Stimulant Prescriptions for ADHD Surge 157% in Ontario Since 2015

A significant rise in stimulant prescriptions for treating Attention Deficit/Hyperactivity Disorder (ADHD) has been observed in Ontario, with new data indicating an increase of 157% from 2015 to 2023. This surge, explored in a study published in JAMA Network Open, suggests that various factors, including increased screen time and the availability of private assessment services, may be contributing to the trend.

The study analyzed all prescriptions for stimulant medications, such as Ritalin and Adderall, dispensed in Ontario between 2015 and 2023. Researchers noted that the number of new stimulant prescriptions rose consistently throughout this period, with a marked acceleration beginning in 2020, coinciding with the onset of the COVID-19 pandemic. During that year, new prescriptions increased by 28% annually, compared to a modest 7% from 2015 to 2019.

Factors Behind the Increase

The researchers from ICES, North York General Hospital, and The Hospital for Sick Children identified several potential causes for this dramatic rise. They pointed to social and environmental shifts, including heightened public awareness of ADHD symptoms and the identification of previously undiagnosed individuals.

Nonetheless, the study authors also expressed concerns about potential misdiagnoses, where conditions mimicking ADHD may lead to incorrect treatment plans. Dr. Daniel Myran, the lead author and a family and public health physician, emphasized the risk of exposing patients to unnecessary medication side effects and the possibility of overlooking other mental health issues.

The most pronounced changes occurred among adult females, with increases of approximately 421% in those aged 25 to 44 and 369% in those aged 18 to 24. “In 2023, more females aged 25 to 44 had used a stimulant in the past year than males,” Dr. Myran noted. This shift reflects a growing recognition of ADHD’s inattentive symptoms, which have historically been underdiagnosed in women.

Concerns and Implications

In addition to adults, there was also a notable increase in children receiving ADHD medications. While the rise among children was less dramatic than that seen in adults, it still raised alarms about the appropriateness of these prescriptions. The data showed that new prescriptions for girls aged 10 to 14 rose by 191%, compared to a 67.5% increase for boys in the same age group.

The pandemic has also seen the emergence of numerous private virtual care clinics offering ADHD assessments, which, according to Dr. Myran, have made diagnosis more accessible but may have led to an increase in misdiagnoses. He highlighted instances in his practice where patients arrived with incorrect diagnoses, a situation that prompted his research. “If you pursue the wrong treatment for an incorrect diagnosis, the right treatment for your actual condition may be overlooked,” he stated.

Medication for ADHD can come with side effects, including loss of appetite, sleep disturbances, and anxiety. Long-term implications may include heightened blood pressure and increased risks for stroke and heart attack. Dr. Myran acknowledged that while some patients may benefit from these medications, the growing prevalence of prescriptions raises questions about the risk-benefit ratio for individuals who may not require them.

The findings from Ontario echo research conducted in British Columbia, where similar trends have been identified. Dr. Heather Palis, who was not involved in the Ontario study, noted the rapid rise in new ADHD diagnoses in her research published in The Lancet. Her study highlighted that the rate of diagnosis among females surged more than twice that of males during the pandemic. “This signals a population that needs services and treatment,” Palis remarked.

As the landscape of ADHD diagnosis and treatment evolves, experts emphasize the importance of ensuring that healthcare providers can effectively monitor and support patients. Dr. Palis stated, “This is a first step in understanding how to meet the service needs of those with new diagnoses while also reaching out to individuals who may be underserved.”

The implications of these findings stress not only the need for careful diagnosis and treatment but also the importance of addressing the mental health needs of a broader population. As more individuals seek assistance, the healthcare system faces the challenge of ensuring that care is both accessible and accurate.