Prescriptions for Stimulants Jumped During the Pandemic

Prescriptions for stimulants have risen in recent years, with the sharpest increases seen during the pandemic, according to the CDC.

In an analysis of claims from employer-sponsored insurance, the percentage of enrollees with one or more prescription stimulant fills rose from 3.6% in 2016 to 4.1% in 2021, Melissa Danielson, MSPH, of the CDC, and colleagues reported in Morbidity & Mortality Weekly Report (MMWR).

The largest single-year increases were seen during 2020-2021, with the annual percentage change exceeding 10% in many groups, Danielson and colleagues reported.

"Although improved access to ADHD care through telehealth during the pandemic might have benefitted some persons with ADHD symptoms, it might have also introduced the potential for inadequate ADHD evaluations and inappropriate stimulant prescribing," the researchers wrote.

Using employee-sponsored insurance claims from the MarketScan database, Danielson and colleagues found that across all years, prescription stimulant fill rates remained stable or decreased among females ages 24 and under and rose modestly among those ages 25-64. However, during 2020-2021, prescription stimulant fills rose substantially among women in most age groups, with the largest annual percentage changes seen among those ages 15-44 and 50-54, ranging from 14.3% to 19.2%.

For males, the pattern was similar, decreasing slightly among those age 24 and under and remaining stable or increasing modestly among those ages 25 and up. But during 2020-2021, prescription stimulant fills rose substantially among those ages 25-44 and 50-54, with annual percentage changes ranging from 11.1% to 14.7%, the researchers reported.

Danielson and colleagues wrote that there are a host of factors at play regarding the uptick in prescription stimulants in 2020-2021. The pandemic had negative effects on mental health, which might have exacerbated ADHD symptoms. Changes in healthcare policy and reimbursement, including expansion of telehealth and easing requirements around in-person visits prior to prescribing stimulants and other schedule II substances might have also played a role, they said.

ADHD among adults has also been increasingly recognized over the years, Danielson and colleagues wrote. Most people in the study with one or more prescriptions for stimulants met the case definition for the receipt of ADHD care in the preceding or current calendar year, suggesting most were receiving ongoing care for ADHD, they noted.

Thus, the study calls attention to the need for clinical practice guidelines for ADHD in adults, they said. While guidance exists for treating children and adolescents, adult ADHD is a public health concern because of "challenges associated with the differential diagnosis of ADHD and general inadequate access to mental health providers trained to diagnose and manage" the condition in adults.

In an editorial published in the Journal of Attention Disorders in conjunction with the MMWR report, Margaret Sibley, PhD, of the University of Washington in Seattle, and colleagues called attention to a lack of knowledge and support for research on adult ADHD.

The NIH RePORTER funding database lists just under $5.5 million in active funding for adult ADHD research, whereas it lists over $42 million in pediatric ADHD research and at least 10-fold greater support for depression research compared with ADHD research overall, "despite only slightly higher population prevalence of depression," they wrote.

"ADHD needs to now take its rightful and more central place in adult mental healthcare," Sibley and colleagues wrote.

At the same time, they acknowledged that, during the pandemic, digital startups "recognized a mounting demand for adult ADHD treatment" and companies capitalized on relaxed regulations.

"Did these companies drive 2021's spike in stimulant fills and subsequent 2022 stimulant shortage?" they wrote. "Start-ups may have shouldered an urgent need for adult ADHD care during the pandemic. However, their purported methods (widespread online advertising, quick assessments, and one-size-fits-all prescription of stimulants) may have oversupplied stimulants to U.S. adults."

When the U.S. Public Health Emergency ends, patients will once again be required to have in-person visits with clinicians before stimulants can be prescribed, the authors noted.

The study included several important limitations, including the fact that it might not be generalizable outside of people with employer-sponsored insurance; it did not include extensive demographic information; it didn't capture stimulants procured through other means; and it couldn't discern whether stimulants were prescribed for conditions other than ADHD.

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