Purpose: To assess the prevalence, patterns, and consequences of ADHD stimulant medication misuse among adults in the United States. Methods: PubMed and PsycINFO were searched for US-based studies from 2004 to 2024. Cross-sectional and longitudinal studies on stimulant medication misuse among adults were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the Quality in Prognosis Studies (QUIPS) tool for longitudinal designs. Data were summarized narratively. Findings: Sixty-four studies met inclusion criteria, including several high-quality federally funded national surveys. Many other incidence and prevalence studies were conducted at universities; these had inconsistent quality due to low response, non-representative samples, or unclear methodology. National surveys show that past-year misuse among adults is declining, with 2023 estimates ranging from 1.4% to 3.7% among young adults and 1.9% among adults of all ages. Misuse is most prevalent among younger, White, metropolitan-dwelling individuals, and among college students. Misuse is primarily oral and infrequent, although a subset of high-frequency users obtain stimulants from physicians or dealers and exhibit higher rates of polysubstance use. Consequences of misuse may include psychiatric admission, emergency department visits, and illicit drug use. Long-term studies do not support a link between prescribed stimulant treatment in adolescence and later substance use disorder; unfortunately, no studies collected data on long-term physical health consequences. Conclusions: ADHD stimulant medication misuse among adults, although declining, remains a public health concern, particularly among high-frequency users. Research gaps remain, especially regarding long-term health outcomes.
Maglione et al. (Thu,) studied this question.
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