In the Journals

Prescribed stimulant use increases more rapidly among adults vs. youth

From 2010 to 2014, prescribed stimulant use significantly increased among adults, while youth experienced a moderate increase.

“Studies of office-based physician visits by adults showed that the proportion of visits with a prescribed stimulant grew 7-fold, from 0.1% between 1994 and 1997 to 0.7% between 2006 and 2009, and the percentage of visits with ADHD diagnosis doubled from 0.3% between 1999 and 2002 to 0.7% between 2007 and 2010,” Mehmet Burcu, MS, of University of Maryland, Baltimore, and colleagues wrote. “However, little is known about the trends in stimulant use within the past few years, specifically within commercially insured U.S. populations.”

To determine recent trends in stimulant use according to age and sex, researchers applied a repeated cross-sectional design to administrative claims data for 2010 to 2014 among youths aged 0 to 19 years and adults aged 20 to 64 years who were continuously enrolled in a Blue Cross Blue Shield health insurance plan annually in Illinois, New Mexico, Oklahoma or Texas. The study cohort included more than 3.5 million individuals per year.

From 2010 to 2014, stimulant use increased across all age groups, though it was significantly greater among adults (P < .001).

Stimulant use increased from 2.7% to 3.1% among children aged 0 to 9 years (adjusted OR = 1.16; 95% CI, 1.13-1.18), from 6.2% to 7.2% in children aged 10 to 19 years (aOR = 1.27; 95% CI, 1.25-1.29); from 2.2% to 3.6% among individuals aged 20 to 39 years (aOR = 1.84; 95% CI, 1.81-1.87); and from 1% to 1.5% among individuals aged 40 to 64 years (aOR = 1.66; 95% CI, 1.63-1.69).

Researchers observed slight but statistically significant differences in increases in stimulant use by sex among participants aged 10 to 19 years and 20 to 39 years.

In 2014, stimulant use was significantly greater among males vs. females aged 0 to 19 years (7.1% vs. 3.5%; P < .001), but did not differ by sex among those aged 20 to 34 years (4% vs. 4%; P = .95).

Among participants aged 35 to 64 years, stimulant prevalence was greater among women than men (1.9% vs. 1.3%; P < .001).

In 2014, amphetamine-related products accounted for the greatest percentage of total stimulant dispensing among adults (83.6%), while methylphenidate-related products were more common among youth (52.5%).

Among individuals prescribed stimulants, clinician-reported ADHD diagnosis was more common among youths than adults (62% vs. 45.5%).

“In a commercially insured population, in just 5 years, between 2010 and 2014, the proportion of adults treated with stimulants grew rapidly in contrast to youths, who had a modest increase in stimulant use,” the researchers wrote. “The increase in adult stimulant use may be largely driven by increases in outpatient diagnoses of adult ADHD. However, consistent with previous reports, we show that a large proportion of stimulant-treated adults lacked an ADHD diagnosis, potentially reflecting off-label use. This raises concerns regarding potential nonmedical use of prescription stimulants.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.

From 2010 to 2014, prescribed stimulant use significantly increased among adults, while youth experienced a moderate increase.

“Studies of office-based physician visits by adults showed that the proportion of visits with a prescribed stimulant grew 7-fold, from 0.1% between 1994 and 1997 to 0.7% between 2006 and 2009, and the percentage of visits with ADHD diagnosis doubled from 0.3% between 1999 and 2002 to 0.7% between 2007 and 2010,” Mehmet Burcu, MS, of University of Maryland, Baltimore, and colleagues wrote. “However, little is known about the trends in stimulant use within the past few years, specifically within commercially insured U.S. populations.”

To determine recent trends in stimulant use according to age and sex, researchers applied a repeated cross-sectional design to administrative claims data for 2010 to 2014 among youths aged 0 to 19 years and adults aged 20 to 64 years who were continuously enrolled in a Blue Cross Blue Shield health insurance plan annually in Illinois, New Mexico, Oklahoma or Texas. The study cohort included more than 3.5 million individuals per year.

From 2010 to 2014, stimulant use increased across all age groups, though it was significantly greater among adults (P < .001).

Stimulant use increased from 2.7% to 3.1% among children aged 0 to 9 years (adjusted OR = 1.16; 95% CI, 1.13-1.18), from 6.2% to 7.2% in children aged 10 to 19 years (aOR = 1.27; 95% CI, 1.25-1.29); from 2.2% to 3.6% among individuals aged 20 to 39 years (aOR = 1.84; 95% CI, 1.81-1.87); and from 1% to 1.5% among individuals aged 40 to 64 years (aOR = 1.66; 95% CI, 1.63-1.69).

Researchers observed slight but statistically significant differences in increases in stimulant use by sex among participants aged 10 to 19 years and 20 to 39 years.

In 2014, stimulant use was significantly greater among males vs. females aged 0 to 19 years (7.1% vs. 3.5%; P < .001), but did not differ by sex among those aged 20 to 34 years (4% vs. 4%; P = .95).

Among participants aged 35 to 64 years, stimulant prevalence was greater among women than men (1.9% vs. 1.3%; P < .001).

In 2014, amphetamine-related products accounted for the greatest percentage of total stimulant dispensing among adults (83.6%), while methylphenidate-related products were more common among youth (52.5%).

Among individuals prescribed stimulants, clinician-reported ADHD diagnosis was more common among youths than adults (62% vs. 45.5%).

“In a commercially insured population, in just 5 years, between 2010 and 2014, the proportion of adults treated with stimulants grew rapidly in contrast to youths, who had a modest increase in stimulant use,” the researchers wrote. “The increase in adult stimulant use may be largely driven by increases in outpatient diagnoses of adult ADHD. However, consistent with previous reports, we show that a large proportion of stimulant-treated adults lacked an ADHD diagnosis, potentially reflecting off-label use. This raises concerns regarding potential nonmedical use of prescription stimulants.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.