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Kim ML, Dalvi N, Valerio DD, Strickler GK, Young LD. Prescribed stimulant medications: Trends in the last decade, pre and post COVID-19 response. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100314. [PMID: 37662698 PMCID: PMC10470379 DOI: 10.1016/j.rcsop.2023.100314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Recent studies indicate that COVID-19 has had a significant impact on access and continuity to opioid and benzodiazepine medications; little is known about its effect on access to and utilization of stimulant medications. Objective To investigate trends of dispensed stimulant medications in relation to the COVID-19 pandemic response. Methods Stimulant prescriptions dispensed during 2011-2021 were analyzed using the Massachusetts Prescription Drug Monitoring Program (PDMP), the state's data repository for all controlled substance medications dispensed to residents from retail pharmacies and out of state mail-order pharmacies. Statewide trends were estimated by age group, sex, and stimulant-naïve patients (individuals with no stimulant prescription in the prior one-year period). Results Overall, stimulant prescriptions increased 70% from 2011 to 2021. Wide differences by sex and age groups were found pre and post COVID response periods. Between 2019 and 2021, stimulant prescriptions for males 12-18 years old decreased 14.6% compared to 0.9% for females. Female stimulant-naïve patients ages 25-34 increased more than males between 2019 and 2021 (11.6% compared to <1%, respectively) and females ages 35-44 increased 4.1% while males decreased by 2.7%. Conclusions Administrators, clinicians, and policy makers should closely monitor stimulant prescribing trends, a critical step in improving access to and quality of care.
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Affiliation(s)
- Meelee L. Kim
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Netrali Dalvi
- Office of Prescription Monitoring and Drug Control, Bureau of Health Professional Licensure, Massachusetts Department of Public Health, Boston, MA, USA
| | - Danielle DeNufrio Valerio
- Office of Prescription Monitoring and Drug Control, Bureau of Health Professional Licensure, Massachusetts Department of Public Health, Boston, MA, USA
| | - Gail K. Strickler
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Leonard D. Young
- Office of Prescription Monitoring and Drug Control, Bureau of Health Professional Licensure, Massachusetts Department of Public Health, Boston, MA, USA
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Hartman CA, Chen Q, Solberg BS, Du Rietz E, Klungsøyr K, Cortese S, Dalsgaard S, Haavik J, Ribasés M, Mostert JC, Libutzki B, Kittel-Schneider S, Cormand B, Vos M, Larsson H, Reif A, Faraone SV, Bellato A. Anxiety, mood, and substance use disorders in adult men and women with and without Attention-Deficit/Hyperactivity Disorder: a substantive and methodological overview. Neurosci Biobehav Rev 2023; 151:105209. [PMID: 37149075 DOI: 10.1016/j.neubiorev.2023.105209] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Knowledge on psychiatric comorbidity in adult ADHD is essential for prevention, detection, and treatment of these conditions. This review (1) focuses on large studies (n> 10,000; surveys, claims data, population registries) to identify (a) overall, (b) sex- and (c) age-specific patterns of comorbidity of anxiety disorders (ADs), major depressive disorder (MDD), bipolar disorder (BD) and substance use disorders (SUDs) in adults with ADHD relative to adults without ADHD; and (2) describes methodological challenges relating to establishing comorbidity in ADHD in adults as well as priorities for future research. Meta-analyses (ADHD: n=550,748; no ADHD n=14,546,814) yielded pooled odds ratios of 5.0(CI:3.29-7.46) for AD, 4.5(CI:2.44-8.34) for MDD, 8.7(CI:5.47-13.89) for BD and 4.6(CI:2.72-7.80) for SUDs, indicating strong differences in adults with compared to adults without ADHD. Moderation by sex was not found: high comorbidity held for both men and women with sex-specific patterns as in the general population: higher prevalences of ADs, MDD and BD in women and a higher prevalence of SUDs in men. Insufficient data on different phases of the adult lifespan prevented conclusions on developmental changes in comorbidity. We discuss methodological challenges, knowledge gaps, and future research priorities.
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Affiliation(s)
- Catharina A Hartman
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands.
