United States trends in non-prescribed use of Adderall and Ritalin: Population Assessment of Tobacco and Health (PATH) Study estimates from 2013 to 2022

Background and Aims

Dispensing of prescription stimulants to adults has risen dramatically over the past decade. Examining trends in nonprescribed use of prescription stimulants can inform public health responses. Most studies in the United States (U.S.) have faced challenges in assessing trends over time due to changes in survey methodologies and variation in populations assessed. We examined data from the Population Assessment of Tobacco and Health (PATH) Study to assess changes in nonprescribed use of prescription stimulants in the U.S. from 2013 to 2022.

Design

The PATH Study is an ongoing longitudinal study of U.S. youth and adults, representative of the civilian noninstitutionalized population. Repeated cross-sectional estimates at each wave were used (8 total waves). Trends from Wave (W) 1 (September 2013–December 2014) to W7 (January 2022–April 2023) were assessed. Full-sample and replicate weights were used; joinpoint analyses and wave-to-wave comparisons were applied to test trends.

Setting

Civilian noninstitutionalized U.S. youth and adults.

Participants/Cases

Youth aged 12–17 and adults aged 18 + were assessed, with a total of 45 727 participants at wave 1 (Ns vary by wave).

Measurements

Past 12-month (P12M) prevalence of nonprescribed use of Ritalin or Adderall was assessed. Nonprescribed use of stimulants was assessed across subgroups according to age (12–17, 18–24, 25–39, ≥40) and sex (male, female).

Findings

While wave-to-wave comparisons showed fluctuations across certain waves, overall, there were no statistically significant changes in P12M prevalence of Ritalin or Adderall nonprescribed use (1.3% at W1 and 1.5% at W7) across the study period. However, statistically significant differences in trends existed across age groups. Among 12–17 year-olds, nonprescribed use prevalence remained stable (1.4% in W1 and 1.5% in W7). Nonprescribed use prevalence also remained stable for 18–24-year-olds from W1 to W3, but then significantly declined (p = 0.016) from W3 (5.3%) to W7 (2.6%). There were no significant changes in nonprescribed use prevalence among 25–39-year-olds (1.7% in W1 and 2.4% in W7) and those aged ≥40 (0.3% in W1 and 0.9% in W7). Across most waves, young adults aged 18–24 had a statistically significantly higher prevalence of nonprescribed use. Neither sex had significant trends in P12M nonprescribed use prevalence.

Conclusions

Despite an increase in dispensing of prescription stimulant medications in the United States, the prevalence of nonprescribed Ritalin or Adderall use does not appear to have increased, as assessed in the nationally representative Population Assessment of Tobacco and Health (PATH) Study. The prevalence of nonprescribed Ritalin or Adderall use among young adults aged 18–24, the age group with the highest nonprescribed use prevalence, declined 2013 to 2022.