ADHD drug shortages won’t change, but access will be more equitable

From February 2026, GPs and nurse practitioners will be able to diagnose and treat adults with ADHD. Dr Steven Lillis is an academic GP at the University of Waikato who works with many patients with ADHD and says the change makes access to ADHD treatment more equitable and accessible.

As told to Eda Tang, Dr Steven Lillis shares his thoughts on this change. 

Who does this change benefit?

This change will benefit the many in Aotearoa with ADHD who have struggled to access effective treatment. Under the current system, access has largely been limited to those who can afford private psychiatric care. This excludes many of the very people most affected. 

ADHD can impact education, employment, and daily functioning, which in turn makes accessing private care even harder. Expanding prescribing authority to general practitioners and nurse practitioners from February 2026 will make effective treatment more equitable and accessible.

Should we be concerned about overdiagnosis or misdiagnosis?

No diagnostic process is perfect, and ADHD can be particularly complex to diagnose. Symptoms often overlap with conditions like PTSD and anxiety, and these can co-exist. My experience is that anxiety in particular is common in those with ADHD and that it is caused by the effect of untreated ADHD in their lives.  

The prescribing change is not being made in isolation. Medsafe, the Royal New Zealand College of General Practitioners, and other stakeholders are working to develop diagnostic and prescribing frameworks. These will support clinicians in making accurate assessments and provide prescribing guidelines.

It seems like everyone has ADHD these days.

This perception reflects increased awareness, not overdiagnosis. The research data is very clear; for many years, ADHD has been significantly under-recognised in Aotearoa. As awareness grows, more people are realising that challenges they’ve faced may be due to a neurodevelopmental difference, not a personal failing. 

Seeking help and effective treatment is a positive step. They want access to a medication that is effective, and they have every right to have access to effective medication.

Is anyone put at risk because of these changes?

There is a small risk of medication diversion or misuse, as with any controlled substance. However, the evidence strongly shows that when people with ADHD receive appropriate treatment, outcomes improve across the board: better academic performance, fewer encounters with the justice system, reduced substance misuse, and improved relationships. 

My view is that the benefits far outweigh the risks, especially when prescribing is done responsibly within a monitored framework.

What needs to happen to manage risks before the change is implemented?

Workforce preparation is key. General practitioners and nurse practitioners will need access to training and clear clinical guidelines. Ongoing support and monitoring mechanisms should also be in place. 

I think that we will see the emergence of clinicians with a particular interest and expertise in neurodiversity who not only prescribe appropriately but also help people navigate broader supports like therapy, lifestyle adjustments, and educational accommodations. There may well be clinical pathways where mental health nurses will complete a diagnostic process, and the prescriber will be informed by this. Such a pathway of shared care exists where I work clinically, and it is an excellent model.

Will increased diagnoses impact the ADHD drug shortages and potentially put people who are already on medication at risk?

The shortages of ADHD medications are a concern both to those already on medication and those who may benefit from being on it. These international  shortages are likely to continue all of 2025. 

The causes are complex and include increased demand for these medications. There is a deeper issue. The FDA (Federal Drug Administration) is responsible for regulating the manufacture of these medications by a quota system based on world wide need. They have noted that not all manufacturers filled their allotted quota. This has led to billions of doses that have not been manufactured or shipped. 

The issue of medication shortage is different morally and ethically from eligibility to medication. Global shortage is, from the perspective of Aotearoa, 'ethically neutral' in that there is nothing locally we can do to change this. Restricting access to those who are wealthy (those who can afford a private psychiatrist) is a structurally embedded inequity. 

If the shortages result in some not having access to medication, at least this could be equitable. Rationing to those who are wealthy is morally and ethically wrong. 

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