The rate of new stimulant prescriptions for adults with ADHD increased rapidly during the COVID pandemic, according to new research.

The sharpest rise in prescriptions took place in the 18- to 24-years age group. Roughly 1 in 50 adults aged 18-34 years was dispensed stimulants by June 2024.

“The particularly high growth among 18- to 24-year-olds may be attributed to pressures this age group faced during the pandemic due to disruptions to postsecondary education, transitions to remote learning, and uncertainty about early career opportunities,” study author Nevena Rebić, PhD, postdoctoral fellow at Unity Health Toronto, told Medscape News Canada. “Younger adults are also more likely to use and seek out information on social media, which could lead to more of them seeking ADHD assessment and management through medications during this period.”

The data were published on March 8 in CMAJ.

Results Consistent With Global Trends

In the past, stimulants were prescribed for pediatric ADHD and certain other conditions. But in the past two decades, ADHD diagnoses and dispensing of stimulant prescriptions have increased globally in adults, particularly after the start of the pandemic. In 2020, a short-term decline in new recipients of stimulant prescriptions was followed by a doubling of these prescriptions.

The goal of the current study of population health administrative data was to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and after the pandemic.

The researchers studied 327,053 adults who were dispensed at least one new prescription for stimulants between January 1, 2016, and June 30, 2024. More than half (55.4%) of participants were women, their median age was 31 years, and most (91%) lived in urban areas. Most (91.6%) adults were given a long-acting stimulant only, most commonly lisdexamfetamine or long-acting methylphenidate.

The researchers examined initial stimulant prescription characteristics such as expected indication, specialty of initiating prescriber, visit type at initiation (ie, virtual vs in-person), initial stimulant formulation and dose category, and stimulant type. They also examined mental health and substance use disorder diagnoses and various types of healthcare interactions related to ADHD.

Primary care physicians and psychiatrists were the top prescribers of the initial stimulant (63.3% and 20.5%, respectively). The proportion of new prescriptions initiated by these clinicians declined, and the proportion initiated by nurses or nurse practitioners increased, during the study period.

The rate of new adult stimulant use was relatively stable before the pandemic (change in monthly rate per 1000 people 0.0004), declined immediately at the start of the pandemic (-0.067), and accelerated thereafter (0.0029). It rose from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024.

Before the pandemic, stimulant prescribing rates were similar between men and women, but during the pandemic, rates rose more rapidly among women in all age groups.

“Many of these findings are consistent with trends in stimulant prescribing observed globally in the postpandemic era and are likely influenced by greater awareness of adult ADHD and improved access to care following a historical pattern of underdiagnosis of ADHD in adulthood — particularly among women,” said study author Mina Tadrous, MD, associate professor of pharmacy at the University of Toronto.

Dispensing by Psychiatrists Declined

The researchers were unable to delineate the diagnostic and treatment trajectory leading to drug initiation. It thus was unclear whether these cases reflected new diagnoses, delayed recognition, or diagnostic substitution from other mental health conditions.

While the study showed an association between stimulant prescriptions and the pandemic, it wasn’t designed to address the reasons for the trend. “There are several factors we identified from other research literature that likely contributed to this,” said Rebić. The pandemic disrupted many people’s daily routines. These disruptions may have affected patients’ ability to manage ADHD-related challenges effectively and may have increased the severity of their symptoms. “Additionally, other mental health conditions can amplify these struggles,” Rebić added.

The awareness of how ADHD may present in adults has grown, driven by social media platforms such as TikTok, and the number of telemedicine companies advertising access to treatment for ADHD increased early in the pandemic, said Rebić. Virtual care also has enabled easier access to clinicians.

Commenting on the findings for Medscape News Canada, Tanya Hauck, MD, PhD, addiction psychiatrist at the Centre for Addiction and Mental Health in Toronto, said, “Access to public and private funding was a contributing factor in the increase in prescriptions.” Hauck did not participate in the study. Pandemic-related increased stress and isolation were possible factors for the increased rate of prescriptions, she added. Long COVID and its potential cognitive effects might have played a role, but the data were not examined to answer this question.

“One of the reasons for the drop in dispensing by psychiatrists might be that they might make recommendations but not do the actual prescribing. We don’t have access to the supplementary data. Perhaps people had a psychiatric consult in the 3-6 months prior to the dispensing of the prescription, but the script wasn’t provided by that psychiatrist,” said Hauck.

The researchers concluded that the increase in new stimulant recipients may have resulted from efforts to improve access to ADHD diagnosis and care. Additional research is needed to clarify the driving factors and impact of these rising prescription rates to support ADHD diagnosis and treatment, they said.

Rebić and Hauck reported having no relevant financial relationships. Tadrous reported funding from Canada’s Drug Agency, the Ontario Ministry of Health, and the Canadian Institutes of Health Research, as well as consulting fees from Canada’s Drug Agency and Innovation, Science and Economic Development Canada.

Evra Taylor is a freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.