The FDA added amphetamine mixed salts to its drug shortage list in October 2022. The listing is still active in September 2026, which makes this one of the longest-running access problems for any commonly prescribed psychiatric medication.
I treat ADHD and I study how these medications get prescribed. Over four years my patients have worked out a set of habits that keep prescriptions filled, and those habits have been more useful than anything in the policy literature. What follows is that playbook, along with the arithmetic underneath the shortage, because a patient who understands the machine argues with it more effectively.
Where Supply Actually Stands
The shortage has improved without ending. Teva currently lists amphetamine mixed salts extended-release 10 mg and 15 mg capsules on back order with release estimated in early September 2026, and the 20 mg capsule estimated in late October 2026. Immediate-release tablets remain inconsistent from strength to strength and from pharmacy to pharmacy.
Three forces sustain it. Amphetamine is a Schedule II controlled substance, so the DEA sets a national production ceiling each year. Manufacturing is concentrated among a small number of generic producers, so a single company's problem propagates across the whole market. And prescribing has risen substantially since 2020, particularly among adults.
The quota picture has moved. The DEA raised d-amphetamine production by roughly 25% in October 2025, and in the final 2026 quota notice published January 5, 2026, set aggregate d,l-amphetamine production at 24,234,443 grams, about 14% above the level it had originally proposed, following more than 5,000 public comments. Methylphenidate was held at 2025 levels. Supply for several amphetamine strengths improved as a result. Supply has not equilibrated, and the FDA has announced no resolution date.
The practical consequence is that this is a strength-by-strength, pharmacy-by-pharmacy problem, and the patients who fare best treat it that way.
The Playbook
Call the pharmacy before the prescription is sent. This is the single highest-yield habit on the list. Ask your prescriber to hold the prescription until you have confirmed that a specific pharmacy has your strength in stock. A controlled-substance prescription sent to an empty pharmacy is stuck there until someone transfers it, and transfers take days.
Ask about equivalent configurations. Two 10 mg tablets deliver the same dose as one 20 mg tablet. Pharmacies frequently have one strength and lack another, and a prescriber can write the same total daily dose in whatever units exist. In my practice this one conversation rescues more fills than every other item here combined.
Know your molecule's relatives. Adderall is mixed amphetamine salts. Lisdexamfetamine (Vyvanse) is a close relative with generics now available, and dextroamphetamine is another. Moving within the amphetamine family is a small clinical step. Moving to the methylphenidate family is a larger one, though it is sometimes the right call. None of this is a do-it-yourself project, and all of it is a reasonable conversation to request.
Work both the chains and the independents. Large chains can query nearby stores' inventory, which saves hours of phone calls. Independent pharmacies sometimes hold supply the chains lack, because distributors allocate to them differently. Patients who build a relationship with one independent pharmacist often stop having this problem altogether.
Do not stretch a supply by skipping doses silently. A planned dose reduction is occasionally reasonable and should involve your prescriber. An unplanned stop returns symptoms at full strength, and driving, work, and school all register it. If a gap is genuinely unavoidable, say so out loud to your prescriber, because bridging options exist.
ADHD Essential Reads
Mind the calendar. Controlled-substance rules restrict early refills, so the buffer you need has to be built deliberately. If you are traveling, or your pharmacy's delivery day is Thursday, the refill conversation starts a week out rather than on the morning the bottle empties.
What the Shortage Has Done to Treatment
For most of its duration, the harm from this shortage was anecdotal. In 2025 that changed. He and colleagues used national dispensing data to compare children and adolescents who had been taking immediate-release Adderall before October 2022 against matched controls (He S, McCabe SE, Conti RM, Chua KP, Pediatrics 2025;155(6):e2025070777). The numbers deserve to be read closely. Children previously on Adderall IR showed a 1.9 percentage point greater decrease in Adderall IR dispensing than controls, alongside an 8.0 percentage point greater increase in dispensing of other stimulants. Outright discontinuation rose by 1.2 percentage points. Switching to non-stimulant medication barely moved, at 0.08 percentage points. The effects were larger among children insured by Medicaid than among commercially insured children.
The dominant signal is substitution. Most children stayed on stimulant treatment and moved to whichever molecule was available, which is a real credit to the prescribers and pharmacists who absorbed that work. However, a 1.2 percentage point increase in discontinuation across a national population describes a large absolute number of children who stopped treatment, and the Medicaid gradient means that the families with the least capacity to absorb a disruption absorbed the most of it.
Interrupted stimulant treatment carries consequences beyond the return of symptoms. My colleagues and I have written about the protective side of this ledger, arguing in an editorial on real-world outcomes that reducing serious externalizing outcomes is an important public health benefit and is only part of the story (Sultan RS, Saunders DC, Veenstra-VanderWeele J, JAMA Psychiatry 2025;82:757-758). In earlier work on adolescents with ADHD, we documented the adverse behaviors and comorbid conditions that cluster around the diagnosis (Sultan RS, Liu SM, Hacker KA, Olfson M, J Adolesc Health 2021;68(2):284-291). Continuity is the mechanism through which treatment delivers those benefits, which is the reason the fill itself belongs inside the treatment plan rather than beside it.
What I Tell Patients
Treat the pharmacy like part of your care team, because for the duration of this shortage it is. Build a week of buffer into every refill. Learn the two or three strengths that would work for you instead of the one you are used to, so that a substitution conversation takes two minutes rather than two visits. And tell your prescriber the moment a fill fails, rather than after the bottle is empty, because almost every workaround above requires lead time.
This shortage will end. Quotas and manufacturing will eventually meet demand, and the 2026 numbers suggest that process is underway. Until it finishes, the patients who do best are the ones who treat the fill as part of the treatment, and the prescribers who do best are the ones who expect the phone call.
I keep a longer, sourced breakdown of the shortage, including how prior authorization compounds it, at ryansultan.com. This post is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.