Peruse an online marketplace like Craigslist, and you’ll find coded classified ads for “Study Help” and “Study Hall”, or calls looking for a “Study Buddy”. Despite the scholarly language, these aren’t people looking for pre-final cram session. They’re plugs for Adderall: the trade name for a combination of amphetamine salts long prescribed as a first-choice treatment for attention deficit hyperactivity disorder (ADHD). It’s a drug that is, of late, in perilously short supply.
The US National Institute for Mental Health estimates that ADHD affects 4.4% of adults between the ages of 18 and 44. The number of adults treated for ADHD has increased in recent decades, attributable to the wider destigmatization of diagnosing the disorder in adults as well as the Covid-19 pandemic and its knockback effects on adult mental health. The Centers for Disease Control and Prevention has found that adult prescriptions for ADHD medication increased by 7.9% between 2020 and 2021, compared with a 1.4% average annual increase between 2016 and 2020. In 2021, doctors authorized in excess of 30m prescriptions for Adderall, serving nearly 4 million patients.
But over the past two years, many of patients have been unable to procure their prescription, due to manufacturing shortfalls. With the delta between demand and supply widening, some adults with diagnosed ADHD are forced to forsake CVS, Rite Aid, Walgreens and other drug retailers, and turn elsewhere.
Smith (not his real name) is a lawyer in his mid-40s. He splits his time between New York City and Toronto, Canada. He was first prescribed Adderall in his 30s, while employed in the tech industry, work that demanded what he calls “sustained periods of concentration”, to which he was unaccustomed. Between transitioning careers, 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 need to take something every day. But occasionally you just need it. You need it right now,” he says. “And it’s not difficult to find, if you know what to look for.”
Smith is familiar with those online black markets, and all the coded slang. In addition to looking for “study help” and “study aids”, search terms such as “NFL” and “footballs” – a 30mg Adderall pill is typically pressed in orange, oblong tablets, vaguely resembling a regulation American football – also prove effective.
There has always been an illicit market for Adderall, and similar drugs. Recreational amphetamine, typically called “speed”, has been used for an array of purposes: as a performance enhancer for athletes; an appetite suppressant; a club drug stimulant, used to temper (or extend) the effects of alcohol and drunkenness. But increasingly, it seems that illicit amphetamines are being used for their stated “on-label” effects: improving focus and concentration by tweaking the brain’s production and regulation of the chemicals dopamine and norepinephrine.
Smith says his typical contact is a “a student in their mid-20s; not someone who typically takes part in drug trafficking. Just someone who has a script, and knows that people are willing to pay for it.” He has made a habit of only buying a few pills on initial meetings, in order to guarantee the pills are bona fide, while also, in his terms, “limiting loss”.
But legitimacy is a huge issue with purchasing prescription amphetamines, or any drug, on the illicit market. In the months since the shortages began affecting the production and distribution of ADHD medications, pills have popped up underground that appear to be prescription drugs, but are anything but.
The anonymous drug-testing database DrugsData.org has found “Adderall” pills circulating that contain straight methamphetamine, in cities from Boston to San Francisco to LA. In September of 2022, the Drug Enforcement Administration’s (DEA) New England office seized a record 660,000 Adderall pills, which were laced with methamphetamine. (The Los Angeles Times also recently reported on an elaborate counterfeiting operation in Mexico, which repackages meth as Adderall, Vyvanse and other name-brand ADHD medications, in an attempt to fleece pharma-tourists seeking help south of the border.) Some experts have compared the increase of illegal meth in the underground Adderall supply to the opioid epidemic, which has seen diminishing reserves of oxycodone replaced with cheaper, and more dangerous, synthetic substitutes.
Acetaminophen, aspirin, the antidepressant duloxetine and caffeine have also circulated illicitly, either pitched as, or pressed to resemble, legitimate Adderall. “The number of counterfeit generic Adderall analyzed by DrugsData was steady in the last 24 months,” a spokesperson explains over email. “The big jump happened between 2021 and 2022.”
Gordon (also 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 that the drug made him “an asshole”. He confesses that, while taking Adderall, he could be “really annoying”. He had a stint selling cannabis, which put him in contact with underground retailers selling prescription ADHD meds. When there’s a shortfall, he says, most illicit dealers tend to fit the profile described by Smith: prescribed users who “hoard it in case of a shortage”.
Facing 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-up has worked for him, especially because he retains a certain wariness about dealing and trading on the illegal market, given the widespread issues of quality and toxicity that have increased as a result of the opioid epidemic. “Going on the black market is very scary right now,” he says. “I’d rather just stay away from it, when things are so crazy.”
Other would-be buyers might not be as cautious as Gordon, or as savvy as Smith, and Adderall shortages look set to continue as drug manufacturers have production strictly limited by the DEA. The DEA has tried to reform its processes allowing drug manufacturers to apply for revised allotments on a quarterly (as opposed to yearly) basis. “DEA is committed to ensuring that patients who need stimulant medications have access to them,” Anne Milgram, the DEA administrator, wrote in a memo late last year.
But for now, limited production remains a consistent problem, with supply falling short of demand by an estimated 1bn doses.
Adderall, and other drugs, can be safely and anonymously tested using the DrugsData laboratory. For more info, visit: https://www.drugsdata.org/send_sample.php
In the US, call or text SAMHSA’s National Helpline at 988. In the UK, Action on Addiction is available on 0300 330 0659. In Australia, the National Alcohol and Other Drug Hotline is at 1800 250 015; families and friends can seek help at Family Drug Support Australia at 1300 368 186
