The ADHD medication shortage was a supply chain failure

FDA and DEA policies played a role, but the US is hugely reliant on key drug inputs from Europe.

This policy brief is based on:

Abstract

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.

The US experienced a widespread shortage of attention-deficit/hyperactivity disorder (ADHD) medications from 2022-2023. These medicines are essential for millions of Americans. In 2023, over 15 million adults had a diagnosis of ADHD, and more than 70% of those taking stimulant medications reported difficulty filling prescriptions during the shortage.

In a 2023 letter to the public, the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) pointed to increased demand, manufacturing delays at a single firm, and firms failing to produce as many drugs as allowable under DEA quotas as contributing factors.

New research using a decade of time series data on US production, consumption, and trade of stimulants paints a more complicated picture. It shows that multiple firms producing stimulants for the US market experienced significant production declines at roughly the same time, and that this aggregate decline coincided with an unprecedented drop in US imports of amphetamines, a key active pharmaceutical ingredient used to manufacture some stimulants, including Adderall. Together, these facts point to a potential supply chain disruption as a key driver of the shortage.

These findings reveal vulnerabilities in pharmaceutical supply chains and highlight policy options that can strengthen supply chain resilience.

What We Learned

Sharp decline in imports of amphetamine coincided with the shortage. US imports of amphetamine—the primary active ingredient in many ADHD medications—fell by more than 35% in 2022, an unprecedented drop after years of steady growth. Imports did not recover until the second half of 2023. Additionally, US imports of phenylacetone—the key precursor used in the manufacturing of amphetamine—declined by approximately 17% in 2022 relative to 2020-2021.

Production declines were widespread—not limited to one firm or one kind of medication. The FDA has said that the problem was isolated to a single manufacturer. Analysis of the new data reveals that multiple small- and mid-sized manufacturers reduced output simultaneously, suggesting a systemic constraint rather than isolated disruptions. As amphetamine-based drugs became scarce, patients shifted to substitutes like lisdexamfetamine, which also experienced shortages by mid-2023.
DEA quotas and other actions played a role, but there would have been a shortage regardless. The DEA sets annual production quotas on stimulant medication, and it’s been suggested that the DEA and pharmaceutical companies failed to work together to adjust these quotas to meet rising demand, particularly for generic products. However, the new research finds that production slowed down at multiple manufacturers, with manufacturers collectively meeting only about 70% of their allowed production quotas in 2022, indicating that production quotas weren’t the only or even primary barrier to meeting demand. Additionally, the DEA–responding to “irregular bookkeeping” at one manufacturer–took measures in 2022 that led to a temporary and at least partial shutdown of the manufacturer. But as previously noted, the slowdown in production extended to many manufacturers and appears systemic.
For amphetamine inputs, the US depends significantly on foreign suppliers, especially in Europe. The research suggests that roughly 20-30% of amphetamine inputs might be sourced internationally, with a heavy reliance on suppliers from one country–Germany.

Policy Recommendations

The 2022–2023 ADHD medication shortage was not primarily the result of federal production limits or rising demand. Instead, the available evidence points to a breakdown in the global supply chain for essential drug ingredients.

Policy responses should therefore shift from a narrow focus on meeting or raising production quotas toward broader efforts to improve supply chain resilience. Without such changes, similar disruptions are likely to recur—not only for ADHD medications, but across the pharmaceutical system.

To improve pharmaceutical supply chain resilience, regulators should:

Prevent concentrated production of key drugs and ingredients. The US should encourage diversification of Active Pharmaceutical Ingredient (API) suppliers across countries and facilities. Regulators should identify drugs and active pharmaceutical ingredients that rely on a small number of production sites and prioritize them for intervention.
Increase manufacturers’ flexibility in sourcing ingredients. It’s not easy for manufacturers to change API suppliers. Currently, drug manufacturers must use the API suppliers they listed on their applications to the FDA, which could have created additional friction during the shortage. Regulatory processes should be streamlined to allow firms to switch API suppliers during disruptions.
Strengthen monitoring of foreign production facilities. “Site Master Files” prepared by pharmaceutical manufacturers should contain information about operations, activities, and quality control measures at each facility. The FDA should expand oversight of overseas API manufacturers and require standardized Site Master Files to improve assessments of the risk of disruption.
Create incentives for building strategic resilience. The US should consider targeted incentives for domestic production or stockpiling of critical inputs, especially for drugs with high public health importance and limited substitutability. Two recent executive orders aim to strengthen pharmaceutical supply chain resilience and promote domestic production of critical medicines. More research is needed to evaluate and understand the potential impacts of these recent measures and policy alternatives.

Data and Methodology

To understand what drove the 2022–2023 ADHD medication shortage, the authors analyze the US market for ADHD stimulant medications from 2015 to 2025. They use multiple sources of time-series data on stimulant production, prescribing, retail distribution, and trade, including Symphony Health estimates, DEA data on quotas and retail distribution, and US trade data on imports of amphetamine and phenylacetone, a key precursor used in amphetamine production.

To understand what drove the shortage, the authors compare changes over time in the production and use of amphetamine-based stimulants with changes in imports of amphetamine and phenylacetone. They also examine production patterns across manufacturers to assess whether disruptions were concentrated in a single firm or spread across multiple manufacturers.

Finally, the authors compare retail distribution and exports with federal production quotas to assess whether DEA limits were binding during the shortage. Taken together, these comparisons across manufacturers and over time allow them to ask whether the shortage is more consistent with rising demand, quota constraints, or disruptions in the supply of key inputs.