Washington
CNN
 — 

The US instructed Iran it was not concerned and had no advance information of Monday’s strike on an Iranian consulate in Damascus, Syria, a US official mentioned.

The communication comes amid concern concerning the struggle between Israel and Hamas widening to a broader regional battle. Iran has vowed retaliation after a strike it blamed on Israel killed two of its prime commanders and 5 others at its consulate in Syria.

“The US had no involvement within the strike and we didn’t find out about it forward of time,” a Nationwide Safety Council spokesperson mentioned.

The US has “communicated this on to Iran,” the US official mentioned.

Axios first reported the US communication to Iran.

On Monday, the State Division mentioned the US was gathering extra details about Monday’s strike in Damascus however expressed issues about any additional regional battle.

“Earlier than now we have gathered details about what precisely this was, I don’t wish to communicate to it, particularly, however in fact we have been at all times involved about something that might be escalatory or trigger a rise in battle within the area,” mentioned State Division spokesperson Matthew Miller.

Iran’s International Minister Hossein Amir-Abdollahian has extensively held the US liable for the assault and mentioned “the US ought to be answerable.” Amir-Abdollahian mentioned Iran’s International Ministry summoned the Swiss chargé d’affaires in Tehran early hours Tuesday native time to debate the incident, given Switzerland’s function in representing US pursuits in Iran.

The US has accused Iran of supporting proxy assaults on US and Western targets for the reason that outbreak of the Israel-Hamas struggle. In January, a drone assault killed three American troopers at a US outpost in Jordan, which the US attributed to the Iran-backed umbrella group Islamic Resistance in Iraq, although the incident caught Tehran without warning and nervous political management there, officers instructed CNN on the time, citing US intelligence.

The actor and singer kicked off the present with Vanna White earlier than Sajak slipped again into his internet hosting slot with no phrase of acknowledgment on the April 1 episode

Seven help staff have been killed when their convoy was hit by an Israeli airstrike in a single day, because it was leaving their Deir al-Balah warehouse, amid ongoing operations delivering help provides inside Gaza.

The meals charity World Central Kitchen (WCK) mentioned that they had coordinated the convoy’s actions with the Israel Protection Forces.

In response to the strike, the IDF acknowledged that it “is conducting a radical overview on the highest ranges to know the circumstances of this tragic incident.”

Israel’s Prime Minister Benjamin Netanyahu said on Tuesday the help staff have been killed in an “unintended strike.”

The destroyed automobiles bear the hallmarks of a precision strike, which solely the IDF has the potential to conduct within the area. Pictures from the aftermath of the strike present that the WCK automobiles have been white and no less than one had the WCK brand and title clearly marked on the roof.

Bellingcat geolocated the automobiles to the outskirts of Deir al-Balah once they have been struck- not removed from the place WCK facilities are based mostly in Deir al-Balah.

Geolocation

Pictures of the aftermath depict three automobiles which have been destroyed by the strike, according to the WCK assertion that the convoy included two armoured automobiles and a tender pores and skin car. The primary, barely much less broken car, might be recognized right here: 31.4118  34.3231.

The second car, which is extra closely broken and suffered fireplace harm, might be recognized about 800 metres away at 31.4168, 34.3290.

The third car was recognized at 31.4005, 34.3115, roughly 1.6 km to the southwest of the primary car. Of the three recognized automobiles, this one seems to have suffered essentially the most harm, and could be the “tender skinned car” talked about within the WCK assertion.

These places are roughly 12 kilometres away from the newly constructed pier that was arrange by WCK particularly to ship help, and are on the outskirts of Dier al-Balah, the place the WCK facilities are based mostly.

The WCK mentioned: “the convoy was hit because it was leaving the Deir al-Balah warehouse, the place the workforce had unloaded greater than 100 tons of humanitarian meals help delivered to Gaza on the maritime route.”

Bellingcat geolocated two of the automobiles on a highway recognized by the UN’s OCHA as being an “Accessible Street  for Humanitarian Assist,” whereas the third was in a discipline instantly subsequent to this highway.

