Prescriptions of controlled stimulants among adolescents and young adults have increased significantly in the United States since 2008.
In a new research letter assessing recent trends in controlled drug prescribing for young Americans, a team of Boston investigators observed a substantial increase in stimulants among adolescents aged 13 to 18 and young adults aged 19 At 25 years. Although the total number of prescriptions peaked in 2016, the trajectory of annual stimulant prescriptions in these age groups remained about twice what it was in 2008.
Investigators led by Michael S. Toce, MD, MS, of the Division of Emergency Medicine at Boston Children’s Hospital, conducted an analysis of trends in the dispensing of controlled medications, including stimulants, narcotics and depressants, in adolescents and young adults from 2008 to 2019. With the abuse of prescription stimulants and benzodiazepines being common among young people – and these prescriptions being linked to overdoses in adolescents and young adults – the team found that the Retrospective analysis was essential for interpreting trends in clinician prescribing.
“High rates of prescription drug abuse among adolescents and young adults have emphasized the judicious use of controlled medications to limit adverse effects related to abuse, addiction, and overdose” , they wrote.
Toce and his colleagues conducted the cohort evaluation using private commercial information data from American adolescents and young adults between 2008 and 2019. The team analyzed pharmaceutical claims to identify patients receiving controlled substances, the distribution prevalence being defined as the number of adolescents and young adults per 1000 enrollees each month dispensed a controlled drug.
Annualized monthly prevalence rates were defined by controlled substance and dispensations were stratified by age and sex.
The final analysis included 9.3 million adolescents and young adults; the average age of adolescents was 15.2 years, with 50.9% being male. The average age of young adults was 22.2 years, with 49.5% being male. Among the population, 15.0% received a prescription for a narcotic, 4.9% a stimulant and 3.8% a depressant. The most commonly dispensed drug in each class was acetaminophen-hydrocodone (64.1%), amphetamine dextroamphetamine (47.8%), and alprazolam (31.2%), respectively.
Stimulants were the most commonly dispensed drug class among the 3 observed in each age group; mean monthly dispersion peaked at 45.0 per 1,000 adolescents (95% CI, 42.3 – 47.8) and 33.1 per 1,000 young adults (95% CI, 32.4 – 33, 9) in 2016. Although the annual dispensing rate decreased in each age group in 2019, it remained twice as high among adolescents (44.0; 95% CI, 41.4 – 46.6 ) and three times higher in young adults (30.4; 95% CI, 29.8 – 31.0) than the rates observed in 2008 (22.5 and 10.3, respectively).
After peaking in 2010, annual narcotic prescription rates have declined each year; depressant prescription rates peaked in 2013 before also gradually declining.
Young adults were more likely to receive narcotic medications (15.5% vs. 12.5%; P <.001 and depressants versus>P <.001 than teenagers. however adolescents were more likely to receive stimulants young adults vs.>P <.001 male teens were twice as likely to receive a stimulant female peer.>
Although the evaluation was limited by the range of commercial insurance data available, the investigators concluded that the prevalence of prescribed stimulants had increased significantly among adolescents and young adults since 2008. Although depressants and narcotics were prescribed less and less over the years, they remained more frequent among young adults. than teenagers.
“The increase in stimulant use deserves attention because (ADHD) can be overdiagnosed and overtreated,” Toce and colleagues concluded. “Furthermore, pronounced differences in the distribution of controlled substances by sex provide opportunities for further investigation.”
The research letter, “Trends in Dispensing of Controlled Medications for Adolescents, Young Adults,” was published online in JAMA