Significant Increase in ADHD Prescriptions During COVID-19

January 23, 2024 steven

TOPLINE:

Prescriptions for Schedule II (C-II) stimulants and nonstimulant attention-deficit/hyperactivity disorder (ADHD) medications significantly increased in the United States during the COVID-19 pandemic, particularly in young adults and females, results of a cross-sectional study showed.

METHODOLOGY:

Using the National Prescription Audit commercial database, which captures more than 94% of US outpatient prescription drug activity, researchers examined US trends in prescriptions dispensed before (April 2018-March 2020) and during (April 2020-March 2022) the COVID-19 pandemic.
Researcher analyzed monthly incident prescriptions for oral formulations of drugs in five classes (antidepressants, benzodiazepines, C-II stimulants, nonstimulant ADHD drugs, and buprenorphine products labeled as medications for opioid use disorder [MOUD]), dispensed to a patient with no prescriptions within the same drug class in the prior 12 months.
For each drug class, investigators ranked the three highest-volume prescriber specialties and identified the top two drugs dispensed.

TAKEAWAY:

After an initial drop in dispensing across all drugs examined, including significant decreases for ADHD drugs and buprenorphine MOUD, prescriptions increased during the pandemic for C-II stimulants (14%) and nonstimulant ADHD drugs (32%), most notably among adults aged 20-39 years (30% and 81%, respectively) and women (25% and 59%, respectively).
Among specialties, the largest increases were for prescriptions written by nurse practitioners across all drug classes, ranging from 7% for benzodiazepines to 78% for buprenorphine MOUD.
Trends in prescriptions dispensed for antidepressants and benzodiazepines did not significantly change as was the case for buprenorphine MOUD, possibly because telemedicine prescribing flexibilities allowed clinicians to continue to diagnose and start treatment for OUD, the authors wrote.
In the C-II stimulant class, amphetamine-dextroamphetamine increased more than methylphenidate, whereas among nonstimulant ADHD medications, there was an increase for atomoxetine but not for guanfacine extended release.

IN PRACTICE:

Increases in ADHD medication prescriptions during the pandemic “underscore the need for robust policies to address unmet needs while balancing public health concerns” wrote the authors, adding that future research “should prioritize clinical ADHD guideline development” to define treatment appropriateness.

SOURCE:

The study was led by Grace Chai, PharmD, MPH, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland. It was published online on January 10, 2024, in JAMA Psychiatry.

LIMITATIONS:

Prescriptions dispensed outside the defined timeframe (during the previous year) may have been misclassified as an incident. The study could not determine causal relationships between drug utilization patterns and effects of the pandemic. Dispensed prescription data may not reflect demand or medical need during periods of drug shortage. The data did not contain information on race.