The Guardian (USA)

Why is it so hard to get my ADHD medication in the US?

- Tom Hawking

Back in 2019, I was diagnosed with ADHD at age 40, a process I described for the Guardian. The diagnosis came as a surprise to me, but not to anyone I knew: sure, I’d never been especially hyperactiv­e (or even, y’know, active), but the chronic lateness, difficulty concentrat­ing, lack of emotional self-regulation and decades-long struggle to locate my keys … these were all classic symptoms.

I was prescribed a medication called Vyvanse, which I’ve been taking daily since. It’s proven immensely helpful, allowing me to settle into a reasonably steady routine of writing and working. The days when I just can’t get anything done have been further and further separated by periods of unpreceden­ted productivi­ty.

In other words, everything has been going pretty damn well on the ADHD front. Or at least, it had until July this year, when I moved to the US.

I lived in New York City for most of the 2010s, returning to my native Australia in late 2017 when the company for which I was working went bust. My American partner joined me in Melbourne. We got married and applied for a green card. Then Covid happened, etc, etc, and it wasn’t until July 2023 that we packed our bags and moved back to New York.

Obviously, I made sure to bring as much Vyvanse as possible with me. “As much as possible” turned out to be two months’ worth, and the first month of our return was occupied exclusivel­y with finding a place to live. Once that was sorted, though, my Vyvanse supply had started to wane, and with a twoweek trip out of state on the horizon, I began looking into getting a new prescripti­on.

Anyone who’s blessed enough not to have experience­d the US’s, um, idiosyncra­tic approach to healthcare might think that this process should have been relatively straightfo­rward.

After all, I am a responsibl­e adult, I’ve been happily taking the medication in question for five years without issues, I have a letter from my doctor attesting to that fact (along with medical records, etc), and I used my newfound freedom to choose an insurance plan to select one that specifical­ly covered ADHD medication­s.

If so, let me gently disabuse you of that notion, because getting Vyvanse in the US in 2023 is a nightmare.

There are two reasons for this. The first is that there’s clearly been a reaction to the opioid fiasco of the 2010s, an era in which I walked away from a root canal with a no-questionsa­sked prescripti­on for 60 Vicodin tablets. Sadly, that reaction hasn’t been anything as sensible as “let’s reform our outdated, pointlessl­y punitive drug laws and throw the Sacklers in prison until the heat death of the universe.” No, it’s been more along the lines of “let’s impose ever more insane restrictio­ns on ‘controlled substances’ and treat anyone trying to obtain them with suspicion.”

The amount of damage this has done to anyone unfortunat­e enough to need prescripti­on opiates to manage pain has been welldocume­nted, but there’s also been a huge overcorrec­tion in regard to other “controlled sub

stances”. Today, just finding a doctor who will prescribe ADHD medication­s is something of an ordeal: most general practition­ers won’t even consult on ADHD, let alone prescribe medication­s. You might have more luck with a psychiatri­st, except that my insurance plan requires a referral from a general practition­er to see a psychiatri­st, which would be fine but for the fact that general practition­ers won’t see you about ADHD, so … sigh.

The first general practition­er who agreed to actually speak to me insisted on trying to diagnoseme with ADHD – a condition with which I have already been being treated for five years, remember – before she’d “even consider” prescribin­g anything. Thankfully, several weeks after my search began, I finally found a doctor who agreed to give me a prescripti­on once she saw the letter from my doctor in Australia. She even offered to set me up with an innovative online pharmacy who’d deliver the medication to my door.

Hurrah! Now I just have to fill the script, and – oh dear Lord. Why does that say “$444.16”?

You may remember that my insurance plan specified explicitly that it covers ADHD medication­s. Well, it turns out that “we cover ADHD medication­s” actually means “we may in fact cover ADHD medication­s – but we may also choose not to, especially if we reckon we can put you on something cheaper.” Again, one might think this would be a question for a doctor, an idea to which the insurance industry’s collective response appears to be “lol”.

OK. Fine. It took a couple of days to sort prior authorizat­ion, and now all I had to do is get the innovative online pharmacy to schedule a delivery.

Wednesday? That’s perfect, because I fly out on Thursday. I’m sure they’ll tell me well in advance if there are any problems. I mean, they wouldn’t do anything as obnoxious as wait until Wednesday night to tell me that they’re out of stock, right? Right?

Oh. And this leads to the second reason why this process has been so awful: there is a severe and ongoing shortage of ADHD medication­s in the US, one whose effects have extended to other countries around the globe. Given that amphetamin­es were first synthesize­d in the 1880s and the cartels seem to be pumping out vast quantities of methamphet­amine happily enough, you might wonder why ADHD meds are so hard to find.

The intuitive answer is that because Vyvanse, Adderall and the like are controlled substances, the Food and Drug Administra­tion (FDA) and Drug Enforcemen­t Administra­tion (DEA) put quotas on their production. However, while it’s hard to know exactly what’s going on, the answer doesn’t seem to be as simple as “the feds won’t let drug companies manufactur­e enough supply.”

A letter issued by the FDA in August 2023 noted that “based on DEA’s internal analysis of inventory, manufactur­ing, and sales data submitted by manufactur­ers of amphetamin­e products, manufactur­ers only sold approximat­ely 70% of their allotted quota for the year, and there were approximat­ely 1bn more doses that they could have produced but did not make or ship,” and that “data for 2023 so far show a similar trend.”

Anyway, the reasons for the shortage don’t matter when you’re just trying to get your medication. And hoo boy, whether or not the controlled substance laws are behind the shortage, they make the process of trying to fill a script absurdly, needlessly difficult. Can I get an actual physical prescripti­on and then ask around until I find a pharmacy? Nope. “Sorry, sir, this is a controlled substance.” Instead, I have to call the doctor and get them to send the prescripti­on to a specific pharmacy. But how to know whether a given pharmacy has stock? Can I call around and ask? “I’m sorry, sir, we can’t tell you that. It’s a controlled substance.” You can’t … go and look in the supply cabinet? “No, sir, it’s a controlled substance.“

There’s something especially obnoxious about forcing people with

Hurrah! Now I just have to fill the script, and – oh dear Lord. Why does that say '$444.16'?

an executive function disorder to negotiate a system so byzantine it’d give Franz Kafka conniption­s.

As I write this – and by God, has writing this ever been a trial – I’ve been unmedicate­d for over a week. I have weird episodes of something that’s not unlike narcolepsy, where out of nowhere, I suddenly get overwhelmi­ngly sleepy. I have intermitte­nt headaches – actual physical ones, in addition to the plentiful metaphoric­al ones that come from trying to deal with this nightmare. And the mental static to which I referred to in my original piece is back with a vengeance: concentrat­ion is slippery and ephemeral, and my attention wanders like a kitten constantly finding new things to play with.

The final irony is that if Vyvanse was any fun, I could probably have it illegally delivered to my door in half an hour, like any other illicitly recreation­al drug for which the US has an appetite. But the thing is that, as a prodrug, with its amphetamin­e component tied to an amino acid molecule, Vyvanse only has bioavailab­ility if swallowed. Just like everything else about this hellish process, it is, in fact, no fun at all.

Tom Hawking is a Melbourne-born writer based in New York City whose work examines the intersecti­ons of politics and culture

 ?? Photograph: SIphotogra­phy/Getty Images/iStockphot­o ?? ‘As I write this – and by God, has writing this ever been a trial – I’ve been unmedicate­d for over a week.’
Photograph: SIphotogra­phy/Getty Images/iStockphot­o ‘As I write this – and by God, has writing this ever been a trial – I’ve been unmedicate­d for over a week.’

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