Stimulant Use Disorder Diagnoses in Adolescent and Young Adult Medicaid Enrollees

Importance There has been a national increase in fatal and nonfatal overdoses involving stimulants, and 4.5 million US individuals meet criteria for stimulant use disorder (UD), with the highest prevalence in young adults. However, limited information exists on trends in diagnosed stimulant UD. Objective To estimate trends in the proportion of adolescent and young adult Medicaid enrollees diagnosed with a stimulant UD from 2001 to 2020. Design, Setting, and Participants A repeated cross-sectional study (2001-2020) was conducted using administrative health care claims data from Medicaid (public insurance program in US). Publicly insured adolescents (aged 13-17 years) and young adults (aged 18-24 or 25-29 years) from 42 US states were included. Data were analyzed from January 2025 to July 2025. Main Outcomes and Measures Stimulant UD was defined as an inpatient or outpatient International Classification of Diseases diagnosis code in the year, with cocaine UD and noncocaine psychostimulant UD evaluated separately. The annual proportion with stimulant UD diagnoses was stratified by age group, sex, race and ethnicity, and presence of attention-deficit/hyperactivity disorder (ADHD) diagnosis or stimulant prescription in the year. Differences comparing 2001 with 2020 were summarized. Characteristics of those diagnosed with stimulant UD in 2020 were described. Results The sample included 5.7 million (2001) to 16.1 million Medicaid enrollees (2020) per year; in 2020, 54.2% were female, and 7.1 million were adolescents. From 2001 to 2020, the proportion diagnosed with noncocaine psychostimulant UD increased from 0.09% to 0.49% (prevalence ratio PR, 5.47 95% CI, 5.20-5.75) in those aged 18 to 24 years, from 0.13% to 1.63% (PR, 12.55 95% CI, 11.83-13.31) for ages 25 to 29 years, and from 0.10% to 0.91% among young adults aged 18 to 29 years. Among adolescents, the proportion diagnosed with noncocaine psychostimulant UD varied between 0.03% and 0.07%. The proportion diagnosed with cocaine UD was stable in young adults (range, 0.17%-0.34% 18-24 years and 0.53%-0.79% 25-29 years) and declined in adolescents (from 0.04% to 0.01%). Cocaine and noncocaine psychostimulant UD diagnoses were 2 to 4 times more common in patients with an ADHD diagnosis or stimulant prescription. Most patients diagnosed with a stimulant UD in 2020 were also diagnosed with a mental health disorder (68%-82%) or other substance UD (72%-78%). Conclusions and Relevance The prevalence of noncocaine psychostimulant UD diagnoses in young adult Medicaid patients increased over the last 2 decades, potentially associated with an increasing use of prescription and illicit stimulants along with increased clinical detection. These trends raise concerns given recent rises in stimulant-involved overdose fatalities and stress the need for evidence-based stimulant UD treatments for young people.