Janet Currie Publications

Importance  The US has faced a nationwide shortage of attention-deficit/hyperactivity disorder (ADHD) medications since 2022, yet the underlying causes remain unclear. Public debate has largely centered on prescribing trends and Drug Enforcement Administration (DEA) quotas, although evidence suggests that quotas were not binding. A sound policy response requires a clear understanding of the drivers behind the shortage.

Objective  To examine descriptive evidence on the potential causes of the shortage.

Setting and Design  In this economic evaluation, we use time series data (2015-2025) from multiple sources, such as Symphony Health and the DEA’s Automation of Reports and Consolidated Orders System (ARCOS) summary reports, to characterize US production, consumption, and trade of amphetamine-based and other stimulants, including manufacturer-level production volumes, before and during the shortage period.

Findings  The sharp, simultaneous production cutbacks across several medium-sized and smaller manufacturers in late 2022 and early 2023 coincided with a steep contraction in US imports of raw amphetamines and more modest declines in phenylacetone, a key precursor.

Conclusions and Relevance  These patterns align with manufacturers’ reports to the US Food and Drug Administration citing a shortage of the active ingredient as the cause of backorders. More broadly, this economic evaluation reframes the discussion of ADHD medication shortages beyond DEA quotas, highlighting the vulnerability of US pharmaceutical manufacturing to international supply chain disruptions and underscoring the need for policies that strengthen supply chain resilience.

Doctors often treat similar patients differently, which affects health outcomes and medical spending. We assess the recent literature on doctor decision-making through the lens of a model that incorporates diagnostic and procedural skills, beliefs, incentives, and differences in patient pools. Decision-making is affected by beliefs, training, experience, peer effects, financial incentives, and time constraints. Interventions to improve decision-making include providing information, guidelines, and technologies like electronic medical records and algorithmic decision tools. Economists have made progress in understanding doctor decision-making, but applications of that knowledge to improving health care are still limited.

Many mental health disorders start in adolescence, and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next 2 years, where treatment is either consistent with US Food and Drug Administration guidelines, consistent with looser guidelines published by professional societies (gray area prescribing), or inconsistent with any guidelines (red-flag prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.

Objective

To examine a 2018 rule change allowing pediatric providers to bill the child’s Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.

Study setting and design

Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.

Data sources and analytic sample

Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.

Principal findings

The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.

Conclusions

The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.

The child mental health crisis has been described as the "defining public health crisis of our time." This article addresses three myths about the crisis: (i) the idea that the crisis is new; (ii) the belief that increases in youth suicide mainly reflect deterioration in children's underlying mental health; and (iii) the myth that investments in children have little impact on children's mental health. In fact, the crisis has existed for decades, youth suicides vary asynchronously with other mental health measures and are impacted by external factors such as firearms legislation, and investments can improve child mental health and prevent suicide.