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Prescription stimulants are used mainly to treat attention-deficit/hyperactivity disorder (ADHD). For decades their use has been rising among adults while holding steady or falling among children and adolescents. Then the COVID-19 pandemic brought policies that made them easier to get through telehealth. CDC looked at what happened next.
The data
CDC analyzed the Merative MarketScan Commercial Database — a large national convenience sample of claims from people in employer-sponsored health plans — for 2016–2021. For each year, it measured the share of people aged 5–64, enrolled all year, who filled at least one stimulant prescription, whatever the diagnosis. Samples ranged from 20.7 million people (2016) to 13.3 million (2021). Changes above 10% in a year are highlighted; with samples this large, formal significance tests would flag trivial differences.
What changed
Overall: the share with a stimulant fill rose from 3.6% in 2016 to 4.1% in 2021 — with the biggest one-year jump in 2020–2021.
Figure 1. Share of people with at least one stimulant fill, by sex, age and year. CDC
| Group | 2016 | 2020 | 2021 | Change 2020–2021 |
|---|---|---|---|---|
| Everyone, 5–64 | 3.6% | 3.8% | 4.1% | +7.9% |
| Females | 3.2% | 3.6% | 4.1% | +13.9% |
| Females 15–19 | 5.3% | 5.3% | 6.1% | +15.1% |
| Females 20–24 | 5.6% | 5.2% | 6.2% | +19.2% |
| Females 35–39 | 3.1% | 4.0% | 4.7% | +17.5% |
| Males | 3.9% | 4.0% | 4.2% | +5.0% |
| Males 10–14 | 10.8% | 10.2% | 9.9% | −2.9% |
| Males 30–34 | 3.4% | 4.1% | 4.7% | +14.6% |
| Males 35–39 | 2.7% | 3.4% | 3.9% | +14.7% |
- Before the pandemic (2016–2020), fills were stable or falling among females 24 and under and rising modestly among women 25–64 (by 2.3% to 6.6% a year). Among males the pattern was similar: falling slightly at 24 and under, stable or rising modestly from 25 up (0% to 6.5% a year).
- In 2020–2021, fills jumped among most female age groups — most among ages 15–44 and 50–54 (up 14.3% to 19.2%). Among males they fell at 19 and under but jumped at 25–44 and 50–54 (up 11.1% to 14.7%).
- The highest shares were among boys and young men aged 5–19 and young women aged 15–24, though the boys' shares fell over time.
Figure 2. Year-to-year change, by sex and age. CDC
People who filled stimulants averaged 7.4 to 7.6 fills a year, and most — at least 75% of those aged 5–19 and 53%–77% of adults — had also received ADHD care. That suggests most were in ongoing ADHD treatment.
Why it matters
ADHD was long seen as a childhood disorder, mostly in boys. It is increasingly recognized as potentially lifelong — and possibly underdiagnosed in girls and adults. Diagnosis and treatment help, and stimulants reduce symptoms in children and adults alike. The pandemic may have worsened mental health and ADHD symptoms, while telehealth and relaxed in-person visit rules for Schedule II drugs lowered the barriers to getting a prescription. That may have helped people who needed care — but it may also have allowed inadequate evaluations and inappropriate prescribing.
Stimulants also carry risks: side effects, drug interactions, and diversion, misuse and overdose — so they need careful prescribing and monitoring. Yet while well-established guidelines exist for diagnosing and treating ADHD in children and adolescents, the United States has no clinical practice guidelines for adults. Adult ADHD is hard to tell apart from other conditions, mental health providers trained in it are scarce, and clinicians from many specialties differ in their training and comfort with it.
The authors recommend: developing guidelines for adult ADHD, and evaluating the pandemic-era prescribing policies — including telehealth — for their benefits, harms and effect on equitable access.
Limits
- The sample covers only people with employer-sponsored insurance.
- There are no data on race and ethnicity, income or other traits.
- Pandemic prescribing rules varied by state, and state results aren't shown.
- Medicines paid for out of pocket or obtained otherwise are missed.
- Claims don't show symptoms, access, quality of care, the prescriber's specialty, whether a visit was by telehealth — so the rise can't be pinned on telehealth — or whether stimulants were prescribed for something other than ADHD.
- Prescription claims carry no diagnosis codes.
- Percent changes are exaggerated in groups with low starting rates.
Sources
Based on Danielson ML, Bohm MK, Newsome K, et al., "Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021," MMWR Morbidity and Mortality Weekly Report volume 72, number 13, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
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