill rates were 11.4% lower in the first five months of 2023 compared to the first five months of 2022.
  • Age-stratified groups followed similar trends, decreasing in prescription fill rates in late-2022 through 2023. Adults (over 18 years old) had higher average fill rates than all age groups under 18. Adults also had a larger decrease in the percent of fills between January – May of 2022 and 2023 compared to those under 18 (adults: -12.4%; children: -10.3%).
  • All age groups under 18 had decreased prescription fill rates in the summer months (likely correlating when school was not in session). Age groups over 18 did not experience this trend.

With over 40 million people receiving attention deficit hyperactivity disorder (ADHD) medication prescriptions in 2020 (Schmidt, 2023), the recent and prolonged amphetamine/dextroamphetamine (Adderall) shortage has emerged as a pressing concern for many individuals across the country. Adderall, the combination drug amphetamine and dextroamphetamine is primarily prescribed for ADHD and narcolepsy. When used to treat ADHD, amphetamine/dextroamphetamine works to increase the amount of dopamine and norepinephrine in the brain (Lener & Hobbs, 2022; Martin & Le, 2023). This, in turn, can increase a person’s focus and calmness (Lener & Hobbs, 2022).

In October 2022, the FDA announced a shortage of amphetamine/dextroamphetamine, citing the cause as increased demand (U.S. Food & Drug Administration, 2023). Now in 2024, the shortage has continued with estimated increased availability of some formulations during March and May of 2024 (U.S. Food & Drug Administration, 2022).

The persistent shortage of amphetamine/dextroamphetamine has posed significant challenges for both patients and healthcare providers alike. In partnership with CNN, we were curious to confirm if there was an increase in amphetamine/dextroamphetamine prescription fills, learn how widespread the impacts of the shortage were, and determine if there was variation for people over and under 18 years of age.

Methods

Using a subset of Truveta Data, we identified people who had an ADHD diagnosis and amphetamine/dextroamphetamine prescription fill between January 2016 and December 2023.
First-time prescription fill rate
We calculated the monthly rate of first-time amphetamine/dextroamphetamine prescription fills divided by all amphetamine/dextroamphetamine prescription fills, as a proxy for increasing demand.
Monthly prescription fills per populations
For each month we defined an eligible population as people had a prescription fill of amphetamine/dextroamphetamine within the past two years and had an encounter during the current month or a subsequent month. An encounter (visit) in the current month or a subsequent month was included as part of the inclusion criteria because prescription fill data is included in a patient’s electronic health record at the time of their encounter. Without an encounter, prescription fill data may be missed.

We calculated the monthly rate of amphetamine/dextroamphetamine prescription fills per eligible population overall and for a population over and under 18 between 2018-2023. We also calculate the rate for three age groups under 18 years of age (0-11 years old, 12-14 years old, and 15-17 years old).

You can view this study — including data definitions and all associated files — in Truveta Studio.

Results

We found a population of 336,355 people who met our inclusion criteria. Most of the population was female (54.6%), white (82.4%), and not Hispanic or Latino (85.5%). Less than a quarter of the population was under age 18 at the time of their first amphetamine/dextroamphetamine prescription fill (20.9%).
First-time prescription fill rate
Between 2020 and the first half of 2022, on average 4.9% of all prescription fills were first-time prescription fills. This peaked at a rate of 7.0% in March 2022 and then declined throughout the remainder of 2022 and 2023.
Truveta Research explores the potential impact of Adderall shortage using EHR data to explore trends in prescription fills for patients with ADHD
Overall population
There was a decrease in the rate of amphetamine/dextroamphetamine prescription fills per eligible population starting in the fall of 2022, with the lowest annual rates experienced in December at 44.5% of the eligible population. Overall, the population reached a minimum dispense rate of 40.7% during February 2023, while the maximum occurred just over a year prior in March 2022 at 50.6%.
Truveta Research explores the potential impact of Adderall shortage using EHR data to explore trends in prescription fills for patients with ADHD
Amphetamine/dextroamphetamine prescription fill rates were 11.4% lower in the first five months of 2023 compared to the first five months of 2022.
Population stratified by age
Truveta Research explores the potential impact of Adderall shortage using EHR data to explore trends in prescription fills for patients with ADHD
Age-stratified groups followed similar trends, decreasing in prescription fill rates in mid-2022 through mid-2023. However, age groups over 18 had both a higher average fill rate and experienced more substantial decreases in fill rates throughout late 2022 and 2023; a decrease of 12.4% for the population over 18 compared to a decrease of 10.3% for the under 18 population from January – May of 2022 and 2023.

