Administrative Burdens of Being Sick: Drugs

I sat down the other morning to fill my pill sorters for another month and discovered that the pharmacy only dispensed ten pills, instead of 30, for the prescription I’d filled the previous day.

I called them up and left a message. No reply.

I drove back to the pharmacy with the bottle. Did my doctor’s office make a mistake in the prescription, or was there a mistake in filling? Good question, said the pharmacist.

Tap tap tap.

We ran out, he said. We don’t know when we will have more. No, we can’t call you when we get more in. No, we can’t give you the rest of the prescription. You’re going to need a new prescription from your doctor. And you can’t fill it for ten days.

I got so frustrated I walked off to calm down, and then went back and apologized to the pharmacist for dumping drama on their day. They were very, very nice about it.

It’s of those ADHD meds. A controlled substance. So the hurdles for filling the prescription are high, very high. 

Once, I waited for half an hour in a busy CVS because the pharmacists had to keep the stuff in a vault, enter a passcode, and wait three minutes. They kept missing the window to open the safe because they were busy helping other patients.

Everyone needs their meds.

But why shortages?

It’s not just ADHD meds — weight-loss drugs and antibiotics also regularly run short, making patients sicker (and sometimes dead) while doctors sink even deeper into bureaucratic quicksand. Almost nine out of ten primary care practices, and one in five patients, struggle to get the medications they need.

For one thing, there’s a profit motive. Is there ever not a profit motive?

Pharmaceutical companies aren’t doing research on antibiotics because they don’t think they’ll make money on them. Insurance companies pay as little as they can manage — which seems reasonable given the cost of drugs with no generic equivalent, but then pharmacies lose money and stop stocking the meds. Which brings us back to the manufacturers, and how they use legal games to keep patents in force.

Albuterol, a widely used asthma medication, was developed in 1966, first sold in 1969, and patented in 1972. The most recent patent expired, finally, in 2020. 

But the supply of ADHD medications has unique limitations.

The DEA says ADHD meds are addictive and controls how many pills can be made every year. In 2022, they cut production of one group of ADHD drugs by almost 30%, resulting in immediate shortages. Drug manufacturers exacerbated the issue by failing to produce their full quotas.

Meanwhile, Covid lockdowns saw ADHD symptoms get worse among young people worldwide, while ADHD diagnoses zoomed* among adults, as demands on executive function increased dramatically with remote work and school. This predominantly affected women, because they (we!) do most of the child and elder care, and because girls with ADHD are so often called ditzy and spaced-out — or misdiagnosed with anxiety or depression.

When I was diagnosed with ADHD and finally started meds, I could suddenly get things done, which made me realize I wasn’t actually lazy, disorganized, and dumb, which in turn vastly improved my mental health. Go figure.

But why are ADHD meds even regulated? 

The idea that disease is caused by weak discipline or poor life choices is widespread and long in the tooth. 

Mental health stigma is particularly deeply ingrained. Denial that ADHD even exists persists, long after it was added to the DSM in 1980 (as ADD). No one (I hope!) would object to stabilizing a broken bone with a cast, but the current US Secretary of Health thinks medications for depression, ADHD, and weight loss are a threat to Americans’ health.

Despite claims of soaring stimulant abuse, 1.4 percent of people older than 12 misuse ADHD medications, and the numbers have gone down in the past decade. 

It is hard to find data on adverse effects experienced by people who misuse ADHD drugs, partly because studies of overdoses often lump them together with other  prescription and black-market stimulants. Large studies of adverse effects associated with ADHD medication abuse report rates of serious side effects between 0.2 and 0.4 percent, though smaller studies have found higher rates; a handful of deaths are reported (pdf, page 106).

For context (pdf, pages 2, 10): In the US in 2024, almost three out of five people older than 12 had used any illicit drug, consumed alcohol, and/or used tobacco in the month before they were surveyed; one in five binge drank. More people used cocaine (1.5%) or hallucinogens (3.6%) than took ADHD medications they hadn’t been prescribed (1.4%, pdf, pages 10, 12, 17).

More context: Drug overdose killed 80,000 people in 2024. Drinking caused about 178,000 deaths annually, in 2020 and 2021. Tobacco use is linked with half a million deaths every year. 40,000 people died in car accidents in 2023.

Medication is really helpful for people with ADHD. 

People with ADHD who take medication have 40% fewer injuries in car crashes. Women on ADHD meds are 41% less likely to commit crimes. (Among men, it’s 32%). Both men and women are 31% less likely are to abuse non-prescription drugs, an effect that holds even after they stop taking ADHD meds.

On top of that, people with ADHD are at higher risk for dementia — but not if they are medicated for it. Fifty percent of people older than 75 are expected to get dementia, mostly women, and it’s not just that we live longer: at any age, almost two times more women than men get diagnosed. 

I’m not likely to start committing crimes or taking cocaine, but I’d love to live out my life without losing my mind, or at least, not losing more of it than Long Covid already took.

And I would love to know why it’s harder to get medication for ADHD than it is to buy a cigarette, a bottle of tequila, or a car.