Study details high prevalence of prescription stimulant use, misuse
Between 2019 and 2022, a quarter of U.S. adults reported misuse of prescription stimulants (amphetamine-type and methylphenidate, controlled medications most commonly used to treat attention-deficit/hyperactivity disorder) and 9% met criteria for prescription stimulant use disorder, according to a survey study of more than 83,000 patients.
More screening and treatment for prescription stimulant use disorder (PSUD) is needed among U.S. adults taking prescription stimulants, especially among those receiving amphetamines, a survey study found.
To better understand rates of misuse and PSUD, researchers assessed data on 83,762 adults ages 18 to 64 years, using the 2019 to 2022 IQVIA Total Patient Tracker and National Prescription Audit New to Brand databases and the 2021 to 2022 National Surveys on Drug Use and Health, which defined PSUD as prescription stimulant use leading to clinically significant impairment or distress. A third of participants (33.8%) were ages 18 to 25 years, 53.0% were ages 26 to 49 years, and 56.0% were women. Findings were published by JAMA Psychiatry on March 19.
One quarter of those using prescription stimulants (25.3%; 95% CI, 23.8% to 26.8%) reported misuse and 9.0% (95% CI, 8.0% to 10.0%) had PSUD. Among individuals with PSUD, 63.6% (95% CI, 56.8% to 69.8%) had mild cases, 72.9% (95% CI, 68.3% to 77.6%) used only their own prescribed stimulants, 87.1% (95% CI, 82.3% to 90.8%) used amphetamines, and 42.5% (95% CI, 36.6% to 48.5%) reported no misuse of the drugs. Patients who were prescribed amphetamines had higher prevalence of misuse (ratio, 3.1; 95% CI, 2.2 to 4.3) and PSUD (ratio, 2.2; 95% CI, 1.3 to 3.8) compared with those using methylphenidate.
Between 2019 and 2022, the greatest increase in prescriptions for stimulants was among women ages 35 to 64 years, from 1.2 million in quarter 1 of 2019 to 1.7 million in quarter 4 of 2022 (average quarterly percentage change, 2.6%; 95% CI, 2.1% to 3.1%). However, compared with other sex- and age-specific subgroups, the prevalence of prescription stimulant misuse was lower among women ages 35 to 64 years (13.7%; 95% CI, 11.1% to 16.8%). By comparison, misuse rates were 22.0% (95% CI, 17.9% to 26.7%) for men ages 35 to 64 years and 36.8% (95% CI, 32.6% to 41.2%) for women ages 18 to 25 years.
The self-reported nature of the data means results are subject to recall and social desirability bias, the researchers cautioned. An additional limitation is the lack of data on attention-deficit/hyperactivity disorder (ADHD) diagnoses and whether prescription stimulants were clinically appropriate.
“The number of unique persons dispensed prescription stimulants increased among all examined sex- and age-specific subgroups, as did the number of prescription stimulants dispensed from retail pharmacies across all examined prescriber specialties in the US,” the authors wrote.
The patients who were identified to have PSUD by the survey and who did not report misuse may have been overlooked and left untreated and might have benefited from PSUD interventions, the study authors noted. They called for universal precautions for PSUD among patients prescribed stimulants, regardless of their misuse status.
Because ADHD is the most common diagnosis for which stimulants are prescribed, the findings also underscore the need for developing and implementing clinical practice guidelines for treating adult ADHD, the researchers concluded.