Prescription Stimulant Supply Shocks: Assessing the Impacts on Health Outcomes and Disparities

Project Abstract In the last decade, there has been an alarming number of prescription drug shortages, with over 100 ongoing shortages each year in the U.S. These shortages may have negative consequences on patients and providers; they can lead to decreased convenience, treatment interruption, less effective care, and, at an extreme, death. The potential effects may be particularly magnified for vulnerable populations with chronic mental health conditions. Yet, there is little rigorous evidence on the impacts of drug shortages on the health of these vulnerable populations. This project will begin filling this gap by studying the impacts on youth with attention-deficit hyperactivity disorder (ADHD) of a 2022 nationwide shortage in immediate-release formulations of amphetamine mixed salts, a class of prescription stimulant medications including Adderall. This shortage received substantial news coverage, with stakeholders voicing their concerns about the impact on patients who can no longer get essential medications. Untreated ADHD may impact a wide variety of short-term health (e.g., emergency department visits) and non-health (e.g., school disruptions) outcomes, which could have significant consequences on the long-term trajectory of patients. To bring evidence to bear on the impact of this shortage, using national data on amphetamine prescriptions as well as comprehensive claims data from Allegheny County, PA, and Medicaid enrollees nationwide, we propose to 1) construct community-level measures of the “amphetamine gap” and broader “stimulant gap,” and then assess their relationships with community-level demographic, socioeconomic, and healthcare characteristics; 2) evaluate whether youths in communities affected by the stimulant shortage experienced differential trends in overall treatment for ADHD, mental health, and substance use disorders; 3) investigate treatment process, mental health, substance use, and educational consequences for youth with ADHD whose treatment regimen may have been interrupted by the shortage, and 4) determine whether there are disparate impacts of the shortage based on patient race and ethnicity, urbanicity, prescriber specialty, and school/community characteristics. In addition to furthering academic and health services research on the impact of drug shortages, the findings from this study can help inform regulators on how to mitigate the impact of supply-side disruptions to stimulants.