Annual Stimulant Prescriptions Have Doubled In Adolescents Since 2008

Michael S. Toce, MD, MS

Prescriptions for controlled stimulants among adolescents and young adults have increased significantly in the US since 2008.

In a new research letter assessing the recent trends of controlled medication prescriptions for young Americans, a team of Boston investigators observed a substantial increase in stimulants among adolescents aged 13-18 years old and young adults aged 19-25 years old. Though the total prescriptions peaked in 2016, the trajectory of annual stimulant prescriptions in these age groups remained approximately twice greater than it was in 2008.

Investigators led by Michael S. Toce, MD, MS, of the division of emergency medicine at Boston Children’s Hospital, conducted an analysis of trends in dispensation of controlled medications including stimulants, narcotics and depressants among adolescents and young adults from 2008-2019. With prescription stimulant and benzodiazepine misuse being common among younger individuals—and such prescriptions being linked to overdoses among adolescents and young adults—the team found the retrospective analysis to be critical to interpret trends in clinician prescribing.

“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,” they wrote.

Toce and colleagues conducted the cohort assessment using the data from the private commercial information of American adolescents and young adults between 2008 and 2019. The team analyzed pharmacy claims to identify patients dispensed controlled substances, with dispensing prevalence defined as number of adolescents and young adults per 1000 enrollees each month dispensed a controlled medication.

Annualized monthly prevalence rates were defined by controlled substance, and dispensations were stratified by age and sex.

The final analysis included 9.3 million adolescents and young adults; mean adolescent age was 15.2 years, with 50.9% male. Mean young adult age was 22.2 years, with 49.5% male. Among the population, 15.0% received a narcotic prescription, 4.9% a stimulant, and 3.8% a depressant. The most commonly dispensed drug in each class was acetaminophen-hydrocodone (64.1%), amphetamine dextroamphetamine (47.8%), and alprazolam (31.2%), respectively.

Stimulants were the most commonly dispensed drug class of the observed 3 in each age group; mean monthly dispersal peaked at 45.0 per 1000 adolescents (95% CI, 42.3 - 47.8) and 33.1 per 1000 young adults (95% CI, 32.4 - 33.9) in 2016. Though the annual rate of dispensations decreased in each age group by 2019, it remained twice greater among adolescents (44.0; 95% CI, 41.4 - 46.6) and 3-fold greater among young adults (30.4; 95% CI, 29.8 - 31.0) than observed 2008 rates (22.5 and 10.3, respectively).

After peaking in 2010, annual narcotic prescription rates decreased each year; depressant prescription rates peaked in 2013 before also gradually decreasing.

Young adults were more likely to be dispensed narcotic medication (15.5% vs 12.5%; P <.001) and depressants (4.6% vs 1.9%; P <.001) than adolescents. However, adolescents were more likely to be dispensed stimulants than young adults (6.1% vs 4.0%; P <.001). Male adolescents were twice as likely to be dispensed a stimulant than a female peer.

Though the assessment was limited by the range of commercial insurance data available, investigators concluded that the prevalence of prescribed stimulants increased significantly in adolescents and young adults since 2008. Though depressants and narcotics were decreasingly prescribed over the years, it remained more prevalent for young adults than adolescents.

“The increase in stimulant use warrants attention because (ADHD) may be overdiagnosed and overtreated,” Toce and colleagues concluded. “In addition, pronounced differences in dispensing of controlled substances based on sex present opportunities for further investigation.”

The research letter, "Trends in Dispensing of Controlled Medications for Adolescents, Young Adults," was published online in JAMA