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. 2018 Nov 28;13(11):e0206100.
doi: 10.1371/journal.pone.0206100. eCollection 2018.

Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016

Brian J Piper  1 , Christy L Ogden  1 , Olapeju M Simoyan  1   2 , Daniel Y Chung  1 , James F Caggiano  1 , Stephanie D Nichols  3   4 , Kenneth L McCall  5
Affiliations

Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016

Brian J Piper et al. PLoS One. .

Abstract

Background: Stimulants are considered the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD) in the US and they are used in other indications. Stimulants are also diverted for non-medical purposes. Ethnic and regional differences in ADHD diagnosis and in stimulant use have been identified in earlier research. The objectives of this report were to examine the pharmacoepidemiological pattern of these controlled substances over the past decade and to conduct a regional analysis.

Methods: Data (drug weights) reported to the US Drug Enforcement Administration's Automation of Reports and Consolidated Orders System for four stimulants (amphetamine, methylphenidate, lisdexamfetamine, and methamphetamine) were obtained from 2006 to 2016 for Unites States/Territories. Correlations between state level use (mg/person) and Hispanic population were completed.

Results: Amphetamine use increased 2.5 fold from 2006 to 2016 (7.9 to 20.0 tons). Methylphenidate use, at 16.5 tons in 2006, peaked in 2012 (19.4 tons) and subsequently showed a modest decline (18.6 tons in 2016). The consumption per municipality significantly increased 7.6% for amphetamine and 5.5% for lisdexamfetamine but decreased 2.7% for methylphenidate (all p < .0005) from 2015 to 2016. Pronounced regional differences were also observed. Lisdexamfetamine use in 2016 was over thirty-fold higher in the Southern US (43.8 mg/person) versus the Territories (1.4 mg/person). Amphetamine use was about one-third lower in the West (48.1 mg/person) relative to the Northeastern (75.4 mg/person, p < .05) or the Midwestern (69.9 mg/person, p ≤ .005) states. States with larger Hispanic populations had significantly lower methylphenidate (r(49) = -0.63), lisdexamfetamine (B, r(49) = -0.49), and amphetamine (r(49) = -0.43) use.

Conclusions: Total stimulant usage doubled in the last decade. There were dynamic changes but also regional disparities in the use of stimulant medications. Future research is needed to better understand the reasons for the sizable regional and ethnic variations in use of these controlled substances.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Total weight of amphetamine, methylphenidate, lisdexamfetamine, and methamphetamine in the US and territories from 2006 to 2016.
(A). Regional analysis of these drugs in 2016. Lixdex: lisdexamfetamine. tp ≤ .001 versus the US Territories; wp < .05 versus the western states (B). Scatterplot depicting moderate association (R2 = 0.40) between percent of the state comprised of Hispanic citizens according to the 2015 US Census and population corrected use of methylphenidate (C).
Fig 2
Fig 2
Heat map of per capita of amphetamine (A, top), methylphenidate (B, middle), or lisdexamfetamine (C, bottom) as reported to the Drug Enforcement Administration in 2016. Ratio relative to the lowest state (amphetamine = 25.52 mg/capita, methylphenidate = 19.70 mg/capita, lisdexamfetamine = 3.63 mg/capita).
See this image and copyright information in PMC

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