The Munition Signature

Though not doable to make certain with out fragments of the munition itself, the WCK automobiles bear the hallmarks of a precision strike by inert or low-yield missiles.

Pictures of the broken automobiles are at first paying homage to harm attributable to an R9X hellfire strike, however the R9X leaves a particular signature which isn’t evident right here. Nonetheless, the comparatively small impression gap within the roofs, the dearth of fragmentation within the bodywork of the automobiles and the intact home windows in some automobiles (albeit nearly definitely armoured glass) do all level to some form of low-yield or inert projectile.

It also needs to be taken into consideration that two of the automobiles have been armoured, which can have mitigated fragmentation harm to them. The third car seems to have suffered considerably extra harm, though it nonetheless seems extra according to a low-yield, moderately than a traditional, munition.

Whereas there’s no proof that the IDF makes use of the R9X, they do use discipline weapons that operate in an analogous method, utilizing their kinetic vitality and a really small explosive payload, moderately than counting on explosive results alone. Through the 2021 Israel–Palestine disaster a number of automobiles appear to have been struck by low-yield munitions, resulting in unfounded hypothesis that the IDF was utilizing R9X.

Strikes with related signatures have additionally appeared in southern Lebanon.

Precision Weapons

With a purpose to hit shifting targets, comparable to automobiles, it’s vital for this type of munition to have the ability to observe the goal in actual time. For missiles much like the R9X which have both low or no yield, this accuracy is important, as it’s essential to hit a shifting goal with excessive accuracy. It’s because the missile kills utilizing the kinetic vitality of the physique of the munition impacting, moderately than steel fragments thrown out by the blast, which is how most different standard munitions function.

Some munitions can do that monitoring by locking onto the thermal signature of a goal, such because the Javelin missile. Some, referred to as “electro-optically guided” are bodily directed to their goal by an operator watching a TV feed, such because the Spike NLOS. Nonetheless, the most typical methodology stays laser steerage, the place a laser is shone at a goal and a missile “rides” down the reflection of the laser beam till it impacts.

With a purpose to efficiently accomplish a laser guided strike it’s vital for a platform, comparable to a drone, to “illuminate” the goal with a laser whereas the missile is launched. With a purpose to obtain correct concentrating on, platforms which participate in this type of concentrating on, comparable to Unmanned Aerial Automobiles or quick jets, are geared up with superior optics and sensor pods. These are able to extraordinarily excessive optical magnification.

That is notable as a result of no less than one of many automobiles clearly bears the emblem of World Central Kitchen on the roof.  It’s seemingly these markings would have been seen from above when the strike was carried out, though this will depend on the potential of the optic used to trace the car.

Though we’re but to see photos of missile fragments, which might be required to establish the precise munition, photos of the broken convoy point out a precision strike was carried out utilizing low-yield or inert munitions.

The IDF has acknowledged that it’s finishing up a overview of the strike “on the highest ranges,” including:

“The IDF makes in depth efforts to allow the protected supply of humanitarian help, and has been working carefully with WCK of their important efforts to supply meals and humanitarian help to the folks of Gaza.”

Israeli Prime Minister Benjamin Netanyahu said Israel’s armed forces had “unintentionally” struck a convoy from the humanitarian group World Central Kitchen in Gaza late Monday, killing seven aid workers.

“Unfortunately, in the last day there was a tragic case of our forces unintentionally hitting innocent people in the Gaza Strip,” Netanyahu said Tuesday as he left a hospital in Jerusalem after a hernia operation. “It happens in war. We will investigate it right to the end. … We are in contact with the governments, and we will do everything so that this thing does not happen again.”

Earlier, the Israel Defense Forces expressed “sincere sorrow” over the deaths while stopping short of accepting responsibility.

In response to the killings, World Central Kitchen suspended its operations delivering vital food aid in Gaza, where Israel’s offensive has pushed hundreds of thousands of Palestinians to the brink of starvation. Cyprus, which has played a key role in trying to establish a maritime corridor, said ships were returning with some 240 tons of undelivered aid.

The strike killed the six World Central Kitchen aid workers and their Palestinian driver, the group said Tuesday, hours after it brought a new shipload of food into northern Gaza, which has been isolated and pushed near famine by Israel’s offensive.

