Adolescents show lower rates of nonmedical ADHD drug use

Despite concerns about increased stimulant prescribing, nonmedical use of ADHD drugs among adolescents has declined in the last 20 years, a University of Michigan study shows.

While medical use of prescription stimulants for ADHD among adolescents increased slightly between 2005 and 2023, nonmedical use declined more.

Lifetime medical use was 2% lower in 2005 when compared to nonmedical use, and is now 2% higher." 

Philip Veliz, study co-author, U-M research associate professor at the U-M School of Nursing and Center for the Study of Drugs, Alcohol, Smoking, and Health

This reversal is important and "is what all parents want to see," he said.

Recently, prescription stimulant dispensing has increased in the United States, especially among adults. While nonmedical prescription stimulant use has decreased among teens, no national studies have examined medical and nonmedical use patterns among U.S. adolescents. One concern is that nonmedical use could have increased along with medical use.

To answer that question, Veliz and colleagues analyzed data from 2005 to 2023 from 19 cohorts of 8th, 10th and 12th grade students in the Monitoring the Future Study, an annual survey at U-M that tracks student substance use and other related trends. 

The current study, supported by the National Institute on Drug Abuse and the U.S. Food and Drug Administration and published in the Journal of the American Medical Association, found that lifetime use of nonmedical stimulants in 2005 was at 10% and dropped to 6% in 2023. Lifetime medical use was roughly 8% in both 2005 and 2023. 

"In other words, while the lifetime prevalence of medical use was relatively stable, with a modest increase in current use, we still saw a decrease in both lifetime and current nonmedical use," Veliz said. "Accordingly, these fears of an uptick in misusing these prescriptions may be slightly overstated given the current trends shown in this study." 

The decline in nonmedical use of prescription stimulants among adolescents follows similar declines in other types of nonmedical prescription drugs use, such as opioids and benzodiazepines.

"This more than likely is linked to public health messaging, prescribing practices and stimulant shortages as it relates to these types of drugs," Veliz said.

He said the findings were not surprising given how substance use has been declining among more recent cohorts of adolescents, and that they will help clinicians and policymakers to consider population-level trends in medical and nonmedical use patterns when weighing the risks and benefits of prescription stimulants.

Co-authors include Sean Esteban McCabe, Vita McCabe and John Jardine, all of U-M; Ty Schepis of Texas State University; Emily Pasman of the University of Illinois Chicago; and Timothy Wilens of Massachusetts General Hospital.