{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:03:50Z","timestamp":1793642630223,"version":"4.5.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"Importance<\/jats:title>The COVID-19 pandemic reportedly increased behavioral health needs and impacted treatment access.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess changes in incident prescriptions dispensed for medications commonly used to treat depression, anxiety, attention-deficit\/hyperactivity disorder (ADHD), and opioid use disorder (OUD), before and during the COVID-19 pandemic.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a cross-sectional study using comprehensive, population-level, nationally projected data from IQVIA National Prescription Audit on incident prescriptions (prescriptions dispensed to patients with no prior dispensing from the same drug class in the previous 12 months) dispensed for antidepressants, benzodiazepines, Schedule II (C-II) stimulants, nonstimulant medications for ADHD, and buprenorphine-containing medication for OUD (MOUD), from US outpatient pharmacies. Data were analyzed from April 2018 to March 2022.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Incident prescriptions by drug class (by prescriber specialty, patient age, and sex) and drug.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Interrupted time-series analysis to compare changes in trends in the monthly incident prescriptions dispensed by drug class and percentage changes in aggregate incident prescriptions dispensed between April 2018 and March 2022.<\/jats:p><\/jats:sec>Results<\/jats:title>Incident prescriptions dispensed for the 5 drug classes changed from 51\u202f500\u202f321 before the COVID-19 pandemic to 54\u202f000\u202f169 during the pandemic. The largest unadjusted percentage increase in incident prescriptions by prescriber specialty was among nurse practitioners across all drug classes ranging from 7% (from 1 811 376 to 1 944 852; benzodiazepines) to 78% (from 157 578 to 280 925; buprenorphine MOUD), whereas for patient age and sex, the largest increases were within C-II stimulants and nonstimulant ADHD drugs among patients aged 20 to 39 years (30% [from 1 887 017 to 2 455 706] and 81% [from 255 053 to 461 017], respectively) and female patients (25% [from 2 352 095 to 2 942 604] and 59% [from 395 678 to 630 678], respectively). Trends for C-II stimulants and nonstimulant ADHD drugs (slope change: 4007 prescriptions per month; 95% CI, 1592-6422 and 1120 prescriptions per month; 95% CI, 706-1533, respectively) significantly changed during the pandemic, exceeding prepandemic trends after an initial drop at the onset of the pandemic (level changes: \u221250\u202f044 prescriptions; 95% CI, \u221280\u202f202 to \u221219\u202f886 and \u221212\u202f876 prescriptions; 95% CI, \u221217\u202f756 to \u22127996, respectively). Although buprenorphine MOUD dropped significantly (level change: \u22122915 prescriptions; 95% CI, \u22125513 to \u2212318), trends did not significantly change for buprenorphine MOUD, antidepressants, or benzodiazepines.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Incident use of many behavioral health medications remained relatively stable during the COVID-19 pandemic in the US, whereas ADHD medications, notably C-II stimulants, sharply increased. Additional research is needed to differentiate increases due to unmet need vs overprescribing, highlighting the need for further ADHD guideline development to define treatment appropriateness.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.5045","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T16:00:47Z","timestamp":1704902447000},"page":"396","source":"Crossref","is-referenced-by-count":57,"title":["Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022"],"prefix":"10.1001","volume":"81","author":[{"given":"Grace","family":"Chai","sequence":"first","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xu","sequence":"additional","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonal","family":"Goyal","sequence":"additional","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Woods","sequence":"additional","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Ho","sequence":"additional","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaejoon","family":"Song","sequence":"additional","affiliation":[{"name":"Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Dal Pan","sequence":"additional","affiliation":[{"name":"Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"yoi230099r1","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1056\/NEJMp2008017","article-title":"Mental health and the COVID-19 pandemic.","volume":"383","author":"Pfefferbaum","year":"2020","journal-title":"N Engl J Med"},{"issue":"10","key":"yoi230099r2","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1038\/s41591-022-02028-2","article-title":"How COVID-19 shaped mental health: from infection to pandemic effects.","volume":"28","author":"Penninx","year":"2022","journal-title":"Nat Med"},{"issue":"10312","key":"yoi230099r3","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic.","volume":"398","author":"Collaborators","year":"2021","journal-title":"Lancet"},{"issue":"464","key":"yoi230099r4","first-page":"1","article-title":"Suicide mortality in the US, 2001-2021.","author":"Garnett","year":"2023","journal-title":"NCHS Data Brief"},{"issue":"8","key":"yoi230099r5","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1177\/10870547231158750","article-title":"ADHD symptoms increased during the COVID-19 pandemic: a meta-analysis.","volume":"27","author":"Rogers","year":"2023","journal-title":"J Atten Disord"},{"issue":"23","key":"yoi230099r8","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1001\/jama.2020.21512","article-title":"Treatment of opioid use disorder among commercially insured patients in the context of the COVID-19 pandemic.","volume":"324","author":"Huskamp","year":"2020","journal-title":"JAMA"},{"issue":"43","key":"yoi230099r9","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.15585\/mmwr.mm6943a3","article-title":"Trends in the use of telehealth during the emergence of the COVID-19 pandemic\u2014US, January-March 2020.","volume":"69","author":"Koonin","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"13","key":"yoi230099r12","doi-asserted-by":"publisher","first-page":"327","DOI":"10.15585\/mmwr.mm7213a1","article-title":"Trends in stimulant prescription fills among commercially insured children and adults\u2014US, 2016-2021.","volume":"72","author":"Danielson","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"yoi230099r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2023.05.016","article-title":"COVID-19 and adolescent outpatient mental health