| Attention deficit hyperactivity disorder medicines like Adderall have been in short supply in the US for over two years, frustrating people who have been unable to easily get their medicines each month. The reasons for the shortage are myriad, but federal drug enforcement officials have identified one impediment that they're looking to address. Matthew Strait, deputy assistant administrator at the Drug Enforcement Administration's diversion control division, laid it out in a recent phone interview. It goes back to opioids. In 2021, state attorneys general reached a settlement with three major drug distributors over their role in the opioid addiction epidemic. That settlement required distributors to set secret limits on the amount of controlled substances — drugs prone to addiction or abuse, like opioids — each pharmacy can order, and report suspicious orders to the DEA. "It was traditionally understood that that was relegated specifically to opioids," Strait said. But, he said, the requirements actually applied to all controlled substances — including ADHD drugs. Then the DEA received a surge of suspicious order reports for these medicines. Pharmacies were suddenly unable to order drugs like Adderall if they hit a secret limit. And drug wholesalers are barred by the settlement agreement from telling pharmacists what the thresholds are, how they're determined or when the pharmacy is getting close to hitting them. Now, the DEA is looking more closely at this. Strait said that the agency has been talking to people at the Department of Health and Human Services about meeting with state attorneys general to discuss the consequences of the settlement. "There are technically changes that could be proposed," Strait said, without providing details. The DEA didn't respond to a request for more information. At the same time, the DEA remains concerned about illegitimate internet prescriptions. ADHD diagnoses and prescriptions jumped at the beginning of the Covid pandemic, when the medicines were easily available through telehealth companies that advertised widely on social media. The DEA says it has taken action against some of those telehealth companies. David Goodman, who treats ADHD patients, said that medicines are more available than they were before, but his patients still have trouble filling prescriptions at times. The fact that distributor limits are affecting supply is not well known, he said. "The perception has been that this is an ongoing manufacturer issue," said Goodman, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine. "We need to stop talking about shortages and start talking about distribution issues." — Ike Swetlitz | 
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