The Adderall Shortage

I recently had my early community immersion experience this past January and February in Asheville, NC. During my time, I kept hearing about an Adderall shortage, and would answer phone calls daily from patients wondering if more Adderall had come in. I was curious as to how there was a shortage, as I couldn’t really imagine that manufacturers simply couldn’t make enough of the product. After doing some research, I found a helpful article written by Matt Stoller, that explains how the shortage is a result of monopolies and has origins in the opioid crisis.  

I’ll summarize some of the things I learned and link Matt Stoller’s article below for more in-depth information, if you’re interested. In short, the opioid crisis was the product of “absentee ownership”. Big wholesalers like Cardinal Health, McKesson, and Amerisource Bergen distributed medications neglectfully, oftentimes to pharmacies that were fronts for organized crime. These massive wholesalers weren’t doing this maliciously, or even to try and sneak a profit. They were simply too large to know their clientele, and just didn’t pay attention. As a result, controlled substances made their way to the streets and brought about the opioid crisis.  

Eventually, there was a settlement where distributors paid money to resolve state litigation involving opioids, for the sake of justice and expelling illicit profits. In addition to this payment, distributors had to follow new rules that rationed the controlled substances they could sell. They had to monitor for “red flags” amongst their customers, a big one being that if the amount of a controlled substance a customer dispenses has grown too much, then they can be “blacklisted” and the wholesaler will not sell them anymore controlled substances. The issue is that wholesalers use algorithms to calculate the quantities their customers can sell. Since the settlement, it has become increasingly difficult for pharmacies to explain to their wholesalers if they have an increase in demand, as the caps set by the algorithm are incredibly rigid.  

However, this results in a vicious cycle. If one pharmacy hits their algorithmic cap and is blacklisted, then patients have to get their controlled medication from a different pharmacy. If these customers all go to a different pharmacy, then eventually that pharmacy will reach its wholesaler’s cap, and the situation just continues to worsen.  
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It is technically possible for pharmacies to just get their controlled substances from smaller wholesalers that don’t have these algorithms. However, pharmacies are locked into contracts with big wholesalers usually to purchase at least 90% of their generics from them. They might be able to get some controlled substances from these smaller wholesalers, but not nearly enough to meet demand. So, there’s a deadlock – pharmacies can’t get their controlled substances from big wholesalers after they’ve reached the cap, and they also can’t get enough from smaller wholesalers because they’ve already signed a contract to purchase a massive majority of their medications from the big wholesaler.  

As a result of the opioid crisis, there is an Adderall shortage, community pharmacies suffer from absentee ownership from their wholesalers, and smaller wholesalers are unable to get into the market. If you’re interested in learning more, I again encourage you to check out what Matt Stoller has written and discovered about the topic! 

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Written by: Andrew Nguyen

Source:
https://mattstoller.substack.com/p/the-monopolies-behind-the-adderall?utm_source=substack&utm_medium=email