service utilization.","author":"Burrell","journal-title":"Acad Pediatr"},{"key":"yoi230099r14","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-023-08383-1","article-title":"Telehealth Initiation of buprenorphine for opioid use disorder: patient characteristics and outcomes.","author":"Nguyen","journal-title":"J Gen Intern Med"},{"issue":"8","key":"yoi230099r16","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1016\/j.jclinepi.2014.12.018","article-title":"Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations.","volume":"68","author":"Jandoc","year":"2015","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"yoi230099r17","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/ije\/dyw098","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial.","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"issue":"6","key":"yoi230099r18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016018","article-title":"Methods, applications, interpretations and challenges of interrupted time series (ITS) data: protocol for a scoping review.","volume":"7","author":"Ewusie","year":"2017","journal-title":"BMJ Open"},{"issue":"11","key":"yoi230099r19","doi-asserted-by":"publisher","first-page":"e2024984","DOI":"10.1001\/jamanetworkopen.2020.24984","article-title":"Changes in health services use among commercially insured US populations during the COVID-19 pandemic.","volume":"3","author":"Whaley","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"yoi230099r20","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1007\/s11121-022-01382-4","article-title":"Mental health and well-being trends through the first year-and-a-half of the COVID-19 pandemic: results from a longitudinal study of young adults in the USA.","volume":"23","author":"Graupensperger","year":"2022","journal-title":"Prev Sci"},{"key":"yoi230099r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.113778","article-title":"Trajectories of depression, anxiety and pandemic experiences; a longitudinal study of youth in New York during the spring-summer of 2020.","volume":"298","author":"Hawes","year":"2021","journal-title":"Psychiatry Res"},{"issue":"15","key":"yoi230099r22","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2014US, 2016.","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"issue":"16","key":"yoi230099r24","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1001\/jama.2023.1207","article-title":"Trends in buprenorphine initiation and retention in the US, 2016-2022.","volume":"329","author":"Chua","year":"2023","journal-title":"JAMA"},{"issue":"5","key":"yoi230099r25","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1001\/jamapsychiatry.2023.0310","article-title":"Association of receipt of opioid use disorder\u2013related telehealth services and medications for opioid use disorder with fatal drug overdoses among Medicare beneficiaries before and during the COVID-19 pandemic.","volume":"80","author":"Jones","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"yoi230099r26","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1007\/s11606-021-07174-w","article-title":"Initiating opioid use disorder medication via telemedicine during COVID-19: implications for proposed reforms to the Ryan Haight Act.","volume":"37","author":"Huskamp","year":"2022","journal-title":"J Gen Intern Med"},{"key":"yoi230099r27","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1141093","article-title":"Barriers to opioid use disorder treatment: a comparison of self-reported information from social media with barriers found in literature.","volume":"11","author":"Bremer","year":"2023","journal-title":"Front Public Health"},{"key":"yoi230099r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108297","article-title":"Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty\u2014US, 2014-2019.","volume":"217","author":"Board","year":"2020","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"yoi230099r33","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-2528","article-title":"Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit\/hyperactivity disorder in children and adolescents.","volume":"144","author":"Wolraich","year":"2019","journal-title":"Pediatrics"},{"issue":"9","key":"yoi230099r34","first-page":"890","article-title":"Diagnosis and management of adult attention-deficit\/hyperactivity disorder.","volume":"85","author":"Post","year":"2012","journal-title":"Am Fam Physician"},{"issue":"9","key":"yoi230099r35","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1377\/hlthaff.2022.00289","article-title":"Trends in mental health care delivery by psychiatrists and nurse practitioners in Medicare, 2011-2019: study examines trends in mental health care delivery by psychiatrists and nurse practitioners in Medicare.","volume":"41","author":"Cai","year":"2022","journal-title":"Health Aff"},{"issue":"12","key":"yoi230099r36","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1176\/appi.ps.201700017","article-title":"Telehealth delivery of mental health services: an analysis of private insurance claims data in the US.","volume":"68","author":"Wilson","year":"2017","journal-title":"Psychiatr Serv"},{"issue":"1","key":"yoi230099r38","doi-asserted-by":"publisher","first-page":"e2142531","DOI":"10.1001\/jamanetworkopen.2021.42531","article-title":"Use of telemedicine for buprenorphine inductions in patients with commercial insurance or Medicare advantage.","volume":"5","author":"Barsky","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"12","key":"yoi230099r39","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1001\/jamapsychiatry.2020.2072","article-title":"Trends in self-payment for outpatient psychiatrist visits.","volume":"77","author":"Benjenk","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"9","key":"yoi230099r40","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1001\/jamapsychiatry.2019.0876","article-title":"Buprenorphine treatment divide by race\/ethnicity and payment.","volume":"76","author":"Lagisetty","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"yoi230099r6","unstructured":"National Center for Health Statistics. Mortality multiple cause of death. Accessed November 14, 2022. https:\/\/www.cdc.gov\/nchs\/nvss\/mortality_public_use_data.htm"},{"key":"yoi230099r7","unstructured":"World Health Organization. The impact of COVID-19 on mental, neurological, and substance use services. Accessed May 22, 2023. https:\/\/www.who.int\/publications\/i\/item\/978924012455"},{"key":"yoi230099r10","unstructured":"McDermott? WT. DEA registrant letter. Accessed September 21, 2023. https:\/\/www.deadiversion.usdoj.gov\/GDP\/(DEA-DC-018)(DEA067)%20DEA%20state%20reciprocity%20(final)(Signed).pdf"},{"key":"yoi230099r11","unstructured":"Prevoznