Incidence of Stimulant-Involved Fatal Overdoses Following the Stimulant Shortages in Rhode Island

Background In 2022, the Food and Drug Administration announced a shortage of immediate-release Adderall®. This report aims to identify whether these shortages impacted the incidence of stimulant-involved fatal overdoses.Methods Stimulant prescriptions dispensed to Rhode Island (RI) residents between January 2018 and June 2025 were obtained from the RI Prescription Drug Monitoring program (PDMP). Overdose deaths were linked to the PDMP to identify stimulant prescriptions dispensed 1-year prior to death. Incidence rates (IR) were compared.Results Between January 2018 and June 2025, the number of RI adults dispensed a stimulant prescription increased 37.65%. Prior to the stimulant shortage, the number of stimulant-involved and non-stimulant-involved fatal overdoses increased, before both declined during the shortage. The incidence of stimulant-involved fatal overdoses before the shortage versus during the shortage did not significantly change; however, the incidence of nonstimulant- involved fatal overdoses significantly decreased (IRR= 1.17; IRR= 0.58, respectively). The specific stimulants contributing to the cause of death did not change significantly (p = 0.06).Conclusion The number of stimulant-involved fatal overdoses has decreased. This data also suggests that there was not a significant increase in stimulant-involved fatal overdoses among individuals in stimulant treatment during the shortage, alleviating some concern that the shortage is driving stimulant-involved deaths.