As awareness of ADHD increases and telemedicine expands, large-scale population studies reveal how the pandemic has reshaped stimulant prescription patterns among adults, especially young women, raising new questions about diagnosis, access to care, and appropriate use.
Study: Patterns of stimulant prescription initiation before and during the COVID-19 pandemic: A population-based time series analysis. Image credit: Neirfy/Shutterstock.com
The rate of new stimulant prescriptions for adults in Ontario has increased rapidly during the coronavirus disease 2019 (COVID-19) pandemic, highlighting the need for careful monitoring to ensure safe and appropriate use. Canadian Medical Association Journal (CMAJ).
Evolving patterns in adult ADHD diagnosis and stimulant use
Prescription stimulants, such as amphetamine salts and methylphenidate, are central nervous system drugs primarily used in the management of attention-deficit/hyperactivity disorder (ADHD). These drugs work by increasing synaptic concentrations of dopamine and norepinephrine, thereby improving alertness and reducing hyperactivity and impulsivity. In some cases, it is prescribed to treat narcolepsy, a sleep disorder characterized by excessive daytime sleepiness.
Stimulants are sometimes used off-label as adjunctive therapy for major depressive disorder, particularly when suboptimal responses are obtained with conventional antidepressant regimens. Although these drugs were primarily prescribed to children, the past two decades have seen a consistent increase in ADHD diagnoses and stimulant prescriptions among adults worldwide.
The increase in ADHD diagnoses in adults may reflect increased awareness of ADHD in this population, an increase in the number of adults receiving a diagnosis for the first time, advances in diagnostic approaches, and increased societal awareness of ADHD. Despite these trends, the underlying factors and potential effects associated with increased stimulant prescriptions among adults remain incompletely understood.
Assessing trends in stimulant prescriptions during the COVID-19 pandemic
Newly released international data reveals a significant increase in prescriptions for stimulants since the onset of the COVID-19 pandemic. While the increased availability of ADHD diagnosis and treatment may be partly responsible for this surge, concerns persist about inappropriate prescribing and the potential long-term effects of stimulant use.
To understand provincial prescribing trends and how they fit into broader international patterns, this study conducted a repeated population-based cross-sectional study of adult prescription stimulant use in Ontario, Canada, from 2016 to 2024. The authors used the Narcotics Monitoring System (NMS) and comprehensive state health databases to obtain demographic and clinical characteristics of new and continuing users. Monthly rates of stimulant administration were assessed. Outcomes were reported as rates per 1000 eligible adults, stratified by age and sex.
Individuals younger than 18 years or older than 105 years, nonresidents, and those who did not recently enroll in state health insurance were excluded. New stimulant recipients were defined as adults who had not received a stimulant prescription in the previous 3 years to ensure a robust incident cohort. The analysis compared trends before and after the onset of the COVID-19 pandemic, adjusting for confounding factors such as gender, prescriber specialty, and previous hospital mental health diagnosis.
Changing patterns in adult stimulant use initiation and prescribing practices
From 2016 to 2024, 327,053 adults in Ontario started stimulant treatment, most of them urban women in their early 30s. Long-acting stimulants, primarily lisdexamfetamine and methylphenidate, were primarily prescribed in primary care and psychiatry for ADHD and anxiety/depression. Just under a third had previously received treatment for ADHD, meaning fewer had any ADHD-related medical treatment recorded in administrative data before starting treatment, but the study could not determine whether this reflected a new diagnosis, delayed recognition, treatment received outside of the records obtained, or an incomplete diagnostic history.
More women and adults ages 24 to 34 have started using stimulants during the pandemic. Psychiatrists’ prescriptions decreased, but the role of nurses increased. The pandemic has accelerated changes in who prescribes stimulants and how quickly patients can receive treatment, raising questions about the appropriateness and consistency of diagnostic practices.
Rates of new stimulant use among adults initially stabilized, then briefly declined before recovering, with the post-pandemic monthly growth rate estimated to be 7.3 times the pre-pandemic trend, reaching 0.44 new stimulant doses per 1,000 adults by June 2024. After the pandemic began, the biggest increases in new use were among adults ages 18 to 24, 25 to 34, and 35 to 44. Stimulant use. Young adults have been the primary demographic driving increased stimulant use.
Before the pandemic, men and women had similar rates of stimulant use. During the pandemic, the proportion of women rose faster and exceeded men in all age groups by June 2024. Among young people aged 18 to 24, 1.31 young women started using stimulants per 1,000, compared to 0.97 young men.
During the pandemic, the proportion of new stimulant users with ADHD or childhood behavioral diagnoses jumped from 23.8% to 31.3%, tripling in absolute numbers. Although rates of anxiety and depression decreased, the number still increased by 74%. By June 2024, 10.4 in 1,000 adults were taking stimulants each month, with the highest monthly rates among those aged 18-24 (22.1/1,000), 25-34 (17.9/1,000), and 35-44 (14.3/1,000). Stimulant use continues to increase among adults, especially among younger age groups, indicating increased and sustained demand.
conclusion
The study highlights a significant increase in the dosage of stimulants prescribed to treat ADHD among Ontario adults during the COVID-19 pandemic. This trend may suggest less stigma and improved access to care for ADHD and anxiety disorders, but it is playing out amid increasing social and digital influences that can shape demand and diagnostic practices.
The relative contribution of increased awareness of potential overdiagnosis and inappropriate prescribing remains uncertain because this study measured medication rather than confirmed drug use and relied on administrative medical records that may not capture all diagnostic interactions.
In the future, research should focus on identifying underlying contributing factors, assessing long-term outcomes, and developing strategies to ensure appropriate diagnosis and treatment of ADHD while minimizing risk of harm and supporting optimal patient care.
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Reference magazines:
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Gomez, T. et al. (2026) Prescription stimulant initiation patterns before and during the COVID-19 pandemic: A population-based time series analysis. CMAJ. 198 (9) E313-E325. Toi: https://doi.org/10.1503/cmaj.251065. https://www.cmaj.ca/content/198/9/E313
