Allen Ginsberg wrote of the ravages of amphetamine misuse in his 1955 poem Howl, “I saw the best minds of my generation destroyed by madness… looking for an angry fix.” He warned friends that “Speed is antisocial, paranoid making, it’s a drag.”
Misuse dropped by more than 50% in recent years
STUDY: Maglione MA et al, J Clin Psychopharmacol 2026
STUDY TYPE: Rapid review (systematic)
FUNDING: US Agency for Healthcare Research and Quality (AHRQ)
Background
The FDA commissioned this rapid review to clarify who is misusing these medications, how often, and what harm follows.
The Study
- 64 US studies published from 2004 to 2024, including several large national surveys
- Cross-sectional and longitudinal designs
- Key questions: patterns of misuse, health consequences, and any link to illicit drug use
Results
Misuse is declining. Among young adults aged 18 to 25, past-year misuse fell from 7.5% in 2016 to 3.1% in 2023. Some of that drop may reflect the nationwide stimulant shortages that began in 2022. Across all adult ages, the 2020 prevalence was 1.9%.
Misuse is most common among young, White, college-educated adults in metropolitan areas.
Most misuse is oral and infrequent. The top reasons are concentration (36%), staying awake (29%), and studying (11%). Only about 9% misuse six or more days per month.
Those with a high-frequency of misuse look different. They get their stimulants from doctors or dealers rather than friends, and they carry higher rates of polysubstance use, including cocaine and opioids.
The longitudinal data are reassuring for treatment. Treating ADHD with stimulants in adolescence does not increase the risk of substance use disorder in adulthood. Adolescents who misused stimulants without an ADHD diagnosis, however, had more than twice the odds of later cocaine use (though causation can’t be inferred from that).
Practice Implications
Misuse is down in the general population, but remains a problem for a subgroup with a high frequency of misuse.
Improve your ADHD diagnosis with a structured interview.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
