New research sounds alarm about increased stimulant use among U.S. adults

Abstract

The number of adults using central nervous system (CNS) stimulants grew by approximately 80% over a 5-year period, according to new findings published in BMJ Open in August 2021. The total number of amphetamine and methylphenidate prescriptions dispensed grew even faster, with an increase of roughly 96%, according to the study results. “My message is this: It's time to start paying attention,” said lead author Thomas J. Moore from the Center for Drug Safety and Effectiveness at Johns Hopkins University Bloomberg School of Public Health. “The opioid epidemic continued for years before the medical and public health community realized action was needed. We need more research to understand this major trend and why it is happening.” Trends in CNS stimulant use that Moore and the research team found included a younger population of adults, as well as adults with higher education degrees who were more likely to be unmarried. “We need to know what is driving this increase, and why so much use is in combination with antidepressants and antianxiety drugs,” said Moore. The study results found that stimulant users frequently reported taking medications for a variety of mental, neurological, and developmental conditions: 77.8% indicated they took medication for ADHD, 26.8% reported taking anxiety medication, 25.1% said they had taken drugs for depression, and 15.3% indicated drug therapy for other mental or neurological conditions. Andrew Peterson, PharmD, PhD, FCPP, executive director of the Substance Use Disorder Institute at the University of the Sciences in Philadelphia, was not surprised by the results of the BMJ Open study. The trend for youths being diagnosed and treated for conditions such as ADHD with stimulant medications has been increasing since the early 2000s, according to CDC. “Therefore, as the youths became adults, the carry-over for using stimulants to treat these conditions may be a strong factor contributing to the increase seen,” said Peterson. “A particularly vulnerable group are college students who may be misusing these agents to improve cognitive ability and academic achievement.” In the BMJ Open study, Moore and the researchers wrote that the growing use of these stimulants should renew interest in updating, characterizing, and managing the risks of this drug class. For example, the larger numbers of younger age groups using CNS stimulants raises the question of whether or when these prescribed stimulants for ADHD in childhood or adolescence should be discontinued as the child grows older. Peterson encourages pharmacists to help counsel patients—youths and parents, as well as adults—about the risks associated with stimulant misuse. He said research should focus on how pharmacists can use evidence-based strategies such as Screening, Brief Intervention and Referral to Treatment (SBIRT) in the community setting to identify individuals at risk for misusing stimulants. But before this, pharmacists and other health care providers need to feel confident addressing substance use disorders with their patients, which includes understanding the prevalence, incidence, and consequences of stimulant use and misuse. “This appears to be a great opportunity for researching the pharmacist's role in providing this education,” Peterson said. While CNS stimulant use was more frequent in the youngest age cohort, according to the study findings, the largest percentage increases occurred in adults aged 25 years and older. Examined by sex, the largest rise occurred among females, with a 72% jump in CNS stimulant use over the 5-year period. “We saw big differences by age, race, and sex,” said Moore. “The growth was largest in younger, white, and female patients, smallest in minorities and older patients. Increase was much larger in amphetamines versus methylphenidate.” Amphetamine product use increased by roughly 119% over the 5-year period. Growth in methylphenidate products was slower with an estimated 39% increase during that time frame. The findings come from the annual U.S. Medical Expenditure Panel Survey, the largest annual health care survey sponsored by the federal government. Researchers analyzed annual surveys from 2013 through 2018 and looked at a random sample of approximately 30,000 individuals and 325,000 prescriptions each year.