Rise in the prescription of stimulants linked to the pandemic

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

The CDC researchers note that the sharp 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 in adults are available in the United States. This gap in guidance for ADHD care in adults is a public health concern,” write Melissa Danielson, MSPH, and colleagues.

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

Pandemic fallout

Researchers used MarketScan trade claims data to assess trends in prescription stimulant fillings before and during the COVID-19 pandemic (2016-2021).

Overall, the percentage of people who filled a prescription for stimulants increased from 3.6% in 2016 to 4.1% in 2021.

During the pre-pandemic period (2016-2020), the percentages remained stable or slightly decreased among women aged 24 or younger (average annual percentage change [APC] ranging from -1.8% to 0.1%) and increased slightly in people aged 25 to 64 (average VAP ranging from 2.3% to 6.6%).

However, during the first year of the pandemic (2020-2021), the percentage of women who filled at least one prescription for stimulants increased significantly across most age groups, with the largest increases seen among women. 15-44 years old and 50-54 years old. (VAP ranging from 14.3% to 19.2%).

The trend among males during the pre-pandemic period was similar to that of age-matched females. The percentage of men who had prescription stimulants filled decreased slightly among those aged 24 and younger (average APC range of -3.8% to -1.7%) and remained stable or increased slightly among people aged 25 and over (average APC range of 0% to 6.5%). ).

In the first pandemic year, the percentage of men whose prescriptions were filled decreased among those aged 19 and under, but increased significantly among those aged 25-44 and 50-54 (VAP ranging from 11.1% to 14.7%).

Consistently throughout the study period, most people who received prescription stimulants had appointments with ADHD diagnosis codes, and they averaged more than seven refills per year, which suggests that most were receiving ongoing care for ADHD, the researchers note.

They note that developing clinical guidelines for the diagnosis and management of ADHD in adults similar to those that exist for children “could help clinicians provide best care practices for adult ADHD and help their patients achieve better outcomes”.

The CDC report was released to coincide with a related comment in the Attention Disorder Diary

Underrecognized adult ADHD

The commentary’s authors note that the observed trends “may stem from incremental efforts (i.e., educating patients and providers about ADHD in adults, expanding access to care ADHD, reducing the disparity in access to health care) and relatively sudden phenomena (i.e., /emotionally overwhelmed patients seeking treatment during the pandemic, a recent online neurodiversity movement producing viral and relatable content on ADHD, digital startups prescribing stimulants online, symptoms of long-COVID),” writes Margaret Sibley, PhD, with University of Washington School of Medicine, Seattle and co-authors.

“Whatever the cause, the CDC MMWR report emphasizes that ADHD arrived as an adult psychiatric condition permeating everyday clinical practice. ADHD must now take its rightful and more central place in mental health care for adults,” they add.

Yet despite its prevalence, “clinicians rarely receive relevant specialized training, and may have misconceptions about, or even fail to recognize, ADHD in adults,” note the editorial writers.

“Practitioners should understand that ADHD is usually chronic and persists into adulthood, but is often overshadowed by its sequelae (eg, addiction, depression, anxiety, personality disorders) or non- traditional (e.g. among women, minorities, the elderly), ” they write.

“High-quality provider education is especially needed as new categories of professionals join the workforce to absorb a growing demand for ADHD treatment among adults,” they add.

The study had no commercial funding. The study authors did not declare any relevant financial relationships. Sibley and the other columnists cite various industry relationships. The complete 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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