Uptick in Stimulant Prescribing Linked to the Pandemic

Megan Brooks

April 03, 2023

During the first year of the COVID-19 pandemic, prescriptions for stimulants, used primarily to treat attention deficit hyperactivity disorder (ADHD), increased 10% among older children and adults, new data from the US Centers for Disease Control and Prevention (CDC), new data show.  

CDC researchers note the large increase in the percentage of adults receiving prescription stimulants during the pandemic draws attention to the need for clinical practice guidelines for ADHD in adults.

"Well-established professional guidelines for diagnostic procedures and treatment algorithms exist for children and adolescents with ADHD; however, no similar diagnostic and treatment guidelines for ADHD among adults are available in the United States. This gap in guidance for adult ADHD care is a public health concern," write Melissa Danielson, MSPH, and colleagues.

The study was published online March 31 in the CDC's Morbidity and Mortality Weekly Report (MMWR).

Pandemic Fallout

The researchers used the MarketScan commercial claims data to gauge trends in prescription stimulant fills before and during the COVID-19 pandemic (2016-2021).

Overall, the percentage of people who filled a stimulant prescription rose from 3.6% in 2016 to 4.1% in 2021.

During the pre-pandemic period (2016-2020), the percentages remained stable or decreased slightly in females aged 24 or younger (average annual percentage change [APC] range –1.8% to 0.1%) and increased modestly in those aged 25-64 years (average APC range 2.3% to 6.6%).

However, during the first year of the pandemic (2020-2021), the percentage of females who filled at least one stimulant prescription rose substantially among most age groups, with the biggest increases seen in those aged 15-44 years and 50-54 years (APC range 14.3% to 19.2%).

The pattern among males during the pre-pandemic period was similar to that among comparably aged females. The percentage of males with prescription stimulant fills decreased slightly in those aged 24 and younger (average APC range  –3.8% to –1.7%) and remained stable or increased modestly among those aged 25 years and older (average APC range 0% to 6.5%).

During the first pandemic year, the percentage of males with prescription fills decreased among those aged 19 and younger but increased substantially among those aged 25-44 and 50-54 years (APC range 11.1% to 14.7%).

Consistently across the study period, most people with prescription stimulant fills had healthcare encounters with ADHD diagnosis codes and they averaged more than seven fills per year, suggesting that most were receiving ongoing care for ADHD, the researchers note.

They note development of clinical recommendations for diagnosing and managing adult ADHD similar to those that exist for children "could help clinicians provide best practice care for adult ADHD and support their patients to achieve better outcomes."

The CDC report was released to coincide with a related commentary in the Journal of Attention Disorders

Adult ADHD Under-recognized

The authors of the commentary note that the trends observed "may stem from gradual efforts (i.e., patient and provider education on adult ADHD, expanding access to ADHD care, reduction of disparity in access to health care) and relatively sudden phenomena (i.e., cognitively/emotionally overwhelmed patients seeking treatment in the pandemic, a recent online neurodiversity movement producing viral, relatable content on ADHD, digital startups prescribing stimulants online, symptoms of long-COVID)," write Margaret Sibley, PhD, with University of Washington School of Medicine, Seattle, and co-authors.

"Regardless of cause, the CDC MMWR report highlights that ADHD has arrived as an adult psychiatric condition permeating everyday clinical practice. ADHD needs to now take its rightful and more central place in adult mental health care," they add.

Yet, despite its prevalence, "clinicians rarely receive relevant specialized training, and may have misconceptions about, or not even recognize, adult ADHD," the editorialists note.

"Practitioners should understand that ADHD is typically chronic and persists into adulthood, but is often overshadowed by its sequalae (e.g., addiction, depression, anxiety, personality disorders) or non-traditional presentations (i.e., in women, minorities, older adults)," they write.

"High-quality provider education is particularly necessary as new categories of professionals join the workforce to absorb a growing demand for adult ADHD treatment," they add.

The study had no commercial funding. The study authors have declared no relevant financial relationships. Sibley and the other editorialists report various relationships with industry. The full list can be found with the original article.

MMWR Morb Mortal Weekly Rep. Published online March 31, 2023. Full text

J Atten Disord. Published online March 22, 2023. Full text

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