Understanding the Stimulant Shortage

The ongoing stimulant shortage has been described as a "perfect storm" and has made treating attention-deficit hyperactivity disorder (ADHD) all the more difficult. As conditions continue to get worse, it is important for clinicians and other mental health professionals to better understand the challenges they're facing both as providers and for their patients. In an interview with Psych Congress Network, Greg Mattingly, MD, associate clinical professor at Washington University in St. Louis and president of the Midwest Research Group, discussed the crisis and examined what clinicians can do in the meantime.

Mattingly's Psych Congress 2023 session, "Navigating the Stimulant Crisis," will also give clinicians and other mental health professionals an update on the shortage, recent FDA warnings in stimulant labels, and strategies to manage the growing demand.

Stay up to date on all conference coverage in our Psych Congress Newsroom. 

Read the Transcript: 

Greg Mattingly, MD: I'm Greg Mattingly, an associate clinical professor at Washington University and president of the Midwest Research Group in St. Louis, Missouri, proud to be here at Psych Elevate 2023 in beautiful Las Vegas.

One of the biggest issues facing clinicians currently is the stimulant crisis. Right now, all across America, children, adolescents, and adults with ADHD are struggling to find their medication. So we have nationwide shortages across the various stimulant categories, and pretty much every generic ADHD medicine has faced shortages over the last six months to a year. When we look at the causes of the stimulant shortage, it's kind of the perfect storm. And the perfect storm was over the last 10 years, we've had increased recognition that ADHD doesn't disappear in childhood, but it can persist into adulthood.

So over the last 10 years, we've increased the diagnosis of adults with ADHD. A lot of women who are missed as children are now coming in saying, "Listen, I've struggled since I was a child. I didn't do well in school. I'm overwhelmed as an adult. I came in to see somebody for anxiety, but I don't think that's what this is. Could it be ADHD?" So we saw a growing increase in especially women coming in, being evaluated to see if they have ADHD. Right at that same time, COVID hit. And for anybody who was vulnerable cognitively, anybody who was already prone to ADHD symptoms, had been treated in the past, all of a sudden now their ADHD was overwhelming. So we saw an increased number of people coming in as a result of the stress of COVID. The digital world we currently live in and the breakdown within our social fabric within the society all increased the number of people coming in for ADHD.

So we have an increased demand. We have increased awareness. We have increased recognition of adult ADHD. Unfortunately, at that same time, we had a set and limited quantity of ADHD stimulants that were being produced. So the FDA had set limit caps on the amount of stimulant medication that can be produced, and many of our generic manufacturers became concerned. They didn't want to be accused of oversupplying the market. So you see that many of our generic manufacturers, some of our largest ones, have limited their production of ADHD medicines. So when we talk about short-acting amphetamines, many of those are in very short supply because the very generic manufacturers have limited production of those compounds.

What I would say for all of our clinicians, this is a time to step back with your patients and proactively say, "Okay, what's going to be the best treatment for you going forward?" That best treatment may not be a short-acting stimulant. It may be converting over to a longer acting medicine that still has supply. That best treatment may be thinking about the option of a non-stimulant. Maybe you've tried a stimulant in the past, but maybe a non-stimulant could help to provide your needs throughout the day without having the burden of taking a stimulant every day. And most of our non-stimulants have had very little shortages when it comes to availability.

So proactively work with your patient, think about transitions to take them off of those short-acting stimulants and find long-acting options that are available, and always consider non-stimulants for your patients.

Greg Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group. He is also a founding partner of St. Charles Psychiatric Associates where he treats children, adolescents, and adults. A St. Louis native, he earned his medical degree and received a Fulbright scholarship while attending Washington University. Dr Mattingly is board certified in adult and adolescent psychiatry and is a Diplomat of the National Board of Medical Examiners. He is an Associate Clinical Professor at Washington University where he teaches psychopharmacology courses for the 3rd year medical students. Dr Mattingly has been a principal investigator in over 400 clinical trials focusing on ADHD, anxiety disorders, major depression, bipolar disorder and schizophrenia. Having served on numerous national and international advisory panels, Dr Mattingly has received awards and distinctions for clinical leadership and neuroscience research. Dr Mattingly currently serves on the board of directors for APSARD-The American Professional Society of ADHD and Related Disorders and is a certified evaluator for the NFL regarding ADHD and head concussions.