April 9, 2025 – Attention deficit hyperactivity disorder is no longer understood as mainly a childhood condition. The number of adult diagnoses has increased significantly in recent years, and the share of patients over 18 being prescribed stimulants – mostly amphetamines – and becoming addicted to them has risen accordingly.
These medications, such as Adderall and Vyvanse, are the most common treatments for adult ADHD and are generally considered safe for long-term use. But while they carry a lower risk of addiction and fatalities compared to opioids, a study of 84,000 adults ages 18 to 64 found that, among those using prescription stimulants, 1 in 4 misused them. Misuse included taking them without a prescription, exceeding prescribed dosages, or using them outside a doctor's guidance. Nearly 10% of people in the study taking prescription stimulants developed prescription substance use disorder (PSUD), defined as the use of prescription stimulants causing significant impairment or distress.
The study, published on March 19 in JAMA Psychiatry, included both users with a prescription and those without, obtaining them on the black market or, more commonly, from friends or relatives. Cases of PSUD emerged in both groups, and they were overwhelmingly (90% of the time) related to amphetamines. The paper also found that adult stimulant prescriptions have been climbing rapidly in the U.S., going up by 34% from 2019 to 2022.
Pinpointing the exact cause of this dramatic rise isn't easy, said Wilson Compton, MD, co-lead author of the study and the deputy director of the National Institute on Drug Abuse. COVID-era relaxation of telehealth regulations may have played a role, he said, though the increase started before that. Advertising and increased awareness likely contributed. "We've seen marketing to individuals to remind them that ADD [attention deficit disorder] can be quite disabling, and that there are effective treatments," he said.
But perhaps the biggest factor is the recent increase in adult diagnoses of ADHD. Studies that followed people over a period of time have established that most people diagnosed with the condition in childhood continue to have its effects as adults, said Brooke S.G. Molina, PhD, a professor of psychiatry, psychology, pediatrics, and clinical and translational science at the University of Pittsburgh.
Further, ADHD used to be seen mainly as a boys' condition. But today, medical professionals recognize that girls have it, too, and so do women, said Molina, who was not involved in the study. The largest increase in stimulant prescriptions between 2019 and 2022 was for women ages 35-64, the study found.
Is Misuse of Stimulants Truly a Crisis?
The concern over stimulant misuse isn't clear-cut. For one thing, Molina said, the study's definition of misuse is quite broad, potentially encompassing behaviors that some may not agree rise to that level. Molina also noted that 64% of the people with PSUD had fairly mild cases. "In this paper, most people who said they had misused stimulants had not misused them in the past month," she said. "That tells you we're not talking about people who misuse on a daily or weekly basis."
Yet the paper's authors view the findings as troubling. "There's a reason why these drugs are prescription and are classified as controlled substances," said Compton. "They have a significant ability to produce reinforcement and reward, which is at the heart of developing a substance use disorder or addiction to these medications." In extreme cases, he said, stimulant overdose can lead to arrhythmias (abnormal heart rhythms), seizures, or strokes, which can be fatal.
The Need for Adult ADHD Medical Guidelines
Part of the problem is that the rise in adult stimulant prescriptions has not been matched by the development of detailed clinical practice guidelines, which medical professionals need so they can deal with the serious issues that can emerge with treatment. These include "misdiagnosis, overdiagnosis, overprescribing, and psychosis associated with high-dose prescription amphetamines," the authors said.
The need for guidelines is especially pronounced given the variety of health practitioners who prescribe ADHD medications. From 2019 to 2022, prescriptions by nurse practitioners and physician assistants grew by 110%, the paper found. Those by internal and osteopathic medicine doctors increased by 26.5%, followed by 16.2% for family and general practice doctors and 10.3% for psychiatrists.
Doctors and other medical professionals need more education about ADHD, said Molina, who is the president-elect of the American Professional Society of ADHD and Related Disorders (APSARD). Adult ADHD is a complex diagnosis. "One of the things that is tricky about diagnosing in adulthood," she said, "is you can have a long history of things you have to sort through – depression, anxiety, PTSD, substance abuse." Health practitioners must establish that the condition began in childhood, she said, when symptoms typically start. "We need to give some guidance to these doctors so they can sort through it or refer to a psychiatrist."
How to Reduce the Risk of Misuse
The study found marked demographic differences in stimulant misuse and addiction. Women ages 35-64, while most likely to have new prescriptions, were the least likely to misuse or become addicted to their medications. Men and women ages 18-25 had the highest prevalence of misuse, followed by the 26-34 crowd.
It's not clear how many of these adults have continued to take Adderall or Ritalin since they were children. There isn't much recent data on this, said Molina. Decades-old studies show that people tend to phase out of their prescriptions as they grow older; but nowadays, many college students take stimulants to stay focused, so that may have changed.
People who have ADHD prescriptions, particularly those taking amphetamines, should learn to recognize the signs of addiction. According to the paper, these include "spending a great deal of time obtaining, using prescription stimulants, or recovering from their effects." Among the withdrawal symptoms are prolonged sleeping, depressed mood, crankiness, and overeating. There are no FDA-approved medications to treat stimulant addiction, and most of the interventions focus on cognitive behavioral therapy and prescription use management.
Resources are available for anyone who has addiction or withdrawal symptoms, including calling or texting 998 (the Suicide & Crisis Lifeline) or contacting the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 800-662-HELP (800-662-4357).
Trusting the prescribing health care professional is crucial, Molina stressed. "Maintain a good relationship with your prescriber," she said. Patients should not wait until the last minute to refill a prescription, she added, because they might have rebound symptoms if they run out of the drug.
Consumers should also take steps to avoid drug diversion by their own families and friends. "The concern is not only misuse of prescription drugs by those to whom they're prescribed, but also sharing the medications with others to whom they weren't prescribed," said Compton. To prevent that, Molina recommends, "Be mindful about with whom you share the fact that you have a stimulant prescription, especially in college."
