Pharmaceutical stimulant diversion, 2002–2022: data from a national sample of law enforcement and regulatory agencies in the US

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Background Nonmedical use (NMU) and diversion of stimulant medications methylphenidate and amphetamines is ongoing. Yet, data describing national diversion rates are not apparent. Methods Data were drawn from a survey of pharmaceutical diversion completed by law enforcement. Quarterly rates of pharmaceutical stimulant diversion (per 100,000 population) were calculated for the period 2002-2022. Analyses examined changes in diversion rates following the COVID-19 pandemic. Results There were 3,324 methylphenidate cases and 12,875 amphetamine cases reported across all 50 states. Diversion rates were characterized by an increase over time, for methylphenidate (t = 5.91, p < .0001, R 2 = 0.299, β = .001) and amphetamines (t = 11.76, p < .0001, R 2 = 0.628, β = .011). Beginning in 1Q2020, amphetamine diversion rates decreased by half, coinciding with the COVID-19 pandemic. Trendlines prior to 1Q2020 indicate an increase in amphetamine diversion rates over time (t = 16.89, p < .0001, R 2 = 0.801, β = .015). Diversion rates post-1Q2020 similarly show an increase over time (t = 2.99, p = .0151, R 2 = 0.499, β = .026). Conclusions Findings show increases in diversion rates of pharmaceutical stimulants. Since 2020, diversion rates are on a trajectory to exceed pre-pandemic levels. Continued surveillance is warranted.