The IDF said it was doing “an in-depth investigation of the incident by the most senior ranks, in order to understand all the circumstances of the incident. The IDF makes great efforts to enable the safe passage of humanitarian aid, and works in full cooperation and coordination with the WCK organization in order to support their efforts to provide food and humanitarian aid to the residents of the Gaza Strip.”

Graphic photographs showed the mangled, bloodied corpses of the aid workers, some still wearing World Central Kitchen t-shirts, with their passports, at Al-Aqsa Martyrs Hospital in the central Gaza town of Deir al-Balah.

A local resident told CBS News that the World Central Kitchen convoy was traveling from Deir al-Balah to Khan Younes at around midnight. The resident said they saw the rear vehicle in the convoy get hit first. The lead vehicle then stopped and went to the rear vehicle, where an injured passenger was pulled out. After that, the lead vehicle was hit, the witness said.

The food charity said early Tuesday that the seven killed included citizens of Australia, Poland and the United Kingdom, and that one was a U.S.-Canada dual citizen and one was Palestinian.

WCK, a nonprofit founded by celebrity chef José Andrés, has shipped more than 37 million meals to Palestinians in Gaza since Oct. 7, the group says.

“This is not only an attack against WCK, this is an attack on humanitarian organizations showing up in the most dire of situations where food is being used as a weapon of war. This is unforgivable,” World Central Kitchen CEO Erin Gore said in a statement

In a lengthy social media post, Andrés said his organization had lost several “brothers and sisters in an IDF air strike in Gaza,” and called on the Israeli government to “stop killing civilians and aid workers, and stop using food as a weapon.”

“I am heartbroken and grieving for their families and friends and our whole WCK family,” Andrés wrote. “These are people … angels … I served alongside in Ukraine, Gaza, Turkey, Morocco, Bahamas, Indonesia. They are not faceless … they are not nameless.”

IDF spokesperson Rear Admiral Daniel Hagari said in a statement that he’s spoken with Andrés and “expressed the deepest condolences of the Israel Defense Forces to the families and the entire World Central Kitchen family. We also express sincere sorrow to our allied nations who have been doing and continue to do so much to assist those in need.”  

The WCK team “was traveling in a deconflicted zone in two armored cars branded with the WCK logo,” the group said in a statement.

“Despite coordinating movements with the (Israeli army), the convoy was hit as it was leaving the Deir al-Balah warehouse,” in central Gaza, the group said, adding that the team had unloaded more than 100 tons of humanitarian food aid brought to Gaza on the maritime route.

In the face of a growing humanitarian disaster in Gaza’s north, several countries worked to open a sea route, hoping it would enable more aid to enter the territory, where supplies have only trickled in through the land routes controlled by Israel. The United States and other countries have also airdropped aid, but humanitarian workers say such efforts are far from sufficient to meet mounting needs.

Israel has barred UNRWA, the main U.N. aid group in the region, from making deliveries to the north, and other aid groups say sending truck convoys north has been too dangerous because of the military’s failure to ensure safe passage.

Three aid ships from the Mediterranean island nation of Cyprus arrived earlier Monday carrying some 400 tons of food and supplies organized by World Central Kitchen and the United Arab Emirates following a pilot was run last month. The Israeli military was involved in coordinating both deliveries.

Cypriot Foreign Ministry spokesman Theodoros Gotsis said Tuesday that around 100 tons of aid had been unloaded before the charity suspended operations, and that the remaining 240 tons of aid would be transported back to Cyprus.

The United States, which has provided key military and diplomatic support for Israel’s offensive, has touted the sea route as a new way to deliver desperately needed aid to northern Gaza, where the U.N. has said much of the population is on the brink of starvation, largely cut off from the rest of the territory by Israeli forces. The U.S. plans to build its own floating dock for aid delivery, with construction expected to take several weeks.

Israel has barred UNRWA, the main U.N. agency in Gaza, from making deliveries to the north, and other aid groups say sending truck convoys north has been too dangerous because of the military’s failure to ensure safe passage.

