The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”
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Gerry Gajadharsingh writes:
“Following on from my recent blog in regard to Dr Suzanne O’Sullivan’s new book, below I comment on the latest research from Medscape looking at stimulant medication misuse.
All medication carries some risk, especially if it is not being used as prescribed.
Stimulant prescriptions for ADHD in adults have surged, raising concerns about misuse and addiction. A new study confirms these fears, revealing that 25% of U.S. adults prescribed stimulants misuse them, and nearly 1 in 10 meet the criteria for prescription stimulant use disorder (PSUD).
Estimating the number of university students in the UK who use ADHD medication—whether through prescription or other means—is challenging due to limited and varied data. Recent research indicates that the overall use of prescription stimulants as cognitive enhancers among UK university students is around 6.9% across surveyed studies. This suggests that approximately 200,000 to 300,000 students may be using these medications. However, these figures should be interpreted with caution. The studies reviewed often had small sample sizes and employed non-representative sampling methods, such as convenience or snowball sampling, which can lead to underestimations.
Furthermore, a report by Unite Students in collaboration with the Bristol University Neurodiversity Society revealed that over 14% of university applicants reported having ADHD and/or being autistic.
I have certainly seen patients where they have abused their ADHD medication (higher dosages and over frequent dosages) with significant adverse effects in including developing psychotic episodes.
While stimulants can be life-changing for some of those with ADHD, the study underscores the urgent need for better screening for substance use disorders. Data from 2019-2022 show a 58% rise in stimulant prescriptions, with the steepest increase among adults aged 31-40 and 71-80.
The study found that misuse was over three times more common with amphetamines than methylphenidate, and PSUD was more than twice as likely. Notably, 73% of those with PSUD used only their prescribed medication, and 43% denied any misuse—suggesting that addiction risks may be underestimated even among those following prescriptions.
Demographic trends show stimulant misuse is highest among young women (37% of those aged 18-25) and lowest among middle-aged women (14% of those 35-64). Meanwhile, prescriptions for women aged 35-64 rose from 1.2M in early 2019 to 1.7M in late 2022.
Experts emphasize the need for improved ADHD diagnosis, prescribing practices, and intervention strategies to curb misuse and PSUD. While only 5% of those who used medication as prescribed developed PSUD, 20% of those who misused stimulants progressed to addiction—highlighting the risks of misuse turning into dependency.
Ensuring responsible prescribing and better screening could help mitigate these rising concerns while preserving the benefits of stimulant therapy for those who truly need it.”
Medscape
Megan Brooks
Stimulants, primarily amphetamines and methylphenidate, are increasingly prescribed to treat attention-deficit/hyperactivity disorder (ADHD) in adults — raising concerns about potential misuse and abuse.
New research confirms this concern, showing that one quarter of US adults who are prescribed stimulants misuse them, with nearly 1 in 10 meeting the criteria for prescription stimulant use disorder (PSUD).
The prevalence of misuse may be even higher, investigators noted, because some adults may not report misuse due to social stigma.
“Prescription stimulants have well-documented benefits for those with ADHD, and they can be life-changing and lifesaving. At the same time, our study highlights the growing need to ensure patients who are prescribed stimulants also receive effective screening for substance use disorder,” Wilson M. Compton, MD, MPE, deputy director of the National Institute on Drug Abuse, Bethesda, Maryland, and corresponding author of the study, told Medscape Medical News.
Stimulant Prescriptions Increasing
The diagnosis of ADHD and the use of prescription stimulants have rapidly increased in children and adults in the past decade.
One study showed a 58% increase in dispensed prescription stimulants from 2012 to 2022, with the greatest increase occurring in adults aged 31-40 years and 71-80 years.
“As the rate of stimulant prescriptions increase in the US, there has been an urgent need to understand how rising usage may be linked to misuse and substance use disorder that can interfere with a person’s well-being,” Compton said.
To address this need, Compton and colleagues quantified prescription stimulant use, misuse, and PSUD among US adults aged 18-64 years.
They analysed data on dispensed prescription stimulants from 2019 to 2022 using two pharmaceutical databases that capture 93% of outpatient prescriptions dispensed in US retail pharmacies (including mail-order prescriptions).
Among a nationally representative sample of 83,762 adults who participated in the 2021-2022 National Surveys on Drug Use and Health, 25% reported misuse of prescription stimulants — defined in the survey as endorsing any of the following statements: Past-year use without a prescription of my own, in greater amounts than prescribed, more often than prescribed, longer than prescribed, or in some other way a doctor did not direct me to use.
Further, 9% of those surveyed had PSUD, according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. About two thirds (64%) of those cases were mild. Among those with PSUD, 73% solely used their own prescribed stimulants, 87% used amphetamines, 43% stated that they did not misuse the drugs.
“The findings suggest an overlooked risk of stimulant use disorder even for those who deny misuse and have their own prescriptions, especially when involving amphetamines,” Compton said.
The prevalence of prescription stimulant misuse was 3.1 times higher and the prevalence of PSUD was 2.2 times higher in those using prescription amphetamines than among those using methylphenidate.
The prevalence of stimulant misuse varied by demographic group, with lower rates among women aged 35-64 years (14%) than other sex- and age-specific subgroups, which ranged from 22% for men aged 35-64 years to 37% for women aged 18-25 years.
The data also confirm increases in stimulant prescriptions dispensed among all sex- and age-specific subgroups, with the largest increase among women aged 35-64 years — rising from 1.2 million in the first quarter of 2019 to 1.7 million in the fourth quarter of 2022.
Misusers Become Abusers
While concerns over misuse and PSUD have typically focused on individuals who take prescription stimulants without clinical supervision, “these new data suggest that even those who think they are using their stimulant medications as directed may be at risk of substance use disorder,” Compton said.
“Our findings emphasize the need for broader screening and more thorough clinical guidance to help improve clinician management of stimulant prescribing practices. It’s also critical to continue to refine diagnostic tools for ADHD and evaluate interventions aimed at reducing misuse and managing prescription stimulant use disorder more effectively,” Compton added.
It’s important to note that this study defines prescription stimulant use as “using one’s own prescription as directed by a physician or misuse,” said Stephen V. Faraone, PhD, distinguished professor, Department of Psychiatry, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, New York, who commented on the findings for Medscape Medical News.
“Among those who used the medication as prescribed, only 5% had PSUD, which is not very high and in the absence of a control group, I would conclude is negligible,” Faraone said.
“Among those who were misusing prescription stimulants, the rate of PSUD was 20.4%. That is high but is not surprising because the group is defined as having already misused stimulants,” Faraone added. “It does tell us that misusers become abusers. That is not surprising, but it is an important public health message.”