Atlanta—Last fall, the FDA warned of an Adderall shortage. In the last few weeks, six pharmaceutical companies that manufacture the drug and its generics reported that some immediate-release formulations were either unavailable or hard to get.

While the reasons for drug shortages are complex, at least one of the reasons pharmacists are having trouble getting stimulants for treating ADHD is the high demand.

The CDC pointed out, “Prescriptions for stimulants, primarily used to treat attention-deficit/hyperactivity disorder (ADHD), were increasing for adults before the COVID-19 pandemic. Policies enacted during the pandemic expanded access to prescription stimulants via telehealth.”

A recent Morbidity & Mortality Weekly Report article explains that the percentage of adolescent and adult females, as well as adult males, receiving prescription stimulant fills increased from 2016 to 2021. That was especially the case during 2020-2021, the CDC authors advised.

“Growing recognition of ADHD in adults and increases in prescription stimulant fills raise questions about current adult ADHD care. Development of clinical recommendations for diagnosing and managing adult ADHD could help guide safe and appropriate stimulant prescribing. Evaluation of policies enacted during the pandemic could identify benefits and harms of those policies,” the researchers wrote.

The increases have primarily occurred among adults in the United States during recent decades, while remaining stable or declining among children and adolescents, according to the report.

The researchers analyzed MarketScan commercial claims data to describe trends in prescription stimulant fills before and during the COVID-19 pandemic (2016-2021). They calculated annual percentages of enrollees aged 5 to 64 years in employer-sponsored health plans who had one or more prescription stimulant fills overall and by sex and age group.

“Overall, the percentage of enrollees with one or more prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021,” according to the article. “The percentages of females aged 15–44 years and males aged 25–44 years with prescription stimulant fills increased by more than 10% during 2020–2021. Future evaluation could determine if policy and health system reimbursement changes enacted during the pandemic contributed to the increase in stimulant prescriptions.”

The authors cautioned that, while stimulants can offer substantial benefits for ADHD patients, they also pose potential harms, including adverse effects, medication interactions, diversion and misuse, and overdoses. Part of the problem, according to the article, is that well-established clinical guidelines exist only for ADHD care of children and adolescents. The authors suggested that clinical practice guidelines for adult ADHD “could help adults also receive accurate diagnoses and appropriate treatment.”

The study noted that, across all years, the percentages of male and female enrollees with one or more prescription stimulant fills were highest among those aged 5 to 19 and 15 to 24 years, respectively. “Overall, the percentage of enrollees with prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021, with percentages and APC varying by sex and age,” the researchers explained. “During 2016–2020, percentages remained stable or decreased among females aged ≤24 years (average APC range = –1.8% to 0.1%) and increased modestly among those aged 25–64 years (average APC range = 2.3% to 6.6%). However, during 2020-2021, the percentage of females with one or more prescription stimulant fills increased substantially among most age groups, with the largest changes among those aged 15-44 and 50-54 years (APC range = 14.3% to 19.2%).”

Prior to the pandemic, the pattern among males was similar to that among comparably aged females. During 2020-2021, however, the percentage of males with prescription fills decreased among those aged 19 years or younger but increased substantially among those aged 25 to 44 years and 50 to 54 years (APC range = 11.1% to 14.7%).

“The percentage of persons with employer-sponsored insurance who received prescription stimulants increased during 2016–2021, with notable increases among adolescent and adult females and adult males,” the study authors wrote. “The largest single-year increases occurred during 2020–2021, with the annual change exceeding 10% in many age groups. Consistently across the study period, most persons with prescription stimulant fills had healthcare encounters with ADHD diagnosis codes, and persons with prescription stimulant fills averaged more than seven fills per year, suggesting that most were receiving ongoing care for ADHD.”

They pointed out that the current study “adds to evidence that the increasing trend in the percentage of adults receiving prescriptions for stimulants has continued during the COVID-19 pandemic, with a notable upturn during 2020–2021. The pandemic has had negative impacts on mental health which might have led to or exacerbated ADHD symptoms.”

Another issue was that, to adapt to the pandemic environment, policy and health system reimbursement changes were put into place, such as the expansion of telehealth and easing of the requirement for having an in-person visit with a clinician before receiving a prescription for stimulants or other Schedule II controlled substances.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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