Boston—In a 12-year period ending in 2019, the prevalence of stimulants dispensed to adolescents and young adults increased substantially, although they fell somewhat from the peak, possibly because of overdiagnosis and overtreatment of attention-deficit/hyperactivity disorder, according to a new study.

On the other hand, according to the research from Boston Children’s Hospital and Harvard Medical School, the prevalence of dispensed depressants and narcotics decreased, remaining higher in young adults than adolescents.

The authors advised in the Journal of the American Medical Association Pediatrics, “The increase in stimulant use warrants attention because attention-deficit/hyperactivity disorder may be over-diagnosed and overtreated. In addition, pronounced differences in dispensing of controlled substances based on sex present opportunities for further investigation.”

All of the adolescents and young adults were commercially insured, and the researchers cautioned that the use of a commercial insurance data set might affect generalizability to other populations.

The study goes on to state, “High rates of prescription drug misuse among adolescents and young adults have put renewed focus on ensuring judicious use of controlled medications to limit adverse outcomes related to misuse, addiction, and overdose. Prescription stimulant and benzodiazepine misuse is common among youths. Prescriptions for these drugs have been associated with youth overdoses.”

In response, the study team sought to examine trends from 2008 to 2019 in dispensations of controlled medications to adolescents (aged 13-18 years) and young adults (aged 19-25 years).

To do that, researchers performed a retrospective cohort analysis of adolescents and young adults enrolled in a commercial health insurance company covering 83 million individuals in all 50 states between January 1, 2008, and December 31, 2019. Data were analyzed from December 1, 2021, to February 1, 2022.

The focus was on pharmacy claims to identify patients who received a controlled substance, including narcotics, stimulants, and depressant medications on the Drug Enforcement Administration controlled substance schedule. Dispensing prevalence was defined as the number of adolescents and young adults per 1,000 enrollees each month dispensed a controlled medication.

The results indicated that, among 9.3 million adolescents with a mean age of 15.2 years (50.9% male) and young adults with a mean age of 22.2 years (50.5% female), 15.0% received a narcotic prescription, 4.9% a stimulant, and 3.8% a depressant. The researchers wrote that the most commonly dispensed medications in each pharmaceutical class were:

• Acetaminophen-hydrocodone (64.1%)
• Amphetamine-dextroamphetamine (47.8%)
• Alprazolam (31.2%).

“Stimulants were the most commonly dispensed pharmaceutical class for both age groups with mean monthly dispensing prevalence peaking in 2016 at 45.0 (95% CI, 42.3-47.8) prescriptions per 1,000 adolescents and 33.1 (95% CI, 32.4-33.9) prescriptions per 1,000 young adults,” the authors wrote. “Prescriptions decreased in both age groups, although the prevalence in 2019 remained twice that in 2008 at 44.0 (95% CI, 41.4-46.6) prescriptions per 1,000 vs. 22.5 (95% CI, 20.6-24.4) prescriptions per 1,000 among adolescents, and 3-fold higher at 30.4 (95% CI, 29.8-31.0) prescriptions per 1,000 vs. 10.3 (95% CI, 9.5-11.2) prescriptions per 1,000 among young adults.”

In contrast, the study reported that the prevalence of narcotic prescriptions decreased each year after 2010 by 0.6 (95% CI, 0.5-0.7) prescriptions per 1,000 adolescents and 1.7 (95% CI, 1.4-2.0) prescriptions per 1,000 young adults. In addition, depressants decreased each year after 2013 by 0.2 (95% CI, 0.1-0.3) prescriptions per 1,000 adolescents and after 2011 by 0.6 (95% CI, 0.4-0.8) prescriptions per 1,000 young adults.

“Compared with adolescents, a higher percentage of young adults were dispensed narcotic medications (15.5% vs. 12.5%; P <.001) and depressants (4.6% vs. 1.9%; P <.001), although adolescents were more likely to receive stimulants (6.1% vs. 4.0%; P <.001),” the researchers added. “Among adolescents, males were nearly twice as likely as females to have a dispensed stimulant (8.0% vs. 4.2%; P <.001).”

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