Increase in Stimulant Use Among Adults Concerns Health Care Industry

A potential area of concern was whether the dramatic increase in adult usage of stimulant was driven by a corresponding increase in outpatient diagnoses of ADHD.

An article published recently in the American Medical Association’s Psychiatry magazine highlighted an increase in stimulant use among American adults, raising concern that a growing population may be using the medication for something other than treatment for attention-deficit/hyperactivity disorder (ADHD).

ADHD-related stimulant usage has been growing nationally among both youth and adults. A U.S. household survey showed usage among youth increased by 50 percent over a 16-year period beginning in 1996, while stimulant usage among adults increased by 700 percent — seven times — over roughly the same time span.

Against this national backdrop, the JAMA Psychiatry article focused on a five-year study of about 3.5 million youth and adults insured by companies carrying Blue Cross and Blue Shield insurance in Illinois, New Mexico, Oklahoma or Texas.

  • From 2010 to 2014, stimulant usage among youth — up to 19 years old — jumped by an average of 15 percent.
  • Stimulant usage among adults — ages 20 to 64 — increased by an average of nearly 60 percent.

A potential area of concern was whether the dramatic increase in adult usage of stimulant was driven by a corresponding increase in outpatient diagnoses of ADHD. Additionally, as the data showed, “a large proportion of stimulant-treated adults lacked an ADHD diagnosis, potentially reflecting off-label use. This raises concerns regarding potential nonmedical use of prescription stimulants.”

“The BCBS data is certainly consistent with the reports about increasing prevalence of ADHD diagnoses in children and adults, as well as increased prescription of stimulants,” said Frank Webster, M.D., a senior medical director of behavioral health for Blue Cross and Blue Shield of Texas (BCBSTX).

“Stimulants are highly effective for the treatment of properly diagnosed ADHD. Non-medication treatments such as proper sleep, hygiene, mindfulness training and managing environment to minimize distractions should always be part of any treatment approach to ADHD. The prescription data in adults may be somewhat impacted by off-label use of stimulants to manage daytime drowsiness in adults with sleep disorders.”

BCBSTX aims to help improve patient safety and quality of care. Therefore, more research on this topic is needed to fully understand the issue. Continued study of ADHD usage trends within our data could help identify if the stimulant medication is being used correctly and for the right patient. This is just one example of how BCBSTX is using data to pinpoint variations in health care for potential intervention.

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