One in four adults prescribed stimulants misuses them. On the other hand, nearly half of those with addiction aren’t misusing at all.
STUDY: Han B et al, JAMA Psychiatry 2025;82(6):572–581
STUDY TYPE: Cross-sectional study
FUNDING: National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention
Background
Stimulant prescriptions have climbed steadily since 2020. While that means better treatment for many, this study looks at a side effect of the growing rates.
The Study
- 83,762 U.S. adults aged 18 to 64, drawn from the 2021–2022 National Survey on Drug Use and Health
- Examined rates of misuse and prescription stimulant use disorder (defined by DSM-5 criteria) among adults currently prescribed stimulants
- Compared amphetamine-type medications (Adderall, Vyvanse) versus methylphenidate (Ritalin, Concerta)
Among adults taking prescription stimulants, 25% reported misuse and 9% reported use that was consistent with criteria for a substance use disorder. Of those with substance use disorders, 73% used only their own prescribed medication, and 42% reported no misuse at all.
As the graph above shows, amphetamines carried a higher risk. Misuse was three times more common than with methylphenidate, and addiction was twice as common. The biggest growth in new prescriptions was in women aged 35 to 64, though this group had the lowest misuse rates, suggesting genuine clinical need rather than drug-seeking.
The proportion of stimulant prescriptions written by nurse practitioners and physician assistants more than doubled during the study period. However, the number of psychiatric nurse practitioners in the US also increased significantly during the same time.
Limitations
Self-reported data, cross-sectional design, and NSDUH excludes incarcerated and homeless populations who likely have higher rates. Drug shortages during this period may have inflated some addiction criteria (e.g., “spending a great deal of time obtaining” medication).
Misuse was broadly defined as taking the medication other than directed.
Practice Implications
- While the definition of misuse is broad here, the rates of use disorder here are concerning.
- The amphetamine peak aligns with lab data, showing higher rewarding effects with this stimulant.
- Other studies find particularly high rates among college students.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
