Kristina Yiaras tends to be hesitant about her kids taking too many medications.

But when her 8-year-old started on Adderall, she couldn't deny that his attention deficit hyperactivity disorder — ADHD — symptoms got better right away.

"He was super excited because he wasn't the trouble kid anymore," she says. "He was actually getting rewarded."

Then earlier this year, Yiaras went to the pharmacy to refill his prescription, but the medicine was out of stock. She went down a list of pharmacies within 50 miles of her home in Kingsland, Georgia. Her mom made calls, too. They couldn't find it anywhere.

"The minute we ran out of it, he was back to getting in trouble every day, getting up out of his seat," Yiaras says. "The teachers immediately noticed that he was off of it."

'Finger-pointing' as shortage persists

In October, the Food and Drug Administration announced that there was a nationwide Adderall shortage. It started as a production issue at Teva, one of the world's largest drugmakers, which makes both generic and brand-name Adderall. Many makers of the drug have told the FDA they've been unable to keep up with the demand. Some manufacturers say they're having problems getting a key ingredient.

Brand-name Adderall is no longer officially in shortage, according to the FDA shortage tracker. But generics, which most people are taking, are expected to be in short-supply until the spring.

Adderall – an amphetamine – is classified as a controlled substance by the Drug Enforcement Administration, which limits the amount of raw ingredients companies can get to manufacture the medication.

"There's a lot of finger-pointing," says Erin Fox, who directs drug information and support services at University of Utah Health hospitals. "A lot of the companies tell us that the reason they can't have full availability is because of DEA quotas. But DEA says that the companies haven't used all of their quota and they're not going to increase it."

The DEA says that manufacturers haven't used up their allotted ingredients the last three calendar years, and the majority of companies told the government they had enough, according to the federal register in December.

Fox says the companies are secretive about the details, and it's frustrating that the FDA can't force the companies to explain what's causing a shortage.

Teva, for its part, says it's working to meet the historic demand.

"We continue to manufacture these products and Teva has supply of both branded Adderall and its generic version," a company spokesperson wrote in a statement to NPR.

Doctors and patients get creative to stretch supply

"We get calls every day about people being unable to get their medication or [asking] what they should do," says Dr. Max Wiznitzer, the interim chief of pediatric neurologyat Rainbow Babies and Children's Hospital in Cleveland and co-chair of the professional advisory board of CHADD, the national advocacy group on ADHD. "On average, it's at least three to six, sometimes it's 10 or 12, and it's been a constant trend even to today, where I've already taken care of two or three circumstances like that."

He's had to be creative to make sure patients get what they need. Sometimes, that means modifying a prescription, either with different strength pills or longer- or shorter-acting ones.

In some cases, he prescribes a different drug altogether, like Ritalin. But even that's in shortage, as of January.

Wiznitzer says even without the supply problems, there's never been such high demand for these drugs.

"During the pandemic, we have these kids at home whose parents finally are seeing the ADHD behaviors," he says, adding that parents could see firsthand what had been going on in the classroom and ask their pediatricians about it. What's more, there's an "increased recognition" of ADHD in adults, he says.

Lisa Wetzel-Trainor, a New Jersey-based writer with ADHD, says she managed to avoid the shortage until this week, when her pharmacy couldn't fill her prescription.

"I literally got out of there, got inside my car and just cried," says Wetzel-Trainor, who also does advocacy work with Patients for Affordable Drugs.

For now, she plans to ration her pills, but she's worried. She depends on Adderall to help keep her on track, and is reminded of what it felt like to be a kid in school who couldn't sit still.

"And now in my adulthood that's part of the panic, too," she says. "It's like, am I going to start slipping, you know, in my career? Am I going to start going backwards?"

She hopes the shortage will end soon. Before her pills run out.

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