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Berit Skretting Solberg
- Child- and adolescent psychiatric outpatient unit, Hospital Betanien, Bergen, Norway; Department of Biomedicine, University of Bergen, Norway
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Søren Dalsgaard
- NCRR - National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Marta Ribasés
- Department of Psychiatry, Mental Health and Addictions, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Genetics, Microbiology & Statistics, University of Barcelona, Barcelona, Spain
| | - Jeanette C Mostert
- Department of Psychiatry, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Center Nijmegen, the Netherlands; Department of Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Berit Libutzki
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital Würzburg, Würzburg, Germany
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Melissa Vos
- University Medical Center Groningen, Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, the Netherlands
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alessio Bellato
- School of Psychology, University of Nottingham, Semenyih, Malaysia
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Antoniou T, McCormack D, Kitchen S, Pajer K, Gardner W, Lunsky Y, Penner M, Tadrous M, Mamdani M, Juurlink DN, Gomes T. Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study. BMC Public Health 2023; 23:85. [PMID: 36631810 PMCID: PMC9832754 DOI: 10.1186/s12889-022-14677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Population-based research examining geographic variability in psychotropic medication dispensing to children and youth and the sociodemographic correlates of such variation is lacking. Variation in psychotropic use could reflect disparities in access to non-pharmacologic interventions and identify potentially concerning use patterns. METHODS We conducted a population-based study of all Ontario residents aged 0 to 24 years who were dispensed a benzodiazepine, stimulant, antipsychotic or antidepressant between January 1, 2018, and December 31, 2018. We conducted small-area variation analyses and identified determinants of dispensing using negative binomial generalized estimating equation models. RESULTS The age- and sex-standardized rate of psychotropic dispensing to children and youth was 76.8 (range 41.7 to 144.4) prescriptions per 1000 population, with large variation in psychotropic dispensing across Ontario's census divisions. Males had higher antipsychotic [rate ratio (RR) 1.40; 95% confidence interval (CI) 1.36 to 1.44) and stimulant (RR 1.75; 95% CI 1.70 to 1.80) dispensing rates relative to females, with less use of benzodiazepines (RR 0.85; 95% CI 0.83 to 0.88) and antidepressants (RR 0.81; 95% CI 0.80 to 0.82). Lower antipsychotic dispensing was observed in the highest income neighbourhoods (RR 0.72; 95% CI 0.70 to 0.75) relative to the lowest. Benzodiazepine (RR 1.12; 95% CI 1.01 to 1.24) and stimulant (RR 1.11; 95% CI 1.01 to 1.23) dispensing increased with the density of mental health services in census divisions, whereas antipsychotic use decreased (RR 0.82; 95% CI 0.73 to 0.91). The regional density of child and adolescent psychiatrists and developmental pediatricians (RR 1.00; 95% CI 0.99 to 1.01) was not associated with psychotropic dispensing. CONCLUSION We found significant variation in psychotropic dispensing among young Ontarians. Targeted investment in regions with long wait times for publicly-funded non-pharmacological interventions and novel collaborative service models may minimize variability and promote best practices in using psychotropics among children and youth.
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Affiliation(s)
- Tony Antoniou
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada ,grid.415502.7Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario Canada
| | | | - Sophie Kitchen
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada
| | - Kathleen Pajer
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, Ontario Canada
| | - William Gardner
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Yona Lunsky
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.155956.b0000 0000 8793 5925Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
| | - Melanie Penner
- grid.414294.e0000 0004 0572 4702Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, Ontario Canada
| | - Mina Tadrous
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada
| | - Muhammad Mamdani
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada ,Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - David N. Juurlink
- grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Tara Gomes
- grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario Canada
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Danielson ML, Holbrook JR, Bitsko RH, Newsome K, Charania SN, McCord RF, Kogan MD, Blumberg SJ. State-Level Estimates of the Prevalence of Parent-Reported ADHD Diagnosis and Treatment Among U.S. Children and Adolescents, 2016 to 2019. J Atten Disord 2022; 26:1685-1697. [PMID: 35603751 PMCID: PMC9489617 DOI: 10.1177/10870547221099961] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide state-level estimates of diagnosed ADHD and associated treatment among children in the United States in 2016 to 2019. METHOD This study used the National Survey of Children's Health to produce national and state-level estimates of lifetime diagnosis and current ADHD among all children aged 3 to 17 years (n=114,476), and national and state-level estimates of medication and behavioral treatment use among children with current ADHD. RESULTS The state-level estimates of diagnosed ADHD ranged from 6.1% to 16.3%. Among children with current ADHD, state-level estimates of ADHD medication usage ranged from 37.8% to 81.4%, and state-level estimates of behavioral treatment ranged from 38.8% to 61.8%. CONCLUSION There was substantial state-level variation for indicators of ADHD diagnosis and associated treatment. These state-level results can be used by policymakers, public health practitioners, health care providers, and other stakeholders to help address the service needs of children with ADHD in their states.
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Affiliation(s)
- Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph R Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sana N Charania
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russell F McCord
- Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
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Arkell TR, Bradshaw K, Downey LA, Hayley AC. Acute effects of amphetamine and related psychostimulants on impulsivity: a systematic review of clinical trials. Addict Biol 2022; 27:e13128. [PMID: 35229937 DOI: 10.1111/adb.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Evidence for acute amphetamine effects on behavioural impulsivity in healthy populations remains elusive and, at times, mixed. This review collates and reviews the clinical literature on the acute effects of amphetamines on measures of behavioural impulsivity in healthy adults. Randomised and placebo-controlled clinical trials that assessed behavioural impulsivity following the administration of an acute dose of amphetamine or a related psychostimulant (including amphetamine analogues and methylphenidate) were eligible for inclusion. The EBSCOHost, SCOPUS, PsychNet, Web of Science and ProQuest databases were searched from inception to 26 April 2021. Study selection, data extraction and the Cochrane risk of bias assessments were conducted by two independent reviewers. Reporting follows PRISMA guidelines, and the review was registered a priori on the PROSPERO database (Registration No: CRD42021249861). A total of 20 studies were included, comprising a total of 737 participants. Overall, results indicate that low-moderate doses of amphetamine and related psychostimulants may improve (i.e., reduce) impulsive responding without compromising performance, reflecting enhanced inhibitory control of behaviour. These effects are mild and appear most pronounced in individuals with high baseline impulsivity. This review highlights the need for greater consistency in behavioural task selection and future high-quality and well-designed studies to address current concerns around growing prescription psychostimulant use and misuse.
