The Growing Challenges of Accessing Prescription Stimulants: What Patients Need to Know About ADHD, Access, and Misuse

The Growing Challenges of Accessing Prescription Stimulants: What Patients Need to Know About ADHD, Access, and Misuse

Managing ADHD can be life-changing, but for many patients, especially adults, navigating treatment options has become more complex than ever. At Philadelphia Integrative Psychiatry, Dr. David Danish and his team remain on the front lines of this evolving landscape. From evaluating stimulant effectiveness to educating patients about potential risks and shortages, our integrative approach ensures that care is both evidence-based and highly personalized. We stay up to date with national research trends to make sure every treatment plan we create aligns with the latest safety and prescribing guidance.

A recent article published in JAMA Psychiatry, titled “Prescription Stimulant Prescribing, Nonmedical Use, and Shortages: US FDA Research and Response,” explores a growing public health issue that’s impacting many of our patients: a sharp increase in adult stimulant prescriptions, the resulting medication shortages, and rising concerns around nonmedical use. These issues are especially relevant as more adults are being diagnosed and treated for ADHD than ever before.

Why Are ADHD Medications Harder to Get?

In recent years, adult diagnoses of ADHD have surged. Between 2012 and 2022, there was a 58% increase in the dispensing of prescription stimulants, with a threefold increase among adults aged 31 to 40 during that time frame [1]. This dramatic rise, especially during and after the COVID-19 pandemic, has significantly strained the supply chain.

Unlike most medications, stimulants are Schedule II controlled substances. This means their production is strictly limited by the DEA, regardless of demand. As a result, shortages aren’t just about supply chain hiccups—they’re baked into the system. Shortages may occur if manufacturers don’t use their full DEA production quotas or if quotas are distributed inefficiently across producers. Additional pressure has come from legal scrutiny following the opioid epidemic, causing distributors to become more cautious in filling controlled substance orders.

The Nonmedical Use Debate: What the Data Really Shows

Stimulants such as mixed amphetamine salts, methylphenidate, and lisdexamfetamine are considered first-line treatments for ADHD, but their potential for misuse is a concern. According to the 2023 National Survey on Drug Use and Health, approximately 3.9 million Americans aged 12 and older reported nonmedical use of prescription stimulants in the past year [2].

However, data shows that nonmedical use has not increased in proportion to prescribing rates [2,10]. Research suggests that when misuse occurs, it is often situational—such as using medication to improve performance temporarily—and not indicative of sustained substance abuse [3]. Still, FDA-mandated boxed warnings on these medications, updated in 2023, now uniformly emphasize the risks of addiction and nonmedical use.

Why Treating Adult ADHD Remains Critical—Despite the Risks

While stimulant prescribing is under scrutiny, untreated adult ADHD carries serious consequences. Studies have linked it to higher mortality rates [4] and poorer functional outcomes in areas such as work performance, relationships, and mental health [5].

Yet, adult ADHD remains underdiagnosed and inconsistently treated. The FDA recently funded a National Academies of Medicine workshop that revealed major gaps in diagnostic criteria, clinical guidelines, and provider education regarding adult ADHD [3]. In response, the FDA has funded new research efforts through the Agency for Healthcare Research and Quality to assess diagnostic accuracy, treatment safety, and misuse trends—key information that can eventually shape future prescribing policies.

FDA and DEA: What’s Being Done About the Shortages?

The FDA's Drug Shortages Staff is actively working with manufacturers and the DEA to improve production efficiency and alleviate backlogs. In 2023 and 2024, the FDA formally notified the DEA about shortages of methylphenidate and lisdexamfetamine, prompting quota increases. However, despite these efforts, stimulant shortages persist. At Philadelphia Integrative Psychiatry, we help patients explore alternative treatment strategies when needed and offer close monitoring to adapt treatment plans during shortages.

Getting in Touch with Dr. Danish and His Team

Whether you’re struggling with ADHD symptoms or want a second opinion on your current medication regimen, our team is here to help. At Philadelphia Integrative Psychiatry, we combine in-depth psychiatric evaluations with integrative solutions, tailoring each treatment plan to the patient’s unique needs. We also stay up to date with national shortages and prescribing guidelines, ensuring that your care remains uninterrupted and aligned with the latest safety standards.

For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:

https://phillyintegrative.com/blog/the-link-between-adhd-symptoms-and-youth-nicotine-use-what-the-latest-research-reveals

Sources

1. https://www.dea.gov/drug-information/drug-scheduling

2. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report

3. https://doi.org/10.1016/S0140-6736(14)61684-6

4. https://doi.org/10.1016/j.jaac.2016.07.774

5. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapsychiatry.2023.5045

6. https://www.fda.gov/patients/learn-about-fda-patient-engagement/patient-listening-session-summaries

7. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapsychiatry.2025.0099