The UNRWA said in its latest report that 173 of its colleagues have been killed in Gaza in the violence. The figure does not include workers for other aid organizations.

Australian Prime Minister Anthony Albanese confirmed that Zomi Frankcom, 44, of Melbourne, was among those killed and said his government has requested an explanation from Israel.

“This is someone who was volunteering overseas to provide aid through this charity for people who are suffering tremendous deprivation in Gaza. And this is just completely unacceptable,” Albanese told reporters.

British Foreign Secretary David Cameron said his country was working to verify reports of the deaths of U.K. nationals in the strike, which he said was “deeply distressing.”

“It is essential that humanitarian workers are protected and able to carry out their work,” he wrote on X, also calling for an investigation.

Poland’s Foreign Ministry posted “sincerest words of sympathy” to the family of a volunteer who had offered assistance to Palestinians in the Gaza Strip, without saying how he was killed. The Foreign Ministry said it is requesting an explanation from Israel.

The mayor of Przemysl, Wojciech Bakun, named the victim on Facebook as Damian Soból and said he was from the city in southeastern Poland.

U.S. National Security Council spokesperson Adrienne Watson said on social media that, “We are heartbroken and deeply troubled by the strike that that killed [World Central Kitchen] aid workers in Gaza. Humanitarian aid workers must be protected as they deliver aid that is desperately needed, and we urge Israel to swiftly investigate what happened.”

WCK said the shipments bound for Gaza were loaded with rice, pasta, flour, legumes, canned vegetables and proteins, and contained enough food to prepare more than 1 million meals. Also on board were dates, which are traditionally eaten to break the daily fast during the holy month of Ramadan.

The United Nations and partners have warned that famine could occur very soon in devastated, largely isolated northern Gaza. CBS News previously reported that an estimated 1.7 million people in Gaza have been displaced in the territory, according to the U.N., with many having no access to food, water, medicine or appropriate shelter.

Tens of thousands of people, mostly civilians, have been killed since Oct. 7, when Hamas-led militants stormed into southern Israel, killing some 1,200 people and taking around 250 hostage. Israel responded with an air, land and sea offensive that has killed nearly 33,000 Palestinians, according to Gaza’s Health Ministry. The ministry doesn’t distinguish between civilians and combatants in its count, but it says women and children make up around two-thirds of those killed.

—S. Dev, Brian Dakss and Camilla Schick contributed reporting.

Millions of people are under weather alerts as a dangerous storm system moves through parts of the Ohio Valley region and the Northeast, bringing heavy rain, threats of isolated tornadoes and snow.

A severe weather outbreak is possible for the Ohio Valley, middle Tennessee and the Southeast on Tuesday with multiple rounds of storms expected throughout the day and into the evening.

The Ohio Valley region is already being hammered by a storm. As many as 4 million people along the Ohio River were under tornado watches until noon ET. Some of these storms could have 90 mph straight-line winds.

A significant outbreak of severe storms stretching from the Great Lakes to the Gulf Coast has put 54 million people at risk.

One weather-related injury was reported in Lexington, Kentucky, Mayor Linda Gorton said, without providing further details.

Dozens of calls have come in, with the Lexington Fire Department receiving 61 calls for emergency service, two calls for trees crashing into homes, and two structure fires caused by downed power lines, the mayor said in a statement Tuesday.

“Three injury collisions” were also reported as well as seven collisions that did not result in injuries.

Kentucky Gov. Andy Beshear declared a state of emergency following the severe weather.

“We have reports of substantial damage to a number of structures — and thankfully, as of right now we are not aware of any fatalities,” Beshear said in a statement. “We need all Kentuckians to stay weather aware as we brace for more severe weather throughout the afternoon and evening.”

The National Weather Service’s Weather Prediction Center said in a post on X on Tuesday that late-season heavy snow and gusty winds across the Great Lakes and the Northeast through midweek are expected.

In Wisconsin, a winter storm warning has been issued beginning at 1 p.m. Tuesday to 1 p.m. Wednesday, according to NBC affiliate WGBA of Green Bay.

