Anyone with ADHD who is lucky enough to be medicated knows that suddenly being unmedicated can be life destroying. And that's not an exaggeration - life-threatening accidents go up, risk of being fired for ADHD-related performance issues go up, interpersonal/telationship conflicts increase, etc, not to mention the increase in anxiety and depression for many while it feels like the very structure of our lives is decaying, and it's ALL OUR FAULT.

So, needless to say, med compliance is really important for stability. But getting med refills can be a chronic problem for people with ADHD.

Most ADHD medications are controlled substances, so we need a new script every month. For various regulatory, legal and ethical reasons, the onus is on the patient to initiate a refill with their doctor rather than the doctor's office being able to provide any kind of proactive support. In a lot of cases, we need an appointment every month, and at a minimum we have to remember to contact our prescriber to ask them for the refill. It's hard to remember to do that, especially to do it in advance so that they can submit the refill in time so we do not miss days. It's particularly hard to do it in advance vbecause we can't request the refill too soon because they're on guard to ensure we only have exactly the number of pills we need and not a single one more. Because we all must be abusing our medication.

In addition, pharmacists can only fill our new prescription the date they show we will run out based on the pick-up date and not a minute earlier. Sometimes a day in advance if we're lucky. Because, again, thw system assumes we must be abusing these medications.

To say the least, the timing of getting a refill is very exacting - for people who literally struggle with exactly this kind of challenge.

On top of all of this, there have been amphetamine supply shortages over the last few years. This is because the DEA restricts the amphetamine market for pharmaceutical companies, but does it in a way that leads to hoarding, exporting, and other market inefficiencies. The DEA will determine that there's enough of the ingredient available to meet patient demands, and won't give pharmaceutical companies additional allotments, even though the companies actually manufacturing the medications don't have the ingredient they need to meet demand. While this has improved since The Year We All Ran out of Pills, the issue is chronic and systemic so shortages still pop up occasionally.

Thus, even if we do everything perfectly to get the prescription, our pharmacy may not be able to fill it when it's time. This can often happen the day before we're going to run out (see above re timing of refills), often the evening before, in fact, because a large number of folks pick up their meds after work.

This then means people with executive dysfunction need to call around for a pharmacy with available pills, and we have to do it RIGHT AWAY because we are going to run out of pills today/tomorrow. Quite often, though, we have to do this while unmedicated, because in the moment we may not have time for the process (and it takes time - I've spent an hour on the phone with pharmacies before) or the pharmacies may not be open. And that assumes we're lucky enough to have access to an alternate pharmacy. Then, even if/when we can find a pharmacy that can help, there's another hurdle: pharmacies often can't transfer prescriptions for controlled substances (even from store to store within the same chain/company), so now we have to coordinate getting a NEW refill from our doctor (and don't get me started on the mess that is partial refills of controlled substances). Fingers crossed that it's our doctor's office's business hours (it never is).

Because forgeting tasks and difficulty with motivation due to executive disfunction are KEY SYMPTOMS of ADHD, this can trigger a (sometimes long) period of without medication, which can be dangerous (see above). AND SO, I have my baby emergency stockpile of pills.

There's not a lot of sympathy for the problems this causes for people with ADHD, which means getting support through this process is challenging. In fact, there's still a lot of stigma. I've personally been treated with suspicion and doubt by a pharmacy assistant while panic-crying because I couldn't get a refill. I've heard comments about how people trying to get refills act like drug addicts. I have thick skin and a supportive community, so those experiences didn't stop me from pushing for what i needed, but I know there are people who would give up after an encounter like that.

There is no political will to improve the system. In fact, there's more political will behind increasing restrictions on and further limiting access to stimulant medications. This comes from the narratives that 1) ADHD isn't real ("everyone forgets things" "everyone gets distracted" "it's trendy to have adhd" "stop making excuses"), 2) ADHD is overdiagnosed and/or overmedicated ("you should just try harder" "why are you so lazy" "have you tried using a planner" "o knew someone who..."), and 3) ADHD medications are being widely abused recreationally.

During the pandemic, the FDA started allowing doctors to prescribe controlled substances via telemedicine, which has increased access to treatment and improved patient ability to actually attend appointments (from decreased time commitment, lack of need for transportation, lack of need for much advance planning/remebering, etc). Add to this the increase in adult diagnoses, particularly for women who went undiagnosed/untreated as a result of systemic social issues when we were children, and the result is a general and not insignificant increase in patients being effectively treated for ADHD, including being prescribed ADHD medication. However, if you doubt ADHD or the effectiveness/importance of medication in treating ADHD to begin with, the increase in stimulant prescriptions is an indication of drug abuse, over diagnosis and over medication, NOT better access to care and decrease in missed diagnoses due to bias. Nevermind pretty solid science around the prevalence of untreated ADHD, medication being the single most effective and life-improving treatment for ADHD, and the very reasonable conclusion that telemedicine improved both access to healthcare as well as ADHD patient appointment attendance.