Misuse of ADHD stimulant medications declines sharply among young adults

Misuse of stimulant medications for attention deficit hyperactivity disorder (ADHD) has declined sharply. In 2023, approximately 3.7% of adults under age 30 misused these medications, down from 7.5% in 2016. In 2023, 1.9% of adults of all ages misused them, with misuse more common among younger adults, white adults, people living in cities and college students. The results were just published in the Journal of Clinical Psychopharmacology.

We found a rapid drop in misuse of these medications, largely driven by a decline in Adderall misuse among young adults. More recent data suggest that those lower rates have remained stable since 2023."

Margaret Maglione, MPP, project leader at the Southern California Evidence Review Center, Keck School of Medicine of USC and study's first author

That decline may be tied, in part, to a nationwide ADHD medication shortage that began in 2022. During the peak of the shortage, an estimated 71.5% of patients said they had difficulty filling their prescriptions, according to the U.S. Centers for Disease Control and Prevention.

The rapid review, which included 64 studies conducted between 2004 and 2024, summarizes data on prevalence and frequency of misuse, reasons and consequences of misuse, demographic patterns, and how medications were obtained and taken.

Two patterns of misuse

ADHD stimulant medications, including Adderall, Ritalin, and Vyvanse, are commonly misused because they can produce immediate cognitive effects, even in people who use them only occasionally. The most common reasons for misuse are to help concentrate (about 35% of users), to be alert or stay awake (about 31%), and to get high or counter the effects of other drugs (about 16%). Most people who misuse these medications get them from friends or relatives with a prescription, who may share them thinking they can help someone study or focus.

Misuse tends to follow one of two patterns, according to the evidence review. One group of users primarily includes young adults, approximately 18 to 30 years old, who occasionally take ADHD medications without a prescription, often to study or focus on detailed work. This group tends to take pills by mouth, is most likely to use Adderall, and is more likely than other users to get pills for free from friends or relatives.

Another group of people misuse ADHD medications more frequently, with "high-frequency use" typically defined as seven or more days per month. People in this group are more likely to be over age 30, to not have a college degree, and to be separated or divorced or on work disability. They are also more likely to obtain medications by doctor-shopping or from a drug dealer and are more likely to snort, smoke or inject the substance.

"The data shows us that most patients do use the medications safely and as prescribed, but these medications are most likely to be misused by those who have a legitimate prescription or those who have access to someone else's medication," said Jaskanwar S. Batra, MD, MHA, a clinical professor and vice chair for clinical affairs in psychiatry and behavioral sciences at the Keck School of Medicine. "Physicians are advised to caution and educate their patients about proper use and safekeeping of these medications."

Consequences of misuse

Misusing ADHD medications can have life-threatening consequences. Between 2012 and 2016, 33,239 incidents involving these drugs were reported to U.S. poison control centers. These incidents included accidental exposures, intentional misuse and suicide attempts.

Many people who misuse ADHD medications report using other substances at or around the same time, making drug interactions a concern. The review found that of adults who misused these medications, 52.8% of adults also simultaneously used alcohol, 26.2% used cannabis, 19.8% used cocaine and 19.5% used other prescription medications.

The researchers cited a study on 1.5 million admissions for substance use treatment, including both inpatient and outpatient programs. They found that only a tiny fraction (0.2%) of admissions were primarily for prescription stimulant misuse.

Importantly, the review found no evidence that taking prescribed ADHD medication during adolescence increases the risk of a substance use disorder later in life.

Filling gaps in research

The researchers found no long-term U.S. studies on the health effects of misusing ADHD stimulant medications. 

"The misuse of stimulants is nothing new-this has been in the public eye for many decades," said Susanne Hempel, PhD, a professor of clinical population and public health sciences at the Keck School of Medicine and director of the Southern California Evidence Review Center, who oversaw the work. "But we didn't find any long-term studies on the physical health consequences of long-term misuse of these drugs, which was surprising."

Another research gap involves people who misuse ADHD medications frequently over a long period of time. More research is needed to understand whether some occasional users go on to become long-term, heavy users, or whether other factors drive these patterns of misuse.

The review was commissioned by the U.S. Food and Drug Administration and is part of a broader analysis of ADHD that covers diagnosis, treatment, monitoring and medication misuse. A 2024 study from the same research team summarized the evidence on diagnosing and treating ADHD, finding that both medication and psychosocial treatments are effective.

Researchers at the Keck School's Department of Psychiatry and Behavioral Sciences and Southern California Evidence Review Center performed the analysis. The latter conducts large-scale reviews of scientific evidence to help distill findings into takeaways that can inform government policy, medical practice, and public health efforts.