Jeremiah is in his early 20s and works for a beverage distributor in Bangor, Maine. He began taking medication to treat his ADHD after college and is now prescribed Adderall.
“I take it every morning, usually around like seven or eight [a.m.]," he said. "But then on weekends when I wake up at nine, it can be a little later.”
Jeremiah, who requested his last name be withheld for privacy reasons, is one of many Mainers to be prescribed stimulant medication. Two years ago, the United States began experiencing a nationwide shortage of medications. While the shortage is affecting millions of Americans it's a particular challenge for patients in a rural state like Maine.
Stimulant medications such as Adderall, Ritalin, and Vyvanse are highly effective in treating people with attention deficit hyperactivity disorder, but the drugs carry a high potential for abuse. As such they’re categorized as Schedule II drugs in the U.S. — the same label given to powerful opioids such as oxycodone and fentanyl.
This regulation comes with more restrictions compared to more common drugs — including pharmacies not being allowed to automatically refill stimulant prescriptions every month. This means patients must call their prescriber and request a new prescription be sent to their pharmacy. Two years ago when the U.S. Food and Drug Administration announced there was a shortage of the key ingredient in Adderall. Other stimulants began suffering similar shortages, and have since become much harder to find.
“Many times out in community pharmacies, it becomes a first come first serve scenario,” said Matt Marston, the Chief Pharmacy Officer for Northern Light Health, Maine's second-largest healthcare system. “Once you run out of that medication in your pharmacy, it’s then left to the patient and the patient’s provider to try to hunt down and locate that medication that’s in short supply. So that causes people to have to shop around at a variety of different locations.”
The reason for the stimulant shortage is unclear: a mixture of supply chain issues for pharma manufacturers, and government medication quotas not keeping up with the surge in prescriptions created during the pandemic. Regardless, it's now on consumers to track down and locate their medication.
Becca Kennedy of Freeport said she spent two hours tracking down a pharmacy that could refill her husband and teenage son’s ADHD prescriptions last month.
"Just the constantly having to call doctor’s offices, pharmacies, and then the driving," said Kennedy. "It’s just stressful to have to plan your life around that stuff."
Contributing to the stress are the narrow refill windows set by Schedule II regulations — where patients can only request a refill when they are down to just a couple of days of medication remaining. That leaves patients with little time to refill their medication before running out completely.
Kristina Faulkner lives in Dyer Brook, a town in Aroostook County with 200 people. Living in a rural area with very few pharmacies, Faulkner said she’s driven up to 3 hours to get her 12-year-old daughter’s monthly prescription.
"[I've driven to] Presque Isle, which is 80 miles [away]," said Faulkner. "I was actually going to be traveling to Bangor one day to get another month’s worth of medication. I mean, I was willing to go to all ends to get my daughter this medicine. And I don’t think parents should have to do that."
The shortage has also sent drug prices skyrocketing, with certain medications doubling in cost according to some reports. During the worst of the shortages, there aren’t many options for prescribers and patients. A common strategy that some patients have turned to is rationing – skipping their medication on certain days, to ensure it is there on days they have to work or go to school.
“[Going off medication] destabilizes patients,” said Dr. Jeff Barkin, the former president of the Maine Medical Association and the Maine Association of Psychiatric Physicians. "If patients can’t get their medications, they do poorly. I mean, that’s intuitively obvious."
Dr. Barkin continued, "By definition for something to be a disorder, it has to cause functional impairment. So it’s not just procrastinating, it’s a level of putting off tasks and avoiding tasks that require sustained mental effort — to the point where you can’t get your work done, you can’t get your schoolwork done, you can’t sustain relationships."
After calling his prescriber at Northern Light Health to get the refill process sorted, Jeremiah managed to get his medication refilled for this month because his local pharmacy had enough Adderall in stock. But with the shortage still ongoing, there’s no telling what next month’s refill will be like.
This cycle would be exhausting for anyone, but it’s particularly tough for those with ADHD, who often struggle with organization and executive functioning. Still, Jeremiah said it’s worth the effort every month to get the treatment he needs.
"It’s almost like I’m alright with jumping through hoops as long as [I get] the result that I want," said Jeremiah. "But sometimes it happens where I do jump through all these hoops [and] I call again and again and again. And no one answers, no one takes care of it and I suffer. So that’s the crappy part, for sure."
It's unclear to experts and patients alike as to when the shortages will finally be resolved. In May, the U.S. Senate Finance Committee drafted legislation that would incentivize health companies to help mitigate drug shortages, but would not be implemented until 2027 if it’s passed.
