Did Adherence to Stimulant and Non-Stimulant Medications Decline in the Wake of the Recent Diagnostic Surge?

Google searches for ADHD 2018-Present_V02In the wake of the COVID-19 pandemic, the landscape of mental health treatment, and attention deficit hyperactivity disorder (ADHD) in particular, has undergone significant shifts. A recent study published in the Journal of the American Medical Association highlighted a remarkable surge in ADHD medication prescriptions, with a pronounced increase between 2020 and 2022 observed among adults ages 20 to 39. A 30% rise in prescriptions for ADHD stimulant medications such as Ritalin and Adderall was seen in this age group — a rate that far surpassed pre-pandemic levels. Even more striking was the 81% increase in non-stimulant ADHD medication prescriptions among the same demographic, coupled with a 59% uptick among women across all age groups. This trend indicates a growing recognition and historical underdiagnosing of ADHD in adults, particularly women. However, some argue that it may also reflect the influence of social media and telemedicine in potential diagnostic inflation. Concerns about ADHD overdiagnosis stem from sudden increases in diagnosis, a lack of specialist involvement, recent broadening of diagnostic criteria, health policy constraints (when a diagnosis is required in order to access certain treatments and services), and significant geographic and demographic variability in diagnosis rates​.

We used Komodo’s MapView™ solution to delve more deeply into these trends. We used MapView’s Drug Adherence template to look at new ADHD diagnoses and prescription rates through 2023. We examined whether drug adherence changed among the demographics that experienced recent surges in diagnosis and treatment — and if so, how. Additionally, we investigated the role of telehealth in these prescribing patterns, looking at the portion of prescriptions that were issued through online healthcare services — a facet of healthcare that saw exponential growth during the pandemic.

2018 ADHD Drug Adherence Market Basket

Here’s what we found: 

The pandemic-era surge in new ADHD diagnoses continued through 2023, with rates remaining significantly higher among ages 20 to 39.
While the rate of increase in this age group did slow between 2022 and 2023, new ADHD diagnosis remained 31% higher in 2023 compared with pre-pandemic rates. (Diagnoses were only considered “new” in patients who had no history of ADHD and the medications in question in the prior 10 years.) The rate of new diagnoses was highest among ages 40 to 59 in 2023 — 28% higher than pre-pandemic rates. New diagnoses among ages 0 to 19 remained significantly lower in 2023 than before the pandemic but continued a slow rebound. 

New ADHD patients by Age

Overall, prescriptions for ADHD treatment (stimulants and non-stimulants) rose 37% between 2018 and 2023.
New prescriptions for stimulants slowed in 2023 after a steep two-year increase, but they remained higher than 2019’s pre-pandemic rates for most age groups. Among ages 20 to 39, stimulant prescriptions declined by 8% between 2022 and 2023 but remained 30% higher than the pre-pandemic rate. Stimulant prescriptions among ages 40 to 49 continued to rise, ending 2023 at 24% higher than the pre-pandemic rate. Stimulant prescriptions also surpassed the pre pandemic rate for ages 0 to 19 for the first time since the pandemic, at 2% higher in 2023. 

Conversely, prescription rates for non-stimulants did not slow. They continued to rise among all age groups through 2023; however, this is likely influenced by the more recent approvals of new non-stimulants. Ages 20 to 39 saw the greatest increase, with prescription rates at 67% higher in 2023 than before the pandemic. Stimulants were more commonly prescribed than non-stimulants.

Stimulant Medications

Patients newly diagnosed with ADHD during or after 2020 maintained similar adherence to treatment as before the uptick in diagnoses.
In 2018, 52% of patients newly started on ADHD medication remained on their medications for at least one year after diagnosis. This increased slightly in 2020 to 57% before declining to 54% in 2023. The slight drop in 2022 and 2023 is likely influenced, at least in part, by the shortage of certain stimulant medications, which began in mid-October 2022 and continued through the end of 2023. 

Looking at recent adherence to treatment, in 2023 specifically, we found that patients were more likely to stay on non-stimulant medications than stimulant medications (55% vs. 74%). Adherence to both types of ADHD medications was highest in patients aged 40 and above at 63% for 2023 and lowest in age 19 and below at 53%. Adherence in 2023 also differed significantly by race and ethnicity, with Black and Hispanic patients having the lowest adherence (48% and 52%, respectively), followed by Asian and “Other” patients (55% and 59%). Non-Hispanic White patients had the highest adherence, at 60%. It’s likely that these differences are influenced by race- and ethnicity-based disparities in access to healthcare. 

Compliance By Year-1

The new utilization of telemedicine in 2020 has only continued to grow as a route to diagnosis and remained high through 2023. Between 2019 and 2023, the rate of prescriptions received via telemedicine increased by more than 6000%.   

This analysis suggests that the increased awareness of ADHD may be translating into actionable medical outcomes rather than a passing fad. Notably, the rise in non-stimulant medication prescriptions also indicates a broadening in treatment approaches. The continued high rate of diagnoses and prescriptions via telehealth platforms highlights the sustained role of digital health technologies in facilitating access to psychiatric care. The sustained adherence amid the increased rate of diagnosed patients supports the efficacy of ongoing treatment strategies. However, the disparities in adherence rates among racial and ethnic groups raise critical concerns about the equity of healthcare access and treatment, and significant work remains to ensure that these benefits are universally accessible. Addressing these disparities requires a multifaceted approach, including targeted community outreach, culturally competent healthcare practices, and policies designed to eliminate systemic barriers to care.

The ability to track new healthcare trends with high fidelity as they emerge is key if stakeholders are to respond with agility and precision. Tools like Komodo's MapView are instrumental in providing real-time analytics to monitor and analyze impactful trends with high rates of change, including health diagnoses, treatment patterns, and patient behavior across demographics. This newfound visibility also facilitates a deeper understanding of the impact of external factors like policy changes or social media on health behaviors. A healthcare system that can adapt quickly to new trends and challenges will deliver timely and effective responses to protect public health and reduce the burden of disease. 

Check out Komodo Health’s recent Drug Snapshots to discover trends in utilization and market share: We’ve tracked the post-approval uptake of VEOZAH®, the first non-hormone drug for the treatment of hot flashes, and changes in the landscape of hematology-oncology treatment with the entry of new drugs.  
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