Nearly 43% of adult patients diagnosed with prescription stimulant use disorder hadn't reported any misuse, despite solely using their prescribed medication, according to a recent study. 

In the cross-sectional study, published in JAMA Psychiatry, investigators from the National Institute on Drug Abuse, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration assessed prescription stimulant use, misuse, and prescription stimulant use disorder (PSUD) among U.S. adults aged 18 to 64 years.

The analysis, led by Beth Han, MD, PhD, MPH, used data from the 2021 to 2022 National Survey on Drug Use and Health, which included 83,762 community-dwelling adults, along with national prescription dispensing data from IQVIA databases covering 2019 through 2022. The investigators applied weighted logistic regression models and Joinpoint regression to estimate prevalence rates and identify dispensing trends.

Among the patients who reported past-year prescription stimulant use, 25.3% reported misuse and 9.0% met criteria for PSUD based on DSM-5 diagnostic standards. Among those with PSUD, 72.9% used just their prescribed stimulants, 42.5% didn't report any misuse, and 63.6% had mild PSUD.

Amphetamine-type stimulant users had higher rates of both misuse and PSUD compared with methylphenidate users. Misuse prevalence was 31.5% among amphetamine users vs 10.2% among those using methylphenidate. PSUD prevalence was 11.2% among amphetamine users compared with 5.1% among methylphenidate users.

From 2019 to 2022, the number of unique dispensed prescription stimulants increased across all examined demographic subgroups. The largest increase was observed among women aged 35 to 64 years, with dispensed prescriptions rising from 1.2 million to 1.7 million, reflecting an average quarterly percentage change of 2.6%. Among this group, stimulant misuse prevalence was the lowest, at 13.7%.

The investigators reported that PSUD frequently occurred among patients who did not report misuse, highlighting the need for routine screening, evidence-based prescribing, and expanded clinical guidance on stimulant use in adult populations. The findings suggested a growing need for physician training and safeguards to support appropriate stimulant prescribing and to address PSUD regardless of misuse status.

Full disclosures can be found in the published study.