Prescribing stimulants, particularly amphetamines and methylphenidate, for attention deficit hyperactivity disorder (ADHD) can be a difficult task because providers worry about the propensity for patient misuse and the development of a substance use disorder. A recent cross-sectional survey study by Han and colleagues examined sex and age-specific trends in the number of persons dispensed stimulants, the prevalence of misuse, and the prevalence of prescription stimulant use disorder (PSUD). Of the 83,762 adults with data included in the study, 56% were women, 33.8% were aged 18 to 25 years, and 53% were aged 26 to 49 years. Significant increases in the number of prescribed stimulants were found among all subgroups from 2019 through 2022, where the largest increase was found among women aged 35 to 64.

Additionally, this study examined the number of prescriptions as a function of prescriber specialty (Figure). Stimulant prescriptions from nurse practitioners and physician assistants increased the most by 110%, followed by internal or osteopathic medicine physicians at 26.5%, general or family practice physicians at 16.2%, and lastly by psychiatrists at a 10.3% increase. Among adult patients using prescription stimulants, 80.9% reported using only their prescribed medication, 25.3% reported prescription stimulant misuse, and 9.0% reported having PSUD. Among those adult patients reporting having only used their prescribed stimulants, 8.3% reported misuse, and 7.8% had PSUD.

Within each category of the examined sociodemographic cohorts, past-year PSUD prevalence was 1.7 to 11.2 times higher among those reporting misuse compared to those not reporting misuse. Interestingly, among adults without prescription stimulant misuse, PSUD was lowest among women aged 35 to 64 years; however, among adults with misuse, PSUD prevalence was highest compared to other subgroups, followed by men 18 to 25. Of the people who reported prescription stimulant misuse, the main motivations and sources of misused stimulants varied, but more than 62% of adults reported that their most recent misuse was to help concentrate or stay alert. When compared to patients with past-year misuse and without past-month misuse, those with 6 or more days of past-month misuse were more likely to buy or steal prescription stimulants from a family or relative.

In conclusion, these data show that prescription stimulant misuse and PSUD were common among US adults aged 18 to 64 years, with 25.3% reporting misuse and 9.0% having PSUD. Additionally, the number of unique persons dispensed prescription stimulants increased among all subgroups. Overall, these data suggest that an increasing number of adults are at risk for prescription stimulant misuse and, thus, developing a PSUD. These results highlight the need for prevention and intervention of prescription stimulant misuse, diversion, or PSUD regardless of misuse status and the reasons for prescribing stimulants.

Reference:
Han B, et al. JAMA Psychiatry. 2025 Mar 19:e250054. Download PDF