More Patients Receiving ADHD Medications, Particularly Adults

The portion of adults using ADHD medications increased 53.4% from 2008 through 2012, compared with 18.9% among children, according to a report from Express Scripts.

Use of medication to treat attention-deficit/hyperactivity disorder (ADHD) has increased dramatically in recent years, particularly among adults, according to a report released on March 12, 2014, by Express Scripts, the country’s largest pharmacy benefits manager. Drawing on data from an annual sample of privately insured patients, the analysis studied pharmacy claims of more than 400,000 patients who filled a prescription for a medication indicated to treat ADHD from 2008 to 2012.

Over the 5-year period, the number of privately insured patients using medications to treat ADHD increased by 35.5% to more than 4.8 million. Teenage boys aged 12 to 18 years were the most prevalent users; as of 2012, 9.3% of this group received ADHD medication, up from 7.9% in 2008. Overall, more than twice the portion of boys aged 4 to 18 used ADHD medications compared with girls the same age: 7.8% compared with 3.5%.

Growing pressure on schools and children to excel on standardized tests, which leaves little tolerance for disruptive behavior, may help explain increasing use of ADHD medication in children, suggests Joseph Austerman, DO, section head of the psychiatry and psychology department at the Center for Pediatric Behavior Health at the Cleveland Clinic, in a note included in the report. “This is especially true among boys who often display the more impulsive and aggressive form of the condition,” he writes.

Although use of ADHD drugs remains highest among children, the greatest proportional increase in use occurred among adults. The portion of adults using ADHD medications increased 53.4% from 2008 through 2012 compared with an increase of 18.9% among children. The increase was particularly dramatic among women; ADHD medication use increased by 85.1% among women aged 26 to 34. In a reversal of trends observed in children, more women used ADHD treatments than did men. Among those older than 18, the portion of men using ADHD medications drops, while the portion of women taking them rises.

“[F]emales tend to be far better patients than men and comply more readily with recommended care,” Dr. Austerman writes. “Additionally, young women are often in more regular contact with their parents, which can help support medication adherence.”

Women were more likely to take ADHD medication than were girls; in 2012, women aged 19 to 25 were 27% more likely to be receiving ADHD treatment than were younger girls. David J. Muzina, MD, Express Scripts vice president of specialist practice, notes that girls often experience less severe ADHD symptoms that may be overlooked. As women age, however, they may become more aware of their symptoms and seek treatment. Dr. Muzina also suggests that some women may be using the drugs inappropriately to lose weight or to cope with their busy lifestyles.

The report finds that spending for ADHD medications has also increased substantially. Spending for ADHD medications increased more than any other traditional drug category, rising 14.2% in 2012 alone. (This increase was largely driven by increased use, though a shortage of some medication ingredients contributed as well.) The report also found that ADHD medication use was highest in the South, with the greatest prevalence overall in South Carolina, and lowest in the West. The data also indicated that although antipsychotic drug use is still significantly higher among those receiving treatment for ADHD, the simultaneous use of both antipsychotic and ADHD medications has decreased in all age groups since 2009.

Although medications to treat ADHD are generally safe, they can have serious side effects and the increases in use observed among adults are somewhat troubling, Dr. Muzina suggests in an Express Scripts article summarizing the report.

“The trends here signal a need to look more closely at how and why physicians prescribe these medications for adults and the need for prescribers to fully assess the entire psychosocial landscape of an individual patient prior to reaching for the prescription pad,” he writes.

To download a PDF of the full report, click here.