The number of millennial and Gen Z adults taking medication for attention-deficit/hyperactivity disorder soared during the pandemic, according to new research.
A study published Thursday by the Centers for Disease Control and Prevention assessed stimulant prescription trends over five years among adults and children who get health insurance through an employer.
It found that the percentage of American adults and children who filled at least one prescription for stimulants rose to 4.1% in 2021, up from 3.6% in 2016. Among certain demographics, the increase is even more pronounced: The percentage of women ages 15 to 44 and men ages 25 to 44 who filled a stimulant prescription jumped 10% over those five years.
“The current study adds to evidence that the increasing trend in the percentage of adults receiving prescriptions for stimulants has continued during the COVID-19 pandemic, with a notable upturn during 2020-2021,” the authors wrote. “The pandemic has had negative impacts on mental health, which might have led to or exacerbated ADHD symptoms.”
A growing body of research shows the dramatic increase in the number of people seeking prescriptions for ADHD medications during the pandemic. That demand was likely driven by the disruption in work and school schedules as well as by growing awareness about the condition on social media platforms like TikTok. It has since resulted in shortages of medications like Adderall and Ritalin.
Research conducted by Trilliant Health last year found that among adults ages 22 to 24, Adderall prescriptions jumped 15% in the second quarter of 2021 compared with the same three months in 2020. The healthcare-data company said there are more people with prescriptions for Adderall than people with a formal diagnosis of ADHD, which can be treated by both stimulant and nonstimulant medications as well as therapy.
Starting in 2020, temporary federal rules allowed people to get prescriptions for scheduled drugs without in-person visits.
“It’s probably the case that telepsychiatry makes treatment more available to people, as possibly it’s the case that the needs of the population have changed because of the way people have changed the way they work over the course of the pandemic,” said Dr. Jeffrey Newcorn, medical director of the Center of Excellence in ADHD and Related Disorders at the Icahn School of Medicine at Mount Sinai in New York.
Three years later, several medications, including Adderall and Ritalin, are still in short supply, and regulators are trying to crack down on stimulant misuse that may have occurred as a result of making it easier to get prescriptions. The Drug Enforcement Administration proposed in February that patients seeking controlled substances like Adderall receive an in-person evaluation before getting an initial prescription from that healthcare provider. The announcement followed concerns that telehealth startups like Cerebral and Done inappropriately prescribed controlled medications that treat conditions like ADHD.
The drug shortage was first confirmed in October, with the Food and Drug Administration citing shortages of Adderall and Adderall IR. The regulator said then that Teva Pharmaceutical Industries
had “ongoing intermittent manufacturing delays” and that other makers of amphetamine mixed salts couldn’t make enough product to meet market demand in the U.S.
Adderall remains hard to find in some parts of the country. For some of the millions of Americans who take ADHD medications, this has meant they must figure out which pharmacies carry their preferred medication, even though many pharmacists won’t disclose over the phone which controlled substances they dispense. Some patients end up switching medications, a decision that involves the involvement of prescribers, since stimulants are controlled substances. A prescription may have to get canceled, rewritten and submitted to another pharmacy — even before questions about health-insurance coverage and prior authorization are addressed. Other patients are rationing or skipping medication altogether, which can put them at risk of fatigue and productivity issues.
“Our [nurse practitioners] have been bending over backward for our clients daily to try to get their scripts filled — sometimes calling as many as 17 pharmacies to see where it’s in stock that they can send it,” said Pritma Dhillon-Chattha, a nurse who co-founded Lavender, an online psychiatry and therapy office.
There are now some secondary shortages of Ritalin, according to the American Society of Health-System Pharmacists.
“For those patients that are not able to get the prescribed medication — in this case, we’re talking about Adderall — and their provider may be sent to an alternative, like either a shorter-acting agent or maybe a nonstimulating agent, there are alternatives there,” said Anna Legreid Dopp, the ASHP’s senior director of clinical guidelines and quality improvement. “There’s a risk of causing a secondary shortage.”
These issues have fueled enough concern that there are proposed changes at the federal level and among prescribers that seek to address the way these drugs are regulated, prescribed and dispensed.
The American Professional Society of ADHD and Related Disorders is working on guidelines that would clarify how to diagnose the disorder in adults. (There are already guidelines for diagnosing children and teens.) The CDC’s researchers also recommend the development and implementation of clinical practice guidelines for adults with ADHD.
“I think guidelines can call attention to the fact that there’s more to ADHD than prescribing Adderall, which is part of the problem here, too,” Newcorn said. “There’s more to taking care of ADHD than just sitting and doing boring things for longer.”