Over the next 24 hours, people should expect a lot of wet, heavy snow; wind gusts up to 40 mph; and slippery roads, it reported. Snow will continue until Thursday across northeast Wisconsin as the storm passes through, making way for sunny weather Friday.

High winds and hail are a threat in central Indiana and Ohio. The weather service warned that the storms could also bring tornadoes in Indiana. NBC affiliate WCMH of Columbus, Ohio, said there is an isolated tornado threat for the region.

At least four tornadoes were reported Monday in Oklahoma and Missouri, and damage was reported Tuesday in Charleston, West Virginia, and Lexington and Nicholasville in Kentucky.

The city clerk for Barnsdall, Oklahoma, said several homes were damaged, but there have been no reports of fatalities. Due to the weather, public schools were closed Tuesday.

Schools were also closed in parts of Ohio.

Flooding is a major concern, with 41 million people from Indiana to New Jersey under flood watches.

As of Tuesday afternoon, flash flood warnings were in effect for Pittsburgh and other areas of western Pennsylvania, where 2 to 4 inches of rain has already fallen.

The highest flood threat Tuesday will be associated with the severe thunderstorms charging across portions of the Ohio Valley. Rainfall rates of 1 to 2 inches per hour could spark flash flooding.

Because of the heavy rain, the Weather Prediction Center issued a slight risk of excessive rainfall over parts of the lower Great Lakes, the Ohio and Tennessee valleys, and the central Appalachians through Wednesday morning. The wet weather will likely create localized flash flooding, with urban areas, roads and small streams being the most vulnerable.

On Wednesday, the mid-Atlantic and Florida were under a severe weather risk. That expanded to include 22 million people from Florida to Maryland.

A secondary low-pressure system along the mid-Atlantic coast could bring heavy, wet snow and some sleet to the Northeast on Wednesday afternoon through Friday, the center said.

Upstate New York and northern New England should expect significant snow accumulations that could create hazardous travel because of low visibility and snow-covered roads.

The center also issued a slight risk of severe thunderstorms over the Florida Peninsula from Wednesday into Thursday morning. The storm is expected to bring frequent lightning, severe wind gusts, hail and possible tornadoes, it said.

The springtime storms follow a wet Monday where unconfirmed tornadoes, hail, strong gusts and heavy rain battered parts of the South.

Lee Siegfried, known as “Crazy Cabbie” to “The Howard Stern Show” fans, has died, according to multiple reports. He was 55. No cause of death has been revealed.

In a previous podcast appearance from 2021, Siegfried spoke about some health issues he suffered from and revealed that he was in a wheelchair and diagnosed with autoimmune disorders like Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy.

Cane Peterson, a radio host and DJ, shared a tribute about Siegfried’s death on his Facebook account Sunday night.

“Sad update on this Easter Sunday,” Peterson wrote. “At 7:09 last night, Lee Siegfried…Crazy Cabbie, peacefully passed way with the love of his life Lexi by his side. He is no longer in pain, and he is now with our Lord and Saviour Jesus Christ. Nobody did radio better than Cabbie, and everyone that knew him, loved him. He had a razor sharp wit, an insatiable lust for life, and most importantly he had a heart of gold. We had our moments, but we were brothers who loved each other very much. Until next time, my friend.”

While Siegfried — who is originally from Minnesota — became known as a regular guest on “The Howard Stern Show,” he used to work as a DJ for 92.3 K-Rock in New York and several other places including two major stations in Twin Cities. His nickname of “Crazy Cabbie” comes from being frequently called “Cabbie” early on in his radio career when he was on “The Andy Savage Show,” which aired on Minneapolis’ 93.7 The Edge. When Howard Stern’s show came to town, Siegfried moved to the “KQRS Morning Show.”

As a regular guest on Stern’s show, Siegfried did everything from participating in boxing matches, taking on “Wack Pack” member Angry Black and former Stern Show member “Stuttering” John Melendez.

The news of Siegfried’s death comes less than a year after Al Rosenberg, an East Windsor resident who was a writer and performer on “The Howard Stern Show,” passed away at the age of 78. Stern’s longtime friend and stylist Ralph Cirella, who was from Jersey City, also passed away in December at the age of 58.

