Amid a national shortage, Adderall’s U.S. black market is booming

PIf you use an online marketplace like Craigslist, you’ll find coded ads for “Study Help” and “Study Hall,” or call looking for a “Study Buddy.” Despite the scientific language, these are not people looking for a pre-final cram session. They are plug-ins for Adderall: the trade name for a combination of amphetamine salts that has long been prescribed as the first-line treatment for ADHD (Attention Deficit Hyperactivity Disorder). It’s a drug that’s been in dangerously short supply lately.

This is estimated by the American National Institute for Mental Health that ADHD affects 4.4% of adults between the ages of 18 and 44. The number of adults being treated for ADHD has increased in recent decades, reflecting the broader destigmatization of the disorder’s diagnosis in adults and the Covid-19 pandemic and its blowback impact on adult mental health. The Centers for Disease Control and Prevention found this that prescriptions for ADHD medications by adults increased 7.9% between 2020 and 2021, compared to an average annual increase of 1.4% between 2016 and 2020. In 2021 qualified doctors more than 30 million prescriptions for Adderall, serving nearly 4 million patients.

But over the past two years, many patients have been unable to obtain their prescriptions due to production shortages. As the delta between supply and demand widens, some adults diagnosed with ADHD are being forced to abandon CVS, Rite Aid, Walgreens and other drug retailers and turn elsewhere.

Smith (not his real name) is a lawyer in his mid-forties. He divides his time between New York City and Toronto, Canada. He was first prescribed Adderall in his 30s, when he worked in the tech industry, work that required what he called “sustained periods of concentration” to which he was unaccustomed. Between career transitions and moving between countries (and healthcare systems with different best practices for prescribing amphetamines), he let his prescription lapse. “My ADHD is not so bad that I have to take something every day. But sometimes you just need it. You need it right now,” he says. “And it’s not hard to find, if you know what to look for.”

Smith is familiar with those online black markets and all the coded jargon. In addition to searching for “study aids” and “study aids,” search terms like “NFL” and “footballs” – a 30 mg Adderall pill usually pressed into orange, oblong tablets, vaguely resembling an American football rulebook – also appear to be effective. are. .

There has always been an illegal market for Adderall and similar drugs. Recreational amphetamine, commonly referred to as ‘speed’, has been used for a range of purposes: as a performance enhancer for athletes; an appetite suppressant; a club drug stimulant, used to moderate (or prolong) the effects of alcohol and intoxication. But it increasingly appears that illicit amphetamines are being used for their so-called ‘on-label’ effects: improving focus and concentration by affecting the production and regulation of the brain chemicals dopamine and norepinephrine.

Smith says his typical contact is a “student in his mid-twenties”; not someone who typically participates in the drug trade. Just someone who has a script and knows people are willing to pay for it.” He has made a habit of buying only a few pills during initial meetings, to ensure the pills are bona fide while at the same time, in his terms, “cutting the loss.”

But legitimacy is a major issue when buying prescription amphetamines, or any drug for that matter, on the illicit market. In the months since shortages began affecting the production and distribution of ADHD drugs, pills that appear to be prescription drugs but are anything but have emerged underground.

The Anonymous Drug Testing Database DrugsData.org has found “Adderall” pills containing pure methamphetamine circulating in cities from Boston to San Francisco to LA. In September 2022, the New England office of the Drug Enforcement Administration (DEA). seized a record 660,000 Adderall pills, which were laced with methamphetamine. (The Los Angeles Times also recently reported this about an elaborate counterfeiting operation in Mexico, repackaging meth as Adderall, Vyvanse, and other name-brand ADHD medications in an effort to dupe pharmaceutical tourists seeking help south of the border.) Some experts have compared the rise of illicit meth in the underground Adderall supply to the opioid epidemic, with dwindling reserves of oxycodone being replaced by cheaper and more dangerous synthetic substitutes.

Acetaminophen, aspirin, the antidepressant duloxetine and caffeine have also been in illegal circulation, either pitched as or pressured to resemble legitimate Adderall. “The number of counterfeit generic Adderall analyzed by DrugsData has been stable over the past 24 months,” a spokesperson explained by email. “The big jump happened between 2021 and 2022.”

Gordon (not his real name) is 40 and works in journalism. He was diagnosed with ADHD in his 20s, but always struggled with Adderall. An ex-girlfriend told him the drug made him “an asshole.” He admits that while on Adderall he could be “very annoying.” He had sold cannabis for a while, which put him in touch with underground retailers selling prescription ADHD drugs. When there is a shortage, he says, most illicit dealers tend to fit the profile described by Smith: prescription users who “hoard it in case of a shortage.”

Faced with a dwindling supply – his local pharmacist told him, “We never have it” – Gordon went to his doctors and switched prescriptions to methylphenidate, which is sold under the brand names Ritalin and Concerta (an extended-release version).

The switch has worked for him, especially as he still maintains a degree of wariness about dealing and dealing in the illicit market given the widespread quality and toxicity issues that have increased due to the opioid epidemic. “Entering the black market is very scary right now,” he says. “I’d rather stay away from it if it’s all so crazy.”

Other potential buyers may not be as careful as Gordon, or as smart as Smith, and Adderall shortages appear to persist as drug production is strictly limited by the DEA. The DEA has sought to reform its processes, allowing drug manufacturers to request revised allocations on a quarterly (rather than annual) basis. “DEA is committed to ensuring that patients who need stimulant medications have access to them,” said Anne Milgram, the DEA administrator, wrote in a memo late last year.

But for now, limited production remains an ongoing problem, with supply lagging demand by an estimated 1 billion doses.

• Adderall and other medications can be tested safely and anonymously using the DrugsData laboratory. For more information, visit: https://www.drugsdata.org/send_sample.php

• In the US you can call or text SAMHSA’s National Hotline on 988. In Britain, Action on Addiction is available on 0300 330 0659. In Australia, the National Alcohol and Other Drug Hotline is on 1800 250 015; Families and friends can seek help from Family Drug Support Australia on 1300 368 186