Attention deficit hyperactivity disorder (ADHD) is no longer seen as primarily a childhood condition. In recent years, diagnoses of ADHD in adults have surged, with a notable increase in the number of people over 18 being prescribed stimulants such as Adderall and Vyvanse. These medications, which are considered the most common and effective treatments for adult ADHD, carry a relatively low risk of addiction and fatality compared to other substances like opioids. However, a study of 84,000 adults found that one in four patients misused their stimulant prescriptions, with misuse ranging from taking medication without a prescription to exceeding the prescribed dosage.
Misuse of prescription stimulants can lead to the development of prescription substance use disorder (PSUD), a condition defined by significant impairment or distress due to the use of these drugs. Nearly 10% of participants in the study were found to develop PSUD, which was overwhelmingly related to amphetamines. This trend has been exacerbated by a significant rise in stimulant prescriptions in the U.S., which increased by 34% from 2019 to 2022.
Several factors contribute to this increase in adult ADHD diagnoses and stimulant use. While the relaxation of telehealth regulations during the COVID-19 pandemic may have played a role, the trend started before that. Increased awareness of ADHD, particularly through advertising campaigns, has likely contributed as well. Furthermore, it has become more widely recognized that ADHD is not just a condition that affects boys in childhood but can also persist into adulthood, affecting both men and women. The most significant growth in stimulant prescriptions from 2019 to 2022 was for women between the ages of 35 and 64.
While the misuse of stimulants is a concern, the definition of misuse can vary. Some experts argue that the study’s broad definition of misuse includes behaviors that might not be considered problematic by all. Additionally, 64% of those diagnosed with PSUD had relatively mild cases, and many people who reported misuse had not misused stimulants recently. Despite this, experts caution that these drugs have the potential to lead to addiction, as they can trigger the brain’s reward system, which is central to the development of substance use disorders. In severe cases, stimulant overdose can result in arrhythmias, seizures, or even strokes.
The rise in stimulant prescriptions highlights the need for more comprehensive clinical guidelines to help medical professionals manage the potential risks associated with ADHD treatment. From 2019 to 2022, there was a notable increase in prescriptions from nurse practitioners and physician assistants, as well as general practitioners, internal medicine doctors, and psychiatrists. This growing trend underscores the need for better education and guidance for healthcare providers on how to diagnose and treat adult ADHD.
The challenge of diagnosing adult ADHD is compounded by the fact that it often coexists with other mental health conditions, such as depression, anxiety, and PTSD. Accurate diagnosis requires a careful history and an understanding of when symptoms first appeared, which typically occurs in childhood. Experts recommend that physicians be better equipped to differentiate between ADHD and other conditions or refer patients to specialists when necessary.
Stimulant misuse is more prevalent among certain demographics, particularly young adults aged 18-25, with men and women in their mid-20s to early 30s following closely behind. However, it is unclear how many of these adults have continued taking stimulants from childhood into adulthood. In the past, many people stopped using stimulants as they grew older, but with increasing use among college students to aid in focus, this pattern may be changing.
For those prescribed stimulants, it’s crucial to recognize the signs of addiction. Symptoms of addiction include spending excessive time obtaining or using prescription stimulants, as well as experiencing withdrawal symptoms such as irritability, fatigue, and changes in appetite. Currently, there are no FDA-approved medications specifically for treating stimulant addiction, but therapies like cognitive behavioral therapy and proper prescription management are commonly used.
To prevent misuse and addiction, patients should build a strong relationship with their healthcare providers and avoid sharing their medications with others. Being mindful about with whom they share their prescription information is essential, particularly in environments like college, where drug diversion can be more common. Taking these steps can help mitigate the risks associated with stimulant use and protect against the growing concerns of misuse and addiction.
