Study shows quantity of ADHD stimulant medications prescribed has risen sharply in Ontario

The number of people taking medications to treat attention deficit/hyperactivity disorder has increased dramatically in Ontario, researchers say, suggesting that factors such as spending more time online and an increase in private assessments for mental conditions may be behind the increase.

A study published on Thursday jama network open Looked at all prescriptions for stimulant drugs like Ritalin and Adderall given in the province between 2015 and 2023.

By 2023, the data shows that total annual new stimulant prescriptions had increased by 157 percent compared to 2015.

The report said prescriptions for ADHD treatments increased throughout the study period and accelerated in 2020, which coincided with lockdowns amid the COVID-19 pandemic. Prescriptions began increasing that year by 28 percent per year, compared to only a seven percent increase from 2015 to 2019.

Researchers at ICES, North York General and The Hospital for Sick Children say the sharp increase may be due to several factors: social and environmental changes such as increased screen time, increased public awareness and acceptance of ADHD symptoms, and the identification of people who were previously undiagnosed.

However, while they acknowledge that there is a lack of data on whether the medication was being prescribed appropriately, they also say that there may be some people who are misdiagnosed – when a condition that causes similar symptoms is incorrectly considered ADHD – or overdiagnosed – when mild symptoms are incorrectly diagnosed as ADHD.

Lead author Dr. Daniel Myron said his concern is that some people may unnecessarily suffer adverse side effects from the drug, and they may miss the opportunity to treat other mental health conditions.

The largest change over the study period was among adult women, with increases of about 421 percent and 369 percent for those ages 25 to 44 and 18 to 24, respectively.

“Their increase is so rapid that in 2023 there will be more women aged 25 to 44 than men who have used a stimulant in the past year,” said Myron, an Ottawa-based family and public health physician and scientist at North York General Hospital.

Historically, the diagnostic criteria for ADHD focused on hyperactivity, which is more common in males. Recently there has been more attention to women’s underdiagnosed inattentive symptoms, such as struggling to stay focused and establish priorities.

“That’s part of getting to it. But the flip side is that it can also lead to overdiagnosis,” Myron said.

There was also a large increase in the number of children starting to take medications for ADHD, although the jump was not as large as the adult groups.

Girls were ahead of boys even with new remedies. They increased by 191 percent among girls aged 10 to 14, and by 67.5 percent among boys in the same age group.

Several private virtual care clinics offering ADHD evaluations opened during the pandemic. Myron said these online options lowered the barrier to diagnosis and potentially led to misdiagnosis or overdiagnosis. He said patients in his family practice have come in with misdiagnoses, which is what really inspired him to start this study.

“If you’re diagnosed wrong and you get the wrong treatment, you’ll never get the right treatment,” he said.

Side effects of the drug include loss of appetite, sleep problems, and anxiety. It also has long-term effects that may include increased blood pressure and increased risk of stroke and heart attack.

“These are things where if you have bad ADHD symptoms that are preventing you from engaging in education or work, the risk is clear.”

But as these drugs become more widely used, Myron said, “I think you start to get into the group of individuals who are being prescribed it, where the risk-benefit basis ratio may not be as favorable.”

Similar findings in B.C.

Heather Pallis, who was not involved in the Ontario study but who conducted a study with similar findings in British Columbia this year, said the rapid increase in new diagnoses also suggests that some of these patients have been underdiagnosed and are managing their symptoms on their own without a health-care provider.

His study was published The Lancet The fastest increase was seen in women with ADHD, with the estimated increase rate during the pandemic being more than double that of men.

“This is a sign to us of a population that needs services and treatment,” said Pallis, a senior scientist at the BC Center for Disease Control. This means access to health care providers who can counsel, communicate, and monitor patients for adverse effects.

“I think this is a first step in really shaping how we meet the service needs of people who have these new diagnoses and also work to include people who potentially have been left behind,” Pallis said.