TOPLINE:

The prevalence of noncocaine psychostimulant use disorder (UD) increased 12-fold between 2001 and 2020 among Medicaid enrollees aged 25-29 years and eightfold in those aged 18-24 years, a new study showed.

METHODOLOGY:

• Researchers conducted a repeated cross‑sectional study of individuals insured by Medicaid or the Children’s Health Insurance Program across 42 US states from 2001 to 2020 with ≥ 10 months of coverage in a calendar year, including 5.7 million recipients in 2001 and 16.1 million in 2020.
• In 2020, 54% of Medicaid recipients were women, 7.1 million were adolescents aged 13-17 years, 5.7 million were young adults aged 18-24 years, and 3.3 million were aged 25-29 years.
• Stimulant UD diagnoses were evaluated using inpatient and outpatient International Classification of Diseases, Ninth and 10th Revisions, Clinical Modification codes; cocaine UD and noncocaine psychostimulant UD were evaluated separately.
• Outcomes included trends in stimulant UD prevalence from 2021 to 2020, identification of patients with attention-deficit/hyperactivity disorder (ADHD) or any mental health diagnosis, and prescription medication use among those diagnosed with stimulant UD in 2020.

TAKEAWAY:

• During the study period, the diagnoses of noncocaine psychostimulant UD increased substantially from 0.1% to 0.9% in young adults aged 18-29 years (prevalence ratio [PR], 8.8). Among the adult subgroups, those aged 18-24 years had an increase from 0.09% to 0.5% (PR, 5.5), and those aged 25-29 years had an increase from 0.1% to 1.6% (PR, 12.6). In adolescents (13-17 years), the rates remained low (about 0.03%-0.07%).
• Cocaine UD remained stable in young adults and declined in adolescents, with a peak in 2006 for all age groups (0.06% for those aged 13-17 years, 0.3% for those aged 18-24 years, and 0.8% for those aged 25-29 years).
• Cannabis UD was the most prevalent stimulant UD in adolescents (56%), whereas opioid UD was most common in adults aged 25-29 years (49%).
• In 2020, most patients with a stimulant UD also had a mental health diagnosis (68%-82%) or another substance UD (72%-78%). Individuals with ADHD or stimulant prescriptions were 2.6-4.4 times more likely to have cocaine or noncocaine psychostimulant UD. However, 89.5% of young adults aged 18-24 years and 69.4% of adolescents with stimulant UD did not have an ADHD diagnosis or prescription.

IN PRACTICE:

“The increase in noncocaine psychostimulant use disorder diagnoses may be due to changes in availability, use, or misuse of prescription and illicit stimulants along with increased clinical detection,” the investigators of the study wrote.

“Increasing stimulant UD diagnoses among young people highlight the need to develop and disseminate more evidence-based treatments,” they added.

SOURCE:

The study was led by Greta Bushnell, PhD, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey. It was published online on October 15 in JAMA Psychiatry.

LIMITATIONS:

The study was limited by insufficient data to identify specific stimulants within noncocaine psychostimulant UD classifications, inconsistent reporting of race and ethnicity across states and years, and potential underestimation of true prevalence of stimulant UD. The study lacked data on uninsured individuals, youth covered by state Children’s Health Insurance Programs, and adults aged 30 years or older, limiting the generalizability of the findings.

DISCLOSURES:

The study was funded by the National Institute on Drug Abuse. Several investigators reported having financial or other ties with various sources and/or testified as expert witnesses in litigation. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.