“In 2021, some 41 million prescriptions were dispensed in the United States for Adderall (and its generic varieties), an amphetamine used to treat Attention Deficit Hyperactive Disorder, symptoms of which include inattention, hyperactivity, and impulsivity. During the Covid era, pharma-startups began using social-media platforms to advertise their wares, while online pharmacies made it much easier to access the drugs. But lately, the legal party seems to be crashing.
Countless young white women on TikTok have recently reported that their Adderall is “working differently.” Their videos exude an air of conspiracy and anxiety. Adderall is already in short supply, with many struggling to fill their prescriptions. And then, once they do get their medication, it seems, well,
different.
“Has anyone figured out what they’re doing to our Adderall yet?” a 20-something under the handle @adderalladventures asks, staring into her camera, perturbed. She is
fatigued and doesn’t understand why. She offers a laundry list of energy aids she has consumed that day: 20 milligrams of Adderall, a Diet Coke, 5 milligrams of Adderall, another 5 milligrams of Adderall. “I’m fighting sleep right now,” she says, refocusing the camera to show that she is in bed.
The complaints multiplied feverishly: that Adderall “wasn’t working,” with young people
urging their viewers to “think critically” about whether the government was allowing or even forcing pharmaceutical companies to water down the drug and its derivatives. Eventually,
The New York Times weighed in. The paper found what you would expect. Despite TikTokers telling their viewers to “submit complaints to the Food and Drug Administration about what they believe is ‘new’ Adderall being distributed,” the
Times couldn’t find evidence that the formula had changed—at least, taking the agency’s word for it.
Rather, the complaints stem from five contributing factors, according to the
Times: tolerance buildup; the impact of starting and stopping medication; cognitive bias; contraindications with other medications, as well as potential comorbidities of an ADHD diagnosis; and then, finally, the most obvious problem, one that many users unwittingly revealed in their videos—young people had switched to generics due to the shortage and didn’t realize the impact that might have.
Even if they are the same drug, generic and brand-name medications will have minor ingredient differences. Unfortunately for some people, a difference in, for example, filler material will change how they metabolize the medication. Add the fact that different pharmacies will use generics from different manufacturers—and that the shortage has also pushed people to get their prescriptions filled at multiple pharmacies—it’s no wonder they feel like their medication isn’t quite the same. You might get the jitters on CVS’s amphetamine salts, but not Walgreens’. Maybe you didn’t experience any emotional side effects from Adderall, but whatever you are getting at the HEB, Publix, or Jewel-Osco pharmacy makes you crash and crash hard.
According to Dani Potter, who goes by @thedandan on TikTok, differences in generics are more significant than variations in how individual people metabolize them. She claims her doctor told her many of his patients were experiencing problems with their generic from Teva. In a video posted March 7, she says she switched manufacturers to Sandoz, and all was good. (Interestingly, her description of Adderall’s impact on her was “butterflies” and, well, basically a stimulant high.)
Even though many malcontented TikTokers claim that they have been using ADHD medication “their whole lives,” just as many have only
recently embraced the label of “neurodivergent.” There had been clues for a while, they claim: chronic fatigue, poor executive functioning, an inability to focus on basic tasks. Many of them, too, have self-diagnosed with checklists they have found online. The rationale is that health-care providers are either too expensive to see, or tend to gatekeep, leaving people unable to get the help they desperately need.
While the mainstream accounts of ADHD self-diagnosis suggest that this is a phenomenon unique to TikTok, or perhaps simply downstream of pill mills that
advertise on TikTok, it’s been a recurring problem online since at least the 1990s.
Dissociative identity disorder was self-diagnosed on Usenet newsgroups and personal home pages; self-harm, depression, psychopathy, and anorexia (to name only a few chronic conditions) were popularized in forums, on LiveJournal and Xanga, MySpace, and later, Tumblr; the “extremely online” have long self-identified as autistic.
In all cases, a small but vocal group of skeptics emerges, for example, in spaces for anorexics. The term “wannarexia,” for example, emerged in reference to people who feign having an eating disorder to be included in virtual communities for people suffering the real thing. In the case of autism, the trend of self-diagnosis happened concurrently with it becoming a news and entertainment trope.
