Amanda Penny’s world changed when she learned she has attention-deficit/hyperactivity disorder. Before the Newcastle resident received her diagnosis at age 42, her untreated ADHD affected nearly every aspect of her life.

She almost failed high school and couldn’t hold down a job. As a parent, she grappled with a never-ending to-do list that kept piling higher and higher. She considered herself “lazy” and “forgetful.”

Last year, Penny reconsidered whether her inability to focus was a character flaw. She found a solution in March 2022, when she was prescribed amphetamine salts for ADHD.

“That was just amazing – my brain stopped going a million miles an hour,” Penny said. “It made me feel like I’m the person that I’ve always thought I was capable of being.”

Amphetamine salts are a stimulant regarded as one of the most effective medications for treating ADHD in adults and children. The drug, marketed as Adderall and other brands such as Mydayis and Adzenys, helps people with ADHD manage symptoms including inattention, hyperactivity-impulsivity and executive dysfunction, which is the difficulty to manage or organize thoughts and tasks.

But now Penny’s progress is halted as she struggles to fill her prescription. For months, a complicated mix of market forces has made the medicine sometimes impossible to find.

ROOTS OF THE PROBLEM

The Food and Drug Administration first announced a shortage of Adderall last October. Many pharmacists, however, reported that they were having trouble obtaining supplies as far back as July, according to a survey by the National Community Pharmacists Association. It’s estimated that the shortage could drag on until June, but no one is sure.

Depending on whom you ask, the blame lies with either pharmaceutical companies or the Drug Enforcement Administration. The federal agency limits production of amphetamine salts because they are classified as a schedule II controlled substance. That quota is based on what the DEA determines is the annual “legitimate medical need” for the drug.

A spokesperson for the manufacturer of the Adderall brand, Teva Pharmaceutical Industries, told Bloomberg in 2022 that the DEA’s production limits were contributing to the shortage. The DEA, on the other hand, said in a December report that manufacturers have not hit the quotas for three years.

There are other reasons for the shortage. Several drugmakers have reported a scarcity of the ingredients needed for production, according to an FDA database, as well as “unprecedented increase in demand.”

Some of that demand is driven by the growth of telehealth companies that focus on diagnosing ADHD and prescribing stimulant medications to treat it. A Google search can direct you to online guides that spell out the steps for getting stimulant prescriptions from companies such as Klarity Health and Done.

A study by research firm Trilliant Health found that the number of 22- to 44-year-olds prescribed Adderall increased 22% from mid-2019 to mid-2021. Another study, by the U.S. Centers for Disease Control and Prevention, found that 40% of Adderall prescriptions in 2022 came from telehealth visits. That figure soared from 2% before the pandemic started and some rules around telehealth prescribing were relaxed.

Telehealth offers access to mental health treatment for people who might not otherwise get it, but there’s a downside, said Dr. Jeffrey Barkin, a Portland psychiatrist and past president of the Maine Medical Association and the Maine Association of Psychiatric Physicians. Although the flexibility around remote prescribing rules will end next month, he’s concerned that telehealth is being abused.

“We’re unscrupulously, perhaps, overprescribing without oversight, doing things on telemedicine platforms with a minimal assessment and prescribing these drugs,” Barkin said.

SEARCHING FOR HELP

When Penny still had her medication, she quickly got a job as a patient registrar at a nearby hospital. She was shocked by her ability to focus on work and even enjoy it. She was on top of house chores and more engaged in parenting. She was exercising, arriving early to events and becoming a more thoughtful friend.

She even was able to go back to graduate school and begin earning a master’s degree in clinical mental health counseling – a lifelong dream.

“I’m right about to end (the first term) and I’ve had straight A’s,” she said at the time. “I’ve never had that in my entire life.”

Kathryn Rice, 17, tells a similar story.

Rice struggled to treat her ADHD with a handful of different medications before she was prescribed Adderall in August.

She’s a senior at Mountain Valley High School in Rumford and has always done well academically. But she waits until the last minute to get her work done, when the pressure is high. Her difficulties weren’t recognized partly because – as with many girls – her ADHD manifested internally.

“I wasn’t bouncing all around, poking people, swinging around on classroom equipment,” she said. “I was bouncing around in my head. Internally, I was all over the place.”

Once she started taking Adderall, Rice said she finally had control over her brain.

The relief has been short-lived.

There are three drugstores near the Rices’ home in Rumford. The pharmacies have rarely received shipments of Adderall during the past six months, so Rice’s prescriptions are sometimes unfilled.

But looking for her daughter’s medication anywhere else would require Abbey Rice to drive at least 45 minutes.

The dilemma is common in Maine, where much of the population lives in rural areas distant from pharmacies. In Oxford County, which includes Rumford, there’s one pharmacy for every 6,514 residents, according to census data. That ratio is about 25% less than the ratio in Cumberland County – despite Oxford County covering nearly twice the area of its southern, more urban neighbor.

Abbey is a mother of five, and the family schedule is packed; traveling farther to search for Kathryn’s medication just isn’t practical. It doesn’t help that Kathryn is one of multiple siblings with ADHD.

“She’s everywhere, all the time,” Kathryn Rice said of her mother.

WHICH PHARMACIES?

Penny has hit roadblocks, too. She’s occasionally managed to find a pharmacy with generic or brand-name Adderall in stock, but there’s often a delay before the prescription is sent there and processed. One time, processing took over a week, and by then the pharmacy had run out of the medication.

University of New England professor Stephanie Nichols, a psychiatric pharmacist and pharmacologist, sees a tragic irony in the situation.

“All the work that’s required, like organizing ‘Which pharmacies do I need to call for this?’ – all of that requires executive function,” Nichols said. “That’s all of the stuff that people with ADHD struggle with.”

The effects of the shortage are also rippling to pharmacists and psychiatrists, who say they are frustrated by not being able to help their patients get the treatment they need.

Amelia Arnold, a pharmacist and legislative liaison for the Maine Pharmacy Association, said she hears from others in the industry how difficult it is to be middlemen in a situation that’s out of their control.

“Obviously, it’s most frustrating for our patients who can’t get their medications. … But it’s really hard being that final entity in the process and not having any control on what’s happening before it gets to us,” Arnold said. “Then there’s having to deliver that news.”

THE WAITING GAME

While Penny has run out of her medication altogether, Kathryn Rice has been rationing pills to save for important days at school.

“It’s really stressful to try to plan something and not know how I’m going to feel … to try to predict how my head is going to work and whether I’m going to be able to control it that day,” Rice said.

But an empty pill bottle and a refill date loom in the distance. After a few more exams and performances of “Footloose,” the high school musical in which Rice has a leading role, she and her mother will have to start the search all over again.

Abbey Rice is sad for her daughter, who hasn’t had the chance to experience the full benefits of the medication.

“It’s a gift that was a hugely useful tool for her,” she said. “And then it was gone.”

Kathryn Rice is counting on an adequate supply of Adderall. Soon enough, she will be away from her family and starting her freshman year at the University of Maine, studying wildlife ecology.

“I’d like (the supply) to be better before then,” she said. “But it needs to be better by next fall.”

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