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Saleah Blancaflor may be reached at sblancaflor@njadvancemedia.com. Follow her on Twitter at @saleyley and Instagram.

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Lee Siegfried, known to many as Crazy Cabbie from his days on Howard Stern’s syndicated radio show, has passed away at 55. His death was confirmed by fellow Minnesota native and air talent Cane Peterson, who shared the news on Facebook on March 31.

Siegfried, whose real name was Lee Anthony Mroszak, had been battling a rare nerve disorder since 2020, which posed a risk of paralysis.

He is best remembered for his time on New York’s 92.3 K-Rock (WXRK) and his appearances on The Howard Stern Show, Siegfried carved out a niche for himself in the radio industry with his unique Crazy Cabbie persona, initially developed during his tenure at two Minneapolis-based radio stations.

Siegfried briefly worked for Stern again at Sirius before being let go.

In his tribute, Cane Peterson said, “Nobody did radio better than Cabbie, and everyone who knew him, loved him. He had a razor-sharp wit, an insatiable lust for life, and most importantly, a heart of gold.”

CNN
 — 

About 1 in every 10 people in the US who uses Adderall or similar combination drugs to treat attention-deficit/hyperactivity disorder (ADHD) has been affected by an ongoing shortage, a new analysis suggests.

The US Food and Drug Administration announced that Adderall was in shortage in mid-October 2022, and the share of people with ADHD who filled their prescriptions for Adderall and related medications plunged in the following months.

In an exclusive analysis for CNN, data from the health data platform Truveta shows that the prescription fill rate for amphetamine/dextroamphetamine medications fell from nearly 49% in October 2022 to a low of less than 41% in February 2023. Overall, the average monthly prescription fill rate was 11% lower in the first half of 2023 than it was in the first half of 2022, and it did not show steady signs of improvement through the end of 2023.

When broken down by age, the data shows that adults were consistently more likely to fill their Adderall prescriptions than children, but adults saw more substantial decreases in fill rates after the shortage was announced. For children, fill rates started to increase in the second half of 2023 – a consistent pattern around the time to return to school – but did not rebound to levels seen in early 2022.

Truveta’s database of electronic health records includes more than 100 million patients across all 50 states. This analysis focused on a set of more than 336,000 people who had an ADHD diagnosis and who had filled a prescription for amphetamine/dextroamphetamine between January 2016 and December 2023. Patients were considered eligible for a monthly prescription fill if they had filled one within the previous two years.

Although Truveta’s database includes records for nearly a third of the US population and covers nearly a fifth of daily clinical care across the country, the findings from this analysis may not be fully representative of nationwide trends.

Prescriptions for medications used to treat ADHD surged during the Covid-19 pandemic, especially among young adults and women, one study found.

This increase in demand, coupled with the residual effects of manufacturing delays that one key drugmaker experienced last fall, are among the “many factors” contributing to the shortage, FDA Commissioner Dr. Robert Califf and Drug Enforcement Administration leader Anne Milgram wrote in a joint letter last summer.

Federal agencies have been interested in understanding why prescription rates have increased recently, along with the methods for diagnosing ADHD, particularly related to misuse and diversion of medications like Adderall, said Dr. David Goodman, an assistant professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine who is also on the executive board of the American Professional Society for ADHD and Related Disorders.

“The question is, ‘What is now perpetuating the shortage?’ And that’s not a question that’s been adequately answered,” he said.

Mary Beth King, who works as Truveta’s social media director but was not involved in the new analysis and spoke to CNN about her personal experience, was diagnosed with ADHD about a decade ago, when she was in her late 20s. After a few months of trial and error with her doctor, she landed on a treatment plan with an Adderall prescription that best helped her manage her symptoms – primarily the inability to focus and severe anxiety that can look and feel like depression.

But it’s been about a year and a half since she’s been able to fill her Adderall prescription in a “totally uneventful” way, she said. From October 2022 to October 2023, she recalls being able to fill her monthly prescription less than half of the time.