While stories about anti-vaxxers who reported that their kids had autism due to vaccine injuries boomed, movies and TV shows like
Adam,
The Good Doctor, and
The Big Bang Theory depicted successful—or at least, entertaining—autistic men and women. Online, teenagers started self-identifying as autistic. They oversaturated social media
so much that some autistic people and their family members started using the hashtag #ActuallyAutistic to differentiate themselves from newcomers.
Of course, there is a key difference between the stories detailed above and an ADHD diagnosis. Where autism or anorexia may come with a prefab identity, ADHD comes with a prescription for legal stimulants.
It’s no secret that, for a time, an ADHD diagnosis was as easy to get as a flu shot. According to
The Washington Post, prescriptions for ADHD medications rose 19 percent on average between 2018 and 2022. Adderall specifically increased by 35 percent over that time. Services like
Cerebral and
Done came under fire for making the process as easy as clicking “add to cart,” galvanized by now-controversial TikTok advertisements. But they weren’t the only companies engaging in questionable practices: Telehealth providers like Circle Medical, a “comprehensive primary care provider,” which has received less media attention than Cerebral and Done, offer only a thin veneer of legitimacy to their ADHD diagnoses.
Appointments for ADHD treatment sit alongside consultations for “gender-affirming” hormone therapy, anxiety and depression treatment, and sleep studies. Users schedule an appointment, usually with a family nurse practitioner or physician’s assistant, and they run through a modest list of questions about symptoms together. In my experience with Circle Medical, no great acting chops were required: The two providers just wanted to make sure I finished the survey. Say “Yes” the magic number of times, and you will get an Adderall prescription. Or, if you prefer and have the gumption to ask, a prescription for Vyvanse or Ritalin.
What’s remarkable about all of this isn’t that telehealth took pill mills online, making them accessible to anyone with a smartphone. It isn’t remarkable that people are trying to game them, either—that has been happening for a long time. What’s remarkable, rather, is the number of cultural ills and personality types the Adderall epidemic seems to intersect with.
There are the people who want to get high, using Adderall recreationally with the certain knowledge that
that’s what they want. There are the people who are so inured to the feel of Adderall that it’s tantamount to a cigarette or cup of coffee to them: It’s not a high—it’s a chemical dependency. Then there are people who treat it as a performance-enhancing drug, like Bay Area software engineers who use it to accomplish high volumes of rote tasks or writers who need to pump out thousands of words a week. There are people who are using it as a sort of off-label antidepressant. There are even those who use Adderall as an anesthetic, who experience an emotional blunting effect from it and long for that. They are hyper-focused, but they aren’t too happy, not too sad; their lives continue in a steady hum of fixation. They crash, then go to bed.
And then there are the TikTok types, who don’t understand why they aren’t operating at the same level anymore—people who seemingly think an Adderall high is a reasonable baseline for their mood.
Their Adderall escapism is about unfettered positivity. These women don’t want to be automatons with a machine-like capacity to work, or at least that isn’t what they describe. They want to live their lives with a vibrancy that only the next best thing to methamphetamine can provide. For most people, before you hit your tolerance wall, Adderall feels like any other stimulant does: unending possibility. There is a reason why MDMA’s street name is “ecstasy.”
It feels silly to speculate why any of this might appeal to someone, or if there is a meaningful difference between that and just wanting to get high. The simple answer is that stimulants feel good. No one needs a think piece about why cocaine feels good—it’s cocaine. But our Adderall obsession comes on the heels of a subsection of the population being fixated on what’s been called “toxic positivity,” an excessive preoccupation with maintaining optimism no matter the situation.
Adderall prescriptions are (or were) booming alongside New Age practices like “manifestation,” which teach that you can
will your desired life into reality. If some portion of Millennials and Zoomers are using an ADHD diagnosis to play the victim, then maybe another portion is using it to hack reality in the style of people who, 15 years ago, subscribed to
The Secret.
It’s uncharitable to call this emotional or intellectual entitlement. My sense is that people just don’t know better. They are not only at sea, but there is no one and nothing to guide them back to the shores of the good life. Some conclude that life is a never-ending quest to “feel good.” And if a pill can offer that—why not?”