Excerpt:

When James Hilton was a high school sophomore in Darien, Connecticut, his parents sent him to a psychiatrist because of the many problems he was having at school: He struggled to do his assignments, and then forgot to turn them in. He played the guitar in the school band, but it was agony to sit still for practice.

“I rarely did my homework. I failed French freshman year,” he told me recently. “It was like a class clown kind of thing.”

The psychiatrist diagnosed attention deficit hyperactivity disorder—ADHD—and prescribed a popular drug that, for almost three decades, has helped people who can’t sit still and focus: Adderall, a stimulant composed of two amphetamines.

The drug changed James’ life.

Adderall became his “morning cup of coffee,” he told me. But it also became much more. Adderall helped him do the things he loved: playing the guitar, working out, reading, getting outside, and having great discussions with friends. His grades went up; he sat still in class; he turned in his homework on time; he became captain of the crew team.

“Taking Adderall made me realize I wasn’t stupid,” he told me. “I started taking this medicine, and it was like, ‘Holy shit, I actually understand everything.’ ”

He was accepted to Columbia University, where he kept up a daily routine. He’d start his day with an Adderall at breakfast, then go to his lectures and rowing practice; then he’d take another Adderall, do his homework, and go to sleep. Now a rising senior majoring in environmental biology, James rows crew (his team won the Head of the Charles Regatta in 2018), and writes and records his own music.

Over the past few months, however, things have changed. James has been waking up around 1:00 p.m. “I don’t really ever start my day,” he says. He has to make to-do lists to keep himself on track and to remember basic chores like laundry and homework.

The cause is the nationwide shortage of Adderall, which the FDA declared about eight months ago. Without his daily pills, James is unraveling: “I no longer have the self-motivating chemicals to go outside,” he told me. “I’m definitely feeling really down.”

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The Adderall shortage has highlighted the central role the stimulant plays in many American lives—more than 19 million children and adults are estimated to have Adderall prescriptions. Some, like James, are desperately searching for the pill they credit with turning them into productive people. Others, mostly in their twenties and thirties, who have been taking Adderall since they were kids, are questioning if they were just normal, restless teens who were given a quick fix—and wound up tethered to the pharmaceutical industry. They now wonder who they would be without it, and are also afraid to find out.

Then there are those who are misusing the drug—they either had a prescription that ran out long ago, or never had one and are obtaining it from friends or the black market. According to a 2020 national survey, more than 5 million people are estimated to misuse prescription stimulants. In the face of the shortage, they are occasionally trying alternatives such as psychedelic mushrooms. But many are also buying counterfeit versions of Adderall that the DEA warned might contain “potentially life-threatening hidden ingredients, such as fentanyl or methamphetamine.” The threat is real. Last year, two students at Ohio State died after taking fake Adderall laced with fentanyl.

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