Fill rates for age groups under 18 began to increase during the second half of 2023 which is likely a seasonal effect of return to school in the fall (it is consistent with previous years). However, rates did not reach the early 2022 values. This was true for each individually stratified age group (0-11 years old, 12-14 years old, and 15-17 years old).

Truveta Research explores the potential impact of Adderall shortage using EHR data to explore trends in prescription fills for patients with ADHD
All age groups under 18 had decreased prescription fill rates in the summer months (likely correlating with school not being in session). Age groups over 18 did not experience this trend.

Discussion

With the continued reported shortage of amphetamine/dextroamphetamine, we were curious to learn how widespread the shortage was and if there were differences by age group. We found increasing first-time use of amphetamine/dextroamphetamine through 2022, and an overall continued decrease in the rate of people receiving amphetamine/dextroamphetamine prescription fills between the end of 2022 through the end of 2023. This was most pronounced for people over 18 years of age. People under 18 years of age began to increase prescription fill rates at the end of 2023. This trend followed similar temporal patterns; people under 18 received more prescription fills during fall, winter, and spring months, compared to summer months. This trend was not seen for the adult population.

We used the percentage of first-time fills as a proxy for increased first-time demand. Between 2020 and the first half of 2022, we saw the average rate of first-time fills increase nearly 5% each month. This aligns with the FDA announcement that there has been an increase in demand for amphetamine/dextroamphetamine (U.S. Food & Drug Administration, 2023).

One study with data through 2019 showed a seasonal effect in dispensing of ADHD medications for children (Board et al., 2020). When the shortage started, physicians stated patients could ration doses over the weekends or only take half the daily recommended dose; even though the effects may not be as strong as a full dose (Amenabar, 2023). Since the shortage has lasted nearly two years (over two summers), there were questions if parents may be stock piling amphetamine/dextroamphetamine over the summer and intending to use it throughout the school year for their children. The results in this report do not support this hypothesis; we see decreased fill rates over the summer months for people under 18.

There are a few limitations with this analysis. First, age groups were determined at the time of first amphetamine/dextroamphetamine prescription fill and did not change over time; therefore, people were only in one age group throughout the study period. Second, we did not take into account if people had extra medication on hand; however, over 96% of the amphetamine/dextroamphetamine dispenses in this study were for 30 or less days (indicating the need to receive a new prescription fill each month). Finally, we included a data definition based on the drug combination amphetamine/dextroamphetamine, there are some brands of drugs that may fit into this definition that are not experiencing a shortage. Future work is needed to differentiate between brands within this study.

These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on March 12, 2024.

You can view this study — including data definitions and all associated files — in Truveta Studio.

Citations

Amenabar, T. (2023, March 14). Doctors share advice on dealing with the Adderall shortage. The Washington Post. https://www.washingtonpost.com/wellness/2022/10/21/adderall-shortage-adhd-alternatives/

Board, A. R., Guy, G., Jones, C. M., & Hoots, B. (2020). Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty—United States, 2014–2019. Drug and Alcohol Dependence, 217, 108297. https://doi.org/10.1016/j.drugalcdep.2020.108297

Lener, M. S., & Hobbs, H. (2022, May 24). Effects of Adderall on the Body. Healthline. https://www.healthline.com/health/adhd/adderall-effects-on-body

Martin, D., & Le, J. K. (2023). Amphetamine. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK556103/

Schmidt, H. (2023, March 22). America’s Amphetamine Problem, Beyond the Pharmaceutical Supply Chain. Healthcare Exec Intelligence. https://healthcareexecintelligence.healthitanalytics.com/features/americas-amphetamine-problem-beyond-the-pharmaceutical-supply-chain

U.S. Food & Drug Administration. (2022). FDA Drug Shortages (Current and Resolved Drug Shortages and Discontinuations Reported to FDA – Amphetamine Aspartate Monohydrate, Amphetamine Sulfate, Dextroamphetamine Saccharate, Dextroamphetamine Sulfate Tablet). https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Amphetamine%20Aspartate%20Monohydrate,%20Amphetamine%20Sulfate,%20Dextroamphetamine%20Saccharate,%20Dextroamphetamine%20Sulfate%20Tablet&st=c

U.S. Food & Drug Administration. (2023). FDA Announces Shortage of Adderall. https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall