Much ink has been spilled over the hallowed tolerance break, affectionately known to us stoners as the slightly threatening, slightly alluring “T-Break.” When you should take them, what they are, why you should take them, and a lot of other thoughtful discussions, that I have participated in, too, all with the goal of being a more thoughtful cannabis consumer. But something in the T-break assumption has always struck me as a little off, a little self-stigmatizing. The baseline assumption is that there’s an inherent threshold of negative amounts of cannabis use for everyone, and I want to try and unpack it here with like-minded readers.

Let me go on record as saying that T-Breaks are incredibly beneficial. While I can only moderately speak to the science behind why, as I’m not a doctor, I also think it’s never a bad idea to evaluate habitual behavior. See if you’re actually paying attention to things, whether or not they are helping or hurting. 

There was a time a couple of years ago, before I got pregnant and had a baby when I was wondering this for myself, whether or not my cannabis consumption was a problem. I smoke a lot of weed. Wake-and-bake, throughout the day puffing and bongs, evening edibles and more bongs and joints. On weekends, I typically also eat edibles during the day. For context, I’m a mother to a one-year-old, a wife, and I help run creative strategy for a media company, in addition to running my cannabis newsletter https://cannabitch.substack.com/. I don’t drink very much, except when tasting wine or cocktails for work, and I’ve got a busy, heady life. I think cannabis helps me—I enjoy how I feel in body and mind after using it, and because I have ADHD, for which I do not take pharmaceutical medication, I also believe it helps to settle my mind and keep me focused.

But I dunno. Everyone else says that smoking lots of weed is very bad for you! Even pro-stoner movies, like Half Baked, revolve around the premise of, “Holy shit, these people light up a lot. Let’s make it a punchline.” At the end of that movie, which is presented as a happy, pro-head conclusion, Thurgood (Dave Chappelle’s character) reveals he’s still smoking weed, which was his struggle versus his anti-weed girlfriend, Mary Jane, all along. Hurrah! But the catch is that it’s still a secret, and the movie fades to black. How is that a win if you still have to hide it!? And that’s just the media that’s created specifically for us. The rest of it is even more judgemental.

So it’s no surprise that anti-weed stigma seeps into even the most THC-laden brains, like mine, even though I should know better. That said, I am a journalist and writer by trade and nature, so I’m down for a little healthy skepticism. I’ve embarked on various T-Breaks of various lengths, some as short as a day or two, others as long as a year, back around a decade ago, and, more recently, one that was about nine months long, give or take (I was pregnant). Before I got pregnant, I was consuming more than I ever had in my life, and that’s where the wondering around my use started to ratchet up in my brain.

For years, I had been at the point where I knew I couldn’t go a day without using cannabis, couldn’t buck the urge. That bothered me in theory more than in practice: my multiple-times-a-day consumption wasn’t affecting my daily life negatively, per se, but I didn’t like nor trust the compulsion. Life took care of that for me in short order: During this period, I became pregnant and promptly stopped consuming anything with THC. Then, I had my baby, who was happy and healthy and who remains so. 

Now, 13 months later, I’m back to consuming throughout the day at levels that would frankly scare most people, especially mothers and folks who have traditional ideas about how mothers should behave and what substances they should consume and when. I work full-time, and I’m firing on all cylinders. I check in with my health practitioners, including my therapist, who is 420-friendly and believes my use helps me manage my ADHD. I spend a lot of time at home with my son and my family. I’m happy, functional, healthy, and, truthfully, currently living my best life.

So, what did I learn after all this thinking and breaking, only to end up more-or-less in the same spot? I’m sure there are many reading this who would be like, “Jackie, you’re addicted to weed,” and that conclusion is supposed to be a bad thing. That I can’t or won’t stop, despite society loudly or quietly hinting I should, and designations swirling around medicine and media like “Cannabis Use Disorder,” which I certainly qualify for, saying my use is problematic. But even if these designations are accurate, if that’s the case, who is it hurting at this present moment? Certainly not me, nor anyone in my family. Not my employers, not my friends. So I’m just not sure it matters, and I think the only person I’ve needed to answer to this whole time is me, and clearly, I lost sight of that. 

So I’m just going to say it once and for all: I consume a ton of weed, and I absolutely love it. Not much more I need to say beyond that.

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In a study that was originally published late last year, researchers unveiled the risks for former cocaine users who may relapse by taking methylphenidate.

Methylphenidate is used as a treatment for attention-deficit hyperactivity disorder (ADHD), and is often recognized through brands such as Aptensio XR, Concerta/Concerta XR-ODT, Jornay PM, and most commonly, Ritalin. As a stimulant drug, these medicines increase brain neurotransmitters such as dopamine and norepinephrine, to help a patient achieve better focus and behavior control. To a lesser degree, methylphenidate can also be used to treat narcolepsy as well.

Methylphenidate is currently a Schedule III substance in the U.S., and has a history of misuse. According to Psypost.org, college students sometimes use methylphenidate to help them focus. Although methylphenidate has shown some promise in studies as a treatment to help people abusing cocaine, it comes with a few concerning side effects such as cravings and relapse. Researchers also found that methylphenidate use in conjunction with fluoxetine (a treatment for depression) actually mirrors the effects of cocaine.

The study entitled “Methylphenidate with or without fluoxetine triggers reinstatement of cocaine seeking behavior in rats,” was originally published in the December 2023 issue of Neuropsychopharmacology, and lead by researchers Lorissa Lamoureux, Joel Beverly, Heinz Steiner, and Michela Marinelli.

Study author Michela “Micky” Marinelli works at the University of Texas as an associate professor, and explained the history behind this unique study topic. “The interest started many years ago, from a creative graduate student I worked with in Dr. Frank White’s lab: Cindy Brandon. Cindy had school-aged children and noticed that more and more children at school were being diagnosed with ADHD and treated with methylphenidate,” Marinelli explained. “She wondered if this could pose a risk to develop stimulant addiction and she set out to study this in rodent models. She found that rats are not likely to self-administer very low doses of cocaine (they are too low to have an effect) but they will self-administer these low doses of cocaine if they have been previously exposed to methylphenidate (Brandon et al., 2001). She continued this line of research as a postdoctoral fellow in Dr. Heinz Steiner’s lab. Dr. Steiner was an expert in studying gene expression and together they found that methylphenidate alters gene expression in the brain in ways that were similar to cocaine, but not quite the same.”

She added that according to Dr. Steiner’s research, methylphenidate elevates just dopamine and norepinephrine in the brain, but cocaine elevates those two as well as serotonin. Because of these similarities. “So he asked: what would happen if people taking methylphenidate also take antidepressant drugs like selective serotonin-reuptake inhibitors (SSRIs), which elevate serotonin. Would the methylphenidate + SSRI combination become cocaine-like?”

Dr. Steiner observed gene expressions in the brain, which revealed the answer to his questions. Together, Dr. Stein and Marinelli wrote a grant study revealing the risks of using both a methylphenidate and an SSRI. “At this point in time, methylphenidate started to be taken not just in the clinic, as a medication for ADHD but also recreationally or as a ‘cognitive enhancer’ so we set out to examine both low and high doses of methylphenidate, to mimic (as much as possible in a rat) doses used in the clinic (low doses) vs. those used recreationally or as a cognitive enhancer (high doses),” Marinelli explained.

In the most recent study, researchers studied male Sprague Dawley rats in a controlled setting. Rats were trained to self-administer cocaine as a way to mimic youth cocaine use. This was followed by a withdrawal phase when cocaine access was removed, where rats exhibited “cocaine-seeking behavior,” which included “nose poking” whenever they would receive the cocaine. Then an extinction phase followed, where the rats would learn to no longer exhibit that behavior.

The next step included giving the rats either a high dose of methylphenidate or a combined dose of methylphenidate and fluoxetine to see if the rats would relapse and begin exhibiting cocaine-seeking behavior once again. “One needs caution extrapolating studies in rodents to human,” Marinelli said to PsyPost in an interview. “But at least in rats, if one has previously taken cocaine, taking methylphenidate can push that individual (rat) to seek cocaine again. This happens at high doses of methylphenidate, comparable to those used recreationally or as a cognitive enhancer.”

Researchers also observed that there was no significant difference between rats who took methylphenidate alone, or the combined methylphenidate with fluoxetine, showing that fluoxetine doesn’t impact the effect. “We were surprised that adding a SSRI (fluoxetine) to methylphenidate did not exacerbate the effects of methylphenidate,” said Marinelli. “The effects we saw were due to methylphenidate alone.”

It’s easier to study rats in an isolated, controlled environment versus studying humans, which leaves much to be desired in human observations. “It will be important to examine how much this work translates to human populations,” said Marinelli. “These are difficult to study as, unlike rats, they are not in a controlled environment, where we can determine the dose, duration, and manner in which they are exposed to different drugs or medications or treatments.”

The rats also did not have ADHD, which could lead to different results in a human trial. “When I teach about addiction in summer camps or to undergraduate students, I ask how many of them know of someone who has taken methylphenidate as a cognitive enhancer. Almost all raise their hand. When I then ask them if any of them have, nobody raises their hand—so self-reported use of methylphenidate might be difficult to obtain. Anonymous questionnaires are helpful, but not if one wants to obtain more information from a person, which is only done face-to-face.”

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When it comes to medical benefits, cannabis is often associated with its anti-inflammatory, pain-relieving and sedative properties. But given the versatile nature of the plant, researchers are looking beyond some of the more common qualifying medical conditions to uncover the full medicinal potential of cannabis. 

Though it’s largely under-researched, it’s possible that cannabis could work to help folks with attention deficit/hyperactivity disorder (ADHD) to better manage their symptoms.

A recent observational study published in the journal Neuropsychopharmacology Reports found that, indeed, medical cannabis may be beneficial for people with ADHD — though not necessarily for reasons associated with focus and attention. Rather, researchers found that cannabis use led to observed improvements in the anxiety, sleep quality and health-related quality of life among participants.

While the results are not definitive, authors argue that the findings are substantial enough to hopefully prompt future research on cannabis and ADHD.

ADHD and Cannabis: A Largely Unexplored Potential Treatment Alternative

The team of UK-based researchers aimed to primarily assess the health-related quality of life and safety outcomes in ADHD patients treated with cannabis-based medicinal products (CBMPs).

ADHD has an estimated global prevalence of 5% in children and 2.5% in adults, with estimated incidences of ADHD diagnosis increasing by approximately 42% in children between 2003 and 2011 and 123% in adults between 2007 and 2016 in the U.S., according to the study.

ADHD is a neurodevelopmental condition generally associated with issues with focus, hyperactivity, impulsivity and/or psychosocial differences in managing relationships. ADHD is also associated with a higher instance of sleep disturbance and co-morbidities like anxiety and depression. 

It falls under the neurodivergent umbrella, characterized as a natural variation in how the human brain processes information.

Researchers note that current treatment for ADHD consists of a combination of psychological therapies and both stimulant and non-stimulant medications. However, they note that stimulant medications may come with unwanted side effects, while non-stimulant medications can similarly result in adverse effects that may hinder people from taking them on a long-term basis.

They note that the endocannabinoid system, which cannabinoids like THC and CBD interact with directly, plays a vital role in cognitive function, motor coordination and homeostasis,” suggesting that medical cannabis could be useful in treating symptoms associated with ADHD.

Improvements in Anxiety, Sleep, Quality of Life as Push For Future Research

In order to examine how cannabis use can impact people with ADHD, researchers tracked data on 68 patients from the UK Medical Cannabis Registry (UKMCR) and patient-recorded outcome measures at one, three, six and 12 months from baseline. Eighty percent of the participants already consumed cannabis at the point of initiating treatment.

At each followup, patients answered surveys regarding severity of generalized anxiety disorder symptoms, sleep quality and health-related quality of life. Ultimately, researchers found that all three elements had improved over time.

Specifically, anxiety and sleep quality metrics showed improvement at each check-in over the observed year. Researchers also observed significant improvements in health-related quality of life during the first six months of the study, but by the 12th month there was no difference between those who were current consumers and those who were not.

Just 11 of the 68 participants reported negative effects, largely insomnia, concentration impairment, lethargy and dry mouth. Despite this, nine patients stopped using their other ADHD medication during treatment.

Researchers argue that future research should include comparative analysis on patients in the UKMCR while highlighting the need to conduct high-quality random controlled trials for the treatment of ADHD.

“This case series is the first of its kind in assessing the clinical outcome of patients from the UKMCR with a primary diagnosis of ADHD prescribed CBMPs for up to 12 months,” authors conclude, adding that the preliminary findings suggest that medical cannabis products may play a role in alleviating symptoms, comorbid anxiety and sleep disruption associated with ADHD. 

“CBMPs were well-tolerated throughout this study and the majority of patients (83.82%) did not report any adverse events,” they continue. “Due to limitations in study design, a causal relationship cannot be determined, thus, a definite conclusion cannot be drawn from these results. The findings from this study guide further investigation to assess the therapeutic efficacy and long-term safety profile of CBMPs.”

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Due to a shortage in stimulant-based drugs for ADHD (attention-deficit/hyperactivity disorder), the U.K.’s limited medical cannabis industry is seeing a spike in patients using cannabis for relief as an alternative. The exodus of patients resorting to medical cannabis shows its growing need.

The Guardian reported last September that doctors in England were told not to prescribe ADHD drugs to new patients because of a national shortage. The medications affected include four out of the five top stimulants prescribed to ADHD patients in the U.K.: methylphenidate, lisdexamfetamine, guanfacine,  and atomoxetine.

It’s been compared to the Adderall (amphetamine/dextroamphetamine salts) shortage impacting the U.S. U.S. brand-name drug makers behind Adderall, Vyvanse and Concerta are able to keep up with the shortage, but the generic versions of all three drugs are struggling to keep up. Is it time to panic? Even with these shortages in medication, doctors still say ADHD is under-diagnosed and patients are under-prescribed.

Some of them are turning to cannabis. BBC reports that a medical cannabis clinic said the U.K.’s medical cannabis industry had seen an 86% increase in ADHD patients nationally over the last year.

Some people believe cannabis can alleviate many of the symptoms associated with ADHD as research advances.

Medical Cannabis Is Better Than No Medicine

Medical cannabis, when prescribed by a registered specialist doctor, was legalized in the U.K., mostly in the form of oils and flower, in November 2018. Since then, treatments, including medical cannabis, that meet “appropriate standards” have been reclassified under Schedule 2, meaning that they have medical value. And while the U.K. has very limited availability for medical use, exports are another story: the U.K. was the world’s largest exporter of legal cannabis in 2016.

Research director Dr. Simon Erridge, who also works at Curaleaf Clinic, said it was “natural for people to explore other options” amid the shortage.

The Department of Health and Social Care (DHSC) told the BBC that while there were no cannabis-based medicines licensed for the treatment of ADHD on the NHS, specialist clinicians “can prescribe cannabis-based products where clinically appropriate and in the best interests of patients.”

“Other ADHD products remain available but cannot meet excessive increases in demand,” the DHSC alert states. “At present, the supply disruptions are expected to resolve at various dates between October and December 2023.”

Suddenly losing access to a stimulant-based drug that patients rely on leaves them with few options.

“A lot of people with ADHD may try a number of different medications to find the one that works best for them, if that is suddenly taken away by shortages it’s only natural for people to explore other options and there’s no reason why that might not include medical cannabis,” Erridge said.

Cannabis for ADHD

Depending on the person, cannabis can both help and distract people from focusing.

A January 2020 study called “Cannabinoid and Terpenoid Doses are Associated with Adult ADHD Status of Medical Cannabis Patients” arrived at mixed results, finding that whole-plant cannabis seemed to be more effective.

“The use of purified THC:CBD in a 1:1 ratio (nabiximols) showed no effect on ADHD symptom severity; however, in a qualitative study, 25% of responses indicated that whole-plant cannabis was therapeutic for ADHD,” researchers wrote. “Here, we demonstrated an association between higher CBN and lower ADHD symptoms frequency. It has been previously demonstrated that the combination of CBN and THC is associated with increased psycho-activity of THC in humans. This indicates a more complex story than simply stratifying treatment based on THC and CBD alone.”

Researchers acknowledged that there’s no one-size-fits-all solution to tackling ADHD when it comes to cannabis. 

“There is no ‘simplistic’ method for tracking only the dominant constituents of cannabis to better understand the medical potential of a cannabis cultivar,” researchers continued. “Thus, the novel perspective of our study is extremely valuable for the [medical cannabis] research field.”

Medical professionals who spoke to High Times for an October 2019 article agreed that ADHD treatments are not one-size-fits-all. Brooke Alpert is a licensed cannabis practitioner and founder of Daily Habit. Alpert touched on the correlation between CBD and ADHD. “The studies that focus on ADHD and CBD have shown some conflicting evidence.” 

She added, “I think more research needs to look at what relief people are finding with cannabis so we can have a better picture of how to further recommend CBD and cannabis for those with ADHD.”

Energizing strains like Sour Diesel, Jack Herer, Green Crack have been reported to actually have calming effects on people living with ADHD, even if they make others jittery.

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The U.S. Food and Drug Administration last week announced the voluntary recall of a medicine used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy after the manufacturer of the drug revealed that the wrong pills were found in packages of the medication. The recall covers one lot of the drug Zenzedi, an ADHD and narcolepsy medication manufactured by Massachusetts-based Azurity Pharmaceuticals.

In a notice about the recall, the FDA noted that a pharmacist had reported finding pills of an antihistamine, carbinoxamine maleate, in a package of Zenzedi. The voluntary recall was announced by Azurity on January 24 and covers packages of Zenzedi 30 milligram tablets with lot number F230169A and an expiration date of June 2025.

The recalled medication was distributed nationwide through retail pharmacies. Pharmacies and drug wholesalers have reportedly pulled the drug from their shelves to comply with the recall. Customers who purchased packages of the recalled lot of Zenzedi are urged to return any remaining pills to the place of purchase. Patients who take the mislabeled medication and have adverse reactions are encouraged to see their doctor. 

Drugs Have Opposite Effects

The two drugs have opposite effects when taken, according to a report from CBS News. Carbinoxamine maleate is an antihistamine that is used to treat allergies and has a sedative effect on some patients, while Zenzedi, a brand name for the drug dextroamphetamine sulfate,  is a stimulant that generally increases a patient’s attentiveness. Zenzedi is used to treat narcolepsy, a sleep disorder that causes overwhelming daytime drowsiness, and ADHD.

The FDA added that patients who take carbinoxamine maleate instead of Zenzedi will experience undertreatment of their symptoms. Patients can also have a potentially deadly elevated risk of accidents or injuries and may have drowsiness, increased eye pressure, urinary obstruction and thyroid disorder, among other symptoms, according to the FDA’s recall notice.                                           

“Patients who take carbinoxamine instead of Zenzedi® will experience undertreatment of their symptoms, which may result in functional impairment and an increased risk of accidents or injury,” the FDA wrote in a notice about the recall. “Patients who unknowingly consume carbinoxamine could experience adverse events which include, but are not limited to, drowsiness, sleepiness, central nervous system (CNS) depression, increased eye pressure, enlarged prostate urinary obstruction, and thyroid disorder.”

Azurity Pharmaceuticals sent recall notification letters to drug wholesalers on January 4 via an overnight letter and has arranged for the return of all affected product at the wholesale level. The company said that no reports of serious injury have been made as a result of the mixup.   

Recall Comes During Shortage of ADHD Meds

The Zenzedi recall comes in the midst of a nationwide shortage of medications used to treat ADHD. The shortage has been affecting supplies of the drug Adderall since a manufacturer experienced production delays in Fall 2022, according to a report from CNN.

At least 11 manufacturers of Adderall or generic versions of the drug were listed on the FDA’s shortage list in September 2023. The shortage of ADHD medication has left many patients struggling to fill their prescriptions, according to healthcare professionals. 

“A lot of the young people that I’ve been treating have had difficulties getting their medications month to month,” Dr. Warren Ng, a professor of psychiatry at Columbia University Medical Center who also serves as president for the American Academy of Child and Adolescent Psychiatry, told CNN.

When taking their prescribed medication, many patients with ADHD are able to function better. But when they run out of their medication, it can have a tremendous impact on their self-esteem.

“I’ve seen kids who want to drop out of school, don’t want to continue with their educational path or drop out of college suddenly making the honor roll,” Ng said. And “instead of seeing, being seen as being lazy or dumb or slow, they can envision themselves really utilizing all of their mental, psychological and intellectual abilities to really see themselves for who they are, which is so much more.”

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While the UK-based team found promising data, it comes with a fair share of caveats.

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Unfortunately, the same drugs with high potential for abuse are also the ones that work best for certain individuals with neurobehavioral conditions. According to GlobalData, penetrating the stimulant-dominated pharmaceutical market remains challenging without comparable efficacy from non-stimulants. 

The attention deficit hyperactivity disorder (ADHD) market is a lucrative business: Stimulants, amphetamines, and methylphenidates continue to dominate the ADHD drug market across the seven major markets, Express Pharma reports. (The seven major markets are in France, Germany, Italy, Spain, the UK, the US, and Japan.)

Non-addictive drugs demonstrate a “crippling lower” efficacy in treating ADHD.

Drug makers are in a race to develop safer alternatives. Three out of the four late-stage pipeline drug candidates in Phase III development within those markets have non-stimulant properties: Axsome Therapeutics Inc’s solriamfetol, Otsuka Pharmaceutical Co Ltd’s centanafadine and Neurocentria Inc’s L-Threonate Magnesium Salt. 

The lower abuse potential of solriamfetol and centanafadine is a major selling point created by developers, but without displaying efficacy comparable to stimulants, they will struggle to penetrate the market—even if they are approved.

The use of stimulants for ADHD treatment is increasing.

The key opinion leaders (KOLs) in the treatment of ADHD say that patients and parents have been hesitant to use stimulants for the treatment of ADHD in children and adolescents, but this is changing with time, and the use of stimulants for ADHD treatment is increasing.

“Marketing emphasis on abuse potential is common in non-stimulates both marketed and pipeline; this is despite KOLs viewing the abuse potential of ADHD stimulants as overstated,” said Lorraine Palmer, Pharma Analyst at GlobalData. “The KOLs interviewed by GlobalData were not concerned about whether a treatment is a stimulant or a non-stimulant, rather they are focused on the pharmaceuticals efficacy and side-effect profile.”

Four non-stimulants are commonly marketed: guanfacine, clonidine, atomoxetine and viloxazine. Sleep disturbances and a decreased appetite have been reported from both clonidine and atomoxetine. 

“All four display cripplingly lower efficacy in the treatment of ADHD than stimulants,” Express Pharma reports.

“Rather than an emphasis on abuse potential, a better alternative strategy to penetrate the saturated ADHD market would be to target key unmet needs in ADHD treatment such as improving compliance or providing coverage into the evening without affecting sleep.”

Part of this challenge likely includes the impact of addiction itself.  Regarding the popular ADHD drug Adderall, adults and children 6 years of age and older are eligible to take Adderall, beginning at 5 milligrams, while children 3 to 5 years of age are able to start at 2.5 mg per day. Only children under the age of 3 are prohibited from being prescribed the drug in all cases.

Adderall’s active ingredients are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate. Columbia University psychiatry professor Carl Hart famously wrote for Vice in 2016 that meth is “almost identical to Adderall” in terms of chemistry and its effects on the brain.

A 2016 study published in the Journal of Clinical Psychiatry indicates that an increasing number of young adults have been checking into emergency rooms over the past few years due to accidental overdoses on Adderall and similar drugs.

Other Reasons for Stimulant Alternatives

High Times reported last September that leading drug makers and pharmaceutical companies are having little luck addressing nationwide shortages of stimulant-based ADHD medications like Adderall, Vyvanse, and Ritalin.

The Adderall shortage began in Fall of 2022, marked by an FDA notice acknowledging the shortages with an estimate that things would be resolved in a month or two. That is not the case, however, as issued a joint notice on August 1 acknowledging that the shortage had been “understandably frustrating” for patients and providers.

“The current shortage of stimulant medications is the result of many factors. It began last fall due to a manufacturing delay experienced by one drug maker,” the joint notice said. “While this delay has since resolved, we are continuing to experience its effects in combination with record-high prescription rates of stimulant medications. Data show that, from 2012 to 2021, overall dispensing of stimulants (including amphetamine products and other stimulants) increased by 45.5 percent in the United States.” 

Teva Pharmaceuticals, Adderall’s biggest manufacturer, reported shortfalls. Teva CEO Richard Francis told Bloomberg that the company is operating at “full capacity” at the moment and blamed their decreased output in previous years to COVID-induced work shortages which they have only just barely recovered from. Should they wish to increase the amount of Adderall they produce, they would have to buy or build more factories as their current infrastructure cannot handle bigger output. The company has declined to comment on whether or not they plan to invest in such infrastructure.

This adds to the multiple reasons less addictive non-stimulant drugs are needed to treat ADHD.

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The biggest manufacturer of Adderall will not be increasing production to address national shortages of ADHD medication, despite a call from the U.S. government for drug makers to do exactly that.

Teva Pharmaceuticals Chief Executive Officer Richard Francis told Bloomberg that they are operating at “full capacity” at the moment and blamed their decreased output in previous years to COVID-induced work shortages which they have only just barely recovered from. Should they wish to increase the amount of Adderall they produce, they would have to buy or build more factories as their current infrastructure cannot handle bigger output. The company has declined to comment on whether or not they plan to invest in such infrastructure.

The pharmaceutical giant valued at just under $11 billion manufactured about 565 million Adderall tablets in 2021 but that was not enough, even with all the other producers in the market, to supply an exponential growth in national demand for ADHD medication or to address what drug makers have alleged are shortages in the materials needed to synthesize such medications. 

The Adderall shortage began in Fall of 2022, marked by an FDA notice acknowledging the shortages with an estimate that things would be resolved in a month or two. That is not the case, however, as issued a joint notice on August 1 acknowledging that the shortage had been “understandably frustrating” for patients and providers.

“The current shortage of stimulant medications is the result of many factors. It began last fall due to a manufacturing delay experienced by one drug maker,” the joint notice said. “While this delay has since resolved, we are continuing to experience its effects in combination with record-high prescription rates of stimulant medications. Data show that, from 2012 to 2021, overall dispensing of stimulants (including amphetamine products and other stimulants) increased by 45.5 percent in the United States.” 

The joint notice did not give any kind of an estimated date this issue is expected to be resolved by, but instead urged drug makers to increase production to meet their allotted limits for production of a controlled substance. In fact, by the estimate provided, drug manufacturer’s only sold 70% of their collective allotment for these particular types of medications, which by the government’s own estimate equated to about a billion doses that did not get produced or sold.

“We (DEA and the FDA) have called on manufacturers to confirm they are working to increase production to meet their allotted quota amount,” the joint notice said. “If any individual manufacturer does not wish to increase production, we have asked that manufacturer to relinquish their remaining 2023 quota allotment. This would allow DEA to redistribute that allotment to manufacturers that will increase production. DEA is also committed to reviewing and improving our quota process.”

The American Society of Health-System Pharmacists also reported last week that 141 different doses or formulations of ADHD medications were in short supply. The shortage was originally isolated to Adderall but as buyers and patients alike sought alternatives, supply of competing drugs like Vyvanse and Ritalin quickly dwindled. The ASHSP also indicated there were no estimated times for the majority of the shortages to be resolved, other than a short list of select medications produced by Sandoz Pharmaceuticals which are estimated to be back in stock sometime around mid-October.

No matter the cause, the shortages don’t appear to be going away anytime soon, especially with Teva unable to produce more than they currently are. Patients everywhere have reported issues refilling their prescriptions. A friend of mine told me she often ends up getting charged extra (double or triple the usual amount) for out-of-network pharmacies and extra doctor visits because pharmacies either don’t have the medication in stock or refuse to fill prescriptions for controlled substances. This process often delays access to medication that, without getting too redundant, is very unpleasant to go without when you have to take it regularly.

“We are calling on key stakeholders, including manufacturers, distributors, pharmacies, and payors, to do all they can to ensure access for patients when a medication is appropriately prescribed,” the FDA/DEA joint notice said. “We want to make sure those who need stimulant medications have access. However, it is also an appropriate time to take a closer look at how we can best ensure these drugs are being prescribed thoughtfully and responsibly.”

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With ADHD, life can feel like everything is happening all at once, making it hard to focus or prioritize. Is there evidence that cannabis can ease or manage its symptoms?

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