“It’s troubling to be on this medication that helps regulate so much in my life and then suddenly not have access to it,” King said. “It is a roller coaster. It’s one more piece of anxiety that a person who’s already very prone to anxiety doesn’t need.”

For her and many others with ADHD, Adderall is much more than a recreational drug or a study aid that helps a college kid pull an all-nighter, as some stereotypes may suggest. It can have “concrete negative impacts” on life, King says, affecting work, relationships, personal safety and more.

“I can drink a bunch of coffee, and there’s certain things that I can try to do to help some of the side effects,” she said. “But there’s no coffee for depression. You really need medication for stuff like that.”

Treating ADHD with Adderall can help reduce impulsivity, improve attention and focus, and manage feelings of anxiety. Inconsistent access to treatment can be very disruptive – and dangerous – for people with ADHD, experts say.

“It would be like ordering glasses and not being able to get them for months. I mean, how are you going to function in the world without your glasses?” Goodman said.

People with ADHD are at increased risk of premature death and other adverse health outcomes, but a recent study out of Sweden found that treating the disorder with medication can help reduce the overall mortality risk.

“Undertreating ADHD is not without consequences,” experts from the New York State Psychiatric Institute and Columbia University Irving Medical Center wrote in an editorial published in the medical journal JAMA last month.

The Adderall shortage can have a compounding effect on people who are also trying to manage their ADHD in ways that complement the medication, said Dr. John Mitchell, an associate professor in psychiatry and behavioral sciences at Duke University School of Medicine. As a clinician, he performs ADHD assessments and works with patients through cognitive behavioral therapy and other non-medication treatments.

Strategies that help people with ADHD establish routines are a common target in therapy, especially around daily medications, he said. But that’s becoming more challenging to address as patients decide skip or ration doses because of the shortage.

“Breaking a routine because the medication isn’t available is going to put a lot more a lot more demand on [patients] to regulate their behavior,” Mitchell said.

People with ADHD can often struggle with regulating emotions, and struggling to access medication can create an immediate stress response.

“If the medication is having its therapeutic effects, patients are able to adopt a lot of strategies more efficiently than when they’re not treated with medication or undertreated with medication,” Mitchell said. The shortage “really increases the stress that these patients are carrying, and being in a state of distress is going to make it more difficult to learn the strategies and to implement them in a consistent way.”

Before the shortage, King would proactively refill her prescription as soon as she was able, so she would never run out. But over the past year and a half, she said, she has taken very conscious steps to try to stretch her medication supply and plan her life around the effects.

“Workwise, if I knew that I had a day where I had a bunch of meetings and also a bunch to get done, I would take my full dose. But then I would recognize that, ‘OK, tomorrow I might not be as productive. I may only get the bare minimum done,’ ” she said. At home, during hours or days that she needed to rest, she and her husband would coordinate care for their toddler.

Internal turmoil could sometimes lead to feelings of inadequacy, she said, but a strong support system – including an understanding manager and a supportive husband – helped. However, the uncertainty of the broader shortage has brought its own set of negative feelings.

“I’ve done a lot of therapy, so I feel like I’m much better now than I was before at recognizing when I need help, when I need to raise my hand, when mentally I’m not doing well,” she said. “That definitely helps. On the other side, no, I don’t feel like I have any control.”

A few months into the shortage, King also explored different medications and doses so that she would get whatever she could find in stock. At one point, she said, a pharmacy rejected her from filling any prescriptions because she had too many on file. But testing various treatment options was far from ideal, too.

“You don’t want to be on one of these medications if it’s not going to be really effective for you. It’s not something that you want to play around with,” King said.

King says she has seen some hopeful signs in recent months that the shortage may be easing.

“I previously had been checking my pharmacy app every day to see if I could add it to my cart and get it scheduled for delivery,” she said. Recently, “it hasn’t been nearly as challenging.”

But the stress remains.

“I have, I don’t know, two weeks worth of my last prescription in my pill bottle,” she said last week. “And I’m like, ‘Oh, my gosh, am I gonna be able to get in to see my doctor in time to get this refilled? And if I can, will I even get it?’ ”