Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study

Abstract

ObjectiveTo assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their medical and/or neurological conditions.DesignCross-sectional study.SettingAnnual US Medical Expenditure Panel Survey, a stratified random sample of approximately 30 000 persons designed to produce national population estimates. It focuses on reported medical spending, medical services used, health status and prescription medications.ParticipantsAdults age 19 years and older who reported obtaining one or more prescriptions for amphetamine or methylphenidate products during two survey years, 2013 and 2018.Main outcomes measuresPrescriptions obtained, the specific stimulant product and annual treatment days of drug supplied.ResultsIn 2018, an estimated 4.1 million US adults (95% CI 3.4 million to 4.8 million) reported prescriptions for CNS stimulants, having filled a mean of 7.3 (95% CI 6.8 to 7.8) prescriptions with a mean of 226 (95% CI 210 to 242) days’ supply. Compared with 2013, the estimated number of adults reporting using CNS stimulants in 2018 increased by 1.8 million (95% CI 1.0 million to 2.7 million) or 79.8%. Most 2018 adult stimulant users reported taking psychoactive medication for one or more mental, behavioural or neurodevelopment disorders. Overall, 77.8% (95% CI 72.6% to 83.0%) reported some medication for adult attention deficit disorder, 26.8% (95% CI 22.2% to 31.5%) took medication for anxiety, 25.1% (95% CI 19.9% to 30.3%) for depression and 15.3% (95% CI 9.8% to 20.8%) indicated drug treatment for other mental or neurological disorders. Adult CNS stimulant use was higher in females, in younger age cohorts and among individuals of white race/ethnicity.ConclusionsAdult medical use of prescription stimulants increased markedly in 5 years and occurred in a population often reporting multiple mental or neurological disorders. Further action is needed to understand and manage this new resurgence in drugs with high risks of dependence.

Medical use and combination drug therapy among US adult users of central nervous system stimulants: a cross-sectional analysis

“…These findings add new public health concerns to those raised by our previous study reporting a 79% increase in stimulant use in adults over a 5-year period 5. This more detailed profile of how these stimulants are being utilised reveals several new patterns.…”

“…These findings add new public health concerns to those raised by our previous study reporting a 79% increase in stimulant use in adults over a 5-year period. 5 This more detailed profile of how these stimulants are being utilised reveals several new patterns. First, once treatment started, most patients become long-term users—75% of patients continued throughout the 1-year period.…”

“…Medical use of the CNS stimulants amphetamine and methylphenidate has been reported to be increasing among adults in observational studies. Using the US Medical Expenditure Survey Panel, a representative sample of all US households, we previously reported a 79% increase from 2013 to 2018 in the number of adults self-reporting prescriptions for these Schedule II stimulants 5. A Centers for Disease Control study using the National Prescription Audit reported increased dispensing rates from 2014 to 2019 ‘driven by notable increases in adults over age 20’ 6.…”

“…Using the US Medical Expenditure Survey Panel, a representative sample of all US households, we previously reported a 79% increase from 2013 to 2018 in the number of adults self-reporting prescriptions for these Schedule II stimulants. 5 A Centers for Disease Control study using the National Prescription Audit reported increased dispensing rates from 2014 to 2019 ‘driven by notable increases in adults over age 20’. 6 A 2022 study in the electronic health records of 70 million patients in 52 healthcare organisations reported stimulant prescriptions increased by 250% from 2006 to 2016, with these substances increasingly dispensed to older individuals.…”

Transcranial Stimulation for the Treatment of Stimulant Use Disorder

“…A steady rise in availability and manufacturing of methamphetamines, along with increased cocaine use in adults and adolescent populations, continues to perpetuate this healthcare problem [ 1 , 2 ]. A study assessing the prevalence of stimulant use for medical purposes estimated a 79.8% increase in stimulant use from 2013 to 2018 [ 3 ].…”