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Affiliation(s)
- Thomas R. Arkell
- Centre for Human Psychopharmacology Swinburne University of Technology Melbourne Victoria Australia
| | - Kristina Bradshaw
- Centre for Human Psychopharmacology Swinburne University of Technology Melbourne Victoria Australia
| | - Luke A. Downey
- Centre for Human Psychopharmacology Swinburne University of Technology Melbourne Victoria Australia
- Institute for Breathing and Sleep Austin Hospital Melbourne Victoria Australia
| | - Amie C. Hayley
- Centre for Human Psychopharmacology Swinburne University of Technology Melbourne Victoria Australia
- Institute for Breathing and Sleep Austin Hospital Melbourne Victoria Australia
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Hart LC, Grosse SD, Danielson ML, Baum RA, Kemper AR. Changes in Provider Type and Prescription Refills Among Privately Insured Children and Youth With ADHD. J Atten Disord 2021; 25:2028-2036. [PMID: 32942928 PMCID: PMC7969464 DOI: 10.1177/1087054720956727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this paper is to understand associations between age and health care provider type in medication continuation among transition-aged youth with ADHD. METHOD Using an employer-sponsored insurance claims database, we identified patients with likely ADHD and receipt of ADHD medications. Among patients who had an outpatient physician visit at baseline and maintained enrollment at follow-up 3 years later, we evaluated which ones continued to fill prescriptions for ADHD medications. RESULTS Patients who were younger at follow-up more frequently continued medication (77% of 11-12 year-olds vs. 52% of 19-20 year-olds). Those who saw a pediatric provider at baseline and follow-up more frequently continued to fill ADHD medication prescriptions than those who saw a pediatric provider at baseline and non-pediatric providers at follow-up (71% vs. 53% among those ages 15-16 years at follow-up). CONCLUSION Adolescents and young adults with ADHD who changed from pediatric to exclusively non-pediatric providers less frequently continued to receive ADHD medications.
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Affiliation(s)
- Laura C. Hart
- Nationwide Children’s Hospital, Columbus, OH, USA,The Ohio State University, Columbus, USA
| | - Scott D. Grosse
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Rebecca A. Baum
- Nationwide Children’s Hospital, Columbus, OH, USA,The Ohio State University, Columbus, USA
| | - Alex R. Kemper
- Nationwide Children’s Hospital, Columbus, OH, USA,The Ohio State University, Columbus, USA
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Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty - United States, 2014-2019. Drug Alcohol Depend 2020; 217:108297. [PMID: 32961454 PMCID: PMC7851748 DOI: 10.1016/j.drugalcdep.2020.108297] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stimulant medications are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder; however, they also have high potential for diversion and misuse. We estimated national stimulant dispensing trends from 2014 to 2019 and differences in dispensing by age, sex, state, prescriber specialty, payor type, patient copay, and stimulant type. METHODS We calculated rates of stimulant dispensing using IQVIA National Prescription Audit (NPA) New to Brand, NPA Regional, and NPA Extended Insights data, which provide dispensing estimates from approximately 49,900 pharmacies representing 92 % of prescriptions dispensed in the United States. Average annual percent change (AAPC) from 2014 to 2019 was analyzed using Joinpoint regression. RESULTS From 2014 to 2019, the national annual rate of stimulant dispensing increased significantly from 5.6 to 6.1 prescriptions per 100 persons. Rates differed by prescription stimulant type, with increases occurring among both amphetamine-type stimulants and long-acting stimulants. Rates among females (AAPC = 3.6 %; P = 0.001) and adults aged 20-39 years (AAPC=6.7 %; P = 0.002), 40-59 years (AAPC=9.7 %; P < 0.001), and ≥60 years (AAPC = 6.9 %; P = 0.001) increased significantly during the study period. Stimulant dispensing rates varied substantially across states, ranging from 1.0 per 100 in Hawaii to 13.6 per 100 in Alabama. CONCLUSIONS National stimulant dispensing rates increased from 2014 to 2019, driven by notable increases among females and adults aged ≥20 years. These trends should be considered when prescribing stimulants given growing concerns over prescription stimulant diversion, misuse, and related health harms.
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