ADHD stimulant misuse drops sharply, but some heavy users remain

Clinical takeaway: Overall falling misuse rates obscure a higher-risk group who use frequently and often combine stimulants with alcohol, cannabis, or cocaine. This makes screening for concurrent use key.

The ongoing ADHD medication shortage has frustrated patients and prescribers alike, but it may have had one unintended upside: fewer people taking the drugs improperly. An FDA-commissioned review covering two decades of US data finds misuse of stimulants like Adderall falling fast among young adults, the group historically most likely to take them without a prescription. The decline tracks closely with the drop in available supply.

Millions of American adults misuse prescription stimulants each year, and the pool of available pills grew as adult prescribing climbed from 2016 to 2021. Then came the shortage. Beginning in 2022, manufacturing problems, surging demand, and tighter Drug Enforcement Administration (DEA) production quotas left an estimated 71.5% of ADHD patients struggling to fill prescriptions, according to CDC.

In 2023, 3.7% of adults aged 19 to 30 misused Adderall, down from 7.8% the year before. That drop was statistically significant, and it comes from Monitoring the Future, a large federally funded annual survey. Ritalin misuse held steady at 1.2%. Among adults of all ages, roughly 1.9% misused a prescription stimulant in the prior year. Misuse was concentrated among younger, White, metropolitan-dwelling adults and among college students, with some campus estimates running as high as 8% to 20%.

The typical pattern is occasional oral use with pills shared by friends or relatives, often to study or focus. High-frequency users, defined as seven or more days a month, look different. They tend to be over 30, without a college degree, and more likely to snort, smoke, or inject the drugs. They source pills from multiple doctors or dealers, and many carry cocaine, heroin, or other substance use disorders. The review found no evidence that prescribed stimulant treatment in adolescence raised the risk of a later substance use disorder.

The rapid evidence review covered 64 US studies from 2004 to 2024, including several high-quality federally funded national surveys. Nearly half the studies focused on college samples, many with low response rates or convenience sampling, and all relied on self-reported use.

The shortage amounts to an unplanned test of supply-side policy, and it is still running. Tighter quotas and scarcer pills coincided with less misuse. But the same squeeze has left many legitimate ADHD patients scrambling for their medication, year after year. The authors argue that any policy leaning on supply restriction has to weigh reduced misuse against ongoing harm to the patients who need these drugs.

"We found a rapid drop in misuse of these medications, largely driven by a decline in Adderall misuse among young adults. More recent data suggest that those lower rates have remained stable since 2023," said Margaret Maglione, MPP, a project leader at the Southern California Evidence Review Center at the Keck School of Medicine of USC and the study's first author.

Source: Maglione MA, et al. (2026 Jun 4) J Clin Psychopharmacol. Adult Misuse of ADHD Stimulant Medication in the United States