A new study from Ontario has found a significant increase in prescriptions for stimulant medications used to treat attention-deficit hyperactivity disorder (ADHD). The research, published in JAMA Network Open, shows that prescriptions have risen especially sharply among adults and women. The authors say clearer clinical guidance is needed to ensure these medicines are used in safety and appropriately, particularly because stimulants can carry risks such as effects on the heart.
ADHD is a neurodevelopmental disorder that affects one’s focus, impulse, and daily functioning. It is considered common and affects approximately five percent of the general population.
ADHD prescriptions rose 157 percent between 2015 and 2023
Researchers from SickKids and North York General Hospital reviewed data from more than 15 million residents in Ontario. About 600,000 were given prescriptions for ADHD stimulants such as amphetamines and methylphenidate. The new study said prescriptions increased 157 percent between 2015 to 2023, but at a noticeably faster rate starting in 2020.
“We are seeing people-diagnosis and prescription rates particularly for adults-far exceeding anything we’ve seen in the past,” says Dr Yaron Finkelstein, Staff Physician and Senior Scientist at SickKids, who is a senior author of the study.
“For people with ADHD, stimulant medications can bring better outcomes, but there’s an increased need for improved clinical training and evidence-based prescribing according to guidelines around diagnosis and treatment,” he adds.
Adults and women show biggest increases
The researchers tracked the prescriptions of stimulants for individuals aged 5 to 105 using Ontario’s Narcotics Monitoring System. The findings presented annual prescription rates that rose from 275 to 708 per 100,000 people between 2015 and 2023. Starting with the COVID-19 pandemic, yearly growth jumped to 29 percent.
Conventionally, ADHD was considered a childhood disorder and was generally diagnosed more frequently in boys than girls. But the new figures show this is clearly changing. The fastest-growing group is women aged 18 to 44, who got new prescriptions at rates more than 200 percent higher than men. Adults aged 45 to 64 also saw a sharp rise in first-time diagnoses in 2023.
Why are the prescriptions on the rise?
The authors highlight various possible reasons for this increase. Increased awareness, easier diagnosis (including virtual diagnosis) of the disorder, and changing social patterns since the pandemic are a few of the reasons. Simultaneously, they indicate that misdiagnosis or overdiagnosis might also be influencing this trend.
“The upward trend in prescriptions around the world highlights an important challenge,” says Dr. Daniel Myran, family physician and ICES scientist.
“On one hand, it is likely showing progress towards identifying and treating ADHD in groups who have historically been underdiagnosed. However, the scale of the increases also raises concerns about mis- or over-diagnosis,” he says further.
He adds that inappropriate prescribing could expose people to unnecessary side effects and delay the treatment of other mental health conditions.
