Residents across the city are reporting persistent difficulty finding pharmacies willing to stock and dispense generic Vyvanse (lisdexamfetamine), one of the most commonly prescribed ADHD medications in the country. For patients who use telehealth providers and pay out of pocket — a growing population in a city full of freelancers, gig workers, and tech contractors without traditional insurance — the experience can feel like navigating a bureaucratic obstacle course just to access medication they've been prescribed by a licensed doctor.

So what's going on? A few things are colliding at once.

First, DEA production quotas on Schedule II stimulants have created supply constraints nationwide. Manufacturers can only produce so much in a given year, and pharmacies — especially independents and smaller chains — sometimes simply can't get the stock. Second, pharmacies have grown increasingly cautious about filling controlled substance prescriptions from telehealth providers, partly due to post-pandemic regulatory crackdowns. The result? Patients with legitimate prescriptions get caught in the crossfire between federal drug policy and pharmacy risk management.

This is a textbook example of over-regulation producing the opposite of its intended effect. The goal is supposedly to prevent stimulant abuse. The actual outcome is that adults with diagnosed ADHD — people trying to hold down jobs, pay rent, and function in one of the most expensive cities on earth — are scrambling from pharmacy to pharmacy hoping someone will fill their script.

No one's asking for a free-for-all. But when law-abiding patients can't access prescribed medication because of supply-side government controls and pharmacy gatekeeping, the system isn't protecting anyone. It's just punishing people who play by the rules.

If San Francisco's leaders want to talk about healthcare access and equity — and they love to — maybe start with the people who have a prescription in hand and literally cannot get it filled. That seems like low-hanging fruit.

For those currently struggling: independent pharmacies and compounding pharmacies tend to have more flexibility. Call ahead, be upfront about your telehealth provider, and don't give up. You shouldn't have to fight this hard, but here we are.