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ADHD prescriptions surged among adults during the COVID-19 pandemic compared to prior years. Milko/Getty Images
  • Adult prescriptions for ADHD medication surged during the COVID-19 pandemic compared to prior years, a new study reports.
  • Other categories of drugs, including benzodiazepines, medications to treat opioid use disorder, and antidepressants, continued along regular trends or remained flat.
  • The increase in ADHD prescriptions among adults is unclear.
  • Experts say factors may include widespread telehealth access, pandemic-related mental health issues, and changes to how controlled substances can be prescribed.

Adult prescriptions for ADHD rose dramatically during the COVID-19 pandemic, a new study from the Food and Drug Administration (FDA) finds. However, the causes of the surge are difficult to unravel.

In a new paper published January 10 in JAMA Psychiatry, researchers utilized national prescribing data to examine trends for various classes of drugs from before and during the COVID-19 pandemic from 2018–2022.

Researchers included the following drug categories in the study:

Prescriptions for ADHD medication surged during the pandemic, with a 32% increase in non-stimulant ADHD prescriptions and a 10% overall increase in stimulant ADHD medications.

Meanwhile, the other three classes remained flat or consistent with pre-pandemic trends. The increase in ADHD prescriptions was driven by adults between the ages of 20–39.

Schedule II stimulants for ADHD, which are controlled substances considered to have a “high potential for abuse,” include amphetamines such as Dexedrine and Adderall, methamphetamine (Desoxyn), and methylphenidate (Ritalin).

Prescribing trends for Schedule II stimulants were relatively flat prior to the pandemic but rose precipitously between 2020-2022. Overall, prescriptions rose by 14%.

Meanwhile, prescriptions of non-stimulant ADHD medications, drugs like Tenex (guanfacine), which acts on the central nervous system, and Strattera (atomoxetine), a selective norepinephrine reuptake inhibitor, rose by 32%.

“I can’t say I was totally surprised [by these findings],” Dr. Elias Aboujaoude, a clinical professor of psychiatry at Stanford University, told Healthline.

“As a practicing clinician and cultural observer, I think it’s been clear that the interest in stimulants has grown steadily in recent years,” he added. Aboujaoude wasn’t affiliated with the research.

The study authors cite numerous factors during the pandemic that may have played a role but stop short of attributing the change in prescribing trends to any one thing in particular.

Pandemic-era factors that could have affected prescribing include:

  • changes in access to medication caused by disruptions in healthcare and supply
  • rise of telehealth services and online pharmacies
  • changes in work, social, and family life caused by lockdowns and quarantines
  • mental health issues associated with isolation

The study notes that more than any other group, nurse practitioners were responsible for the largest increase in prescriptions for ADHD medication.

For stimulants, nurse practitioners prescribed 57% more during the pandemic than in the previous two years; for non-stimulant ADHD medication, nurse practitioners were responsible for a 75% increase during the pandemic.

Telehealth businesses don’t always rely on doctors to issue prescriptions.

“I know that some of these online platforms rely more heavily on coaches as opposed to therapists and nurse practitioners as opposed to MDs,” Abdoujaoude said.

“It does make me wonder whether this discrepancy in training level might be part of the explanation. I think it is something that deserves further research,” he noted.

During the pandemic, federal agencies, including the Drug Enforcement Administration (DEA) and Department of Health and Human Services, specifically the Substance Abuse and Mental Health Services Administration (SAMHSA), relaxed rules around prescribing controlled substances, which include stimulants for ADHD.

The changes allowed doctors and nurse practitioners greater flexibility to prescribe drugs via telemedicine, allowing patients to circumvent previously required in-person medical evaluations. The changes also allowed prescribers to issue prescriptions across state lines.

These changes effectively opened the door to more online and telehealth services during the pandemic.

While some of these services legitimately helped increase access to necessary drugs when supply chain issues marred the healthcare system, there were also notorious bad actors.

The most obvious example of such bad actors was the telehealth startup Cerebral, which the United States Department of Justice investigated due to its alleged prescribing practices around controlled substances like Adderall and Xanax.

The company also famously utilized social media platforms like TikTok and Instagram to advertise its services, some of which were later pulled for being deceptive.

Telehealth and relaxed prescribing oversight have led some to speculate as to whether the rise in ADHD medication prescriptions is due to overprescribing rather than unmet needs.

However, the study’s authors note that more research is needed to clarify the issue.

With so many factors in the mix, some experts say it’s too early to understand what is driving the increase in prescriptions.

“More research is needed to clarify the observed increase in incident ADHD medication prescriptions during the 2018-2022 time period,” said Dr. Anish Dube, Chair of the American Psychiatric Association’s Council on Children, Adolescents, and Their Families.

“As the authors point out, possible explanations are likely multifactorial,” he added (Dube was not affiliated with the new study).

A new study indicates that prescriptions for ADHD medication increased during the pandemic compared to previous years. Other classes of drugs examined either maintained their pre-pandemic trend or stayed flat.

The cause of the increased number of prescriptions for ADHD medication is unclear but could be the result of overprescribing or unmet needs revealed by the pandemic.

Experts say that more data is needed to better understand the increased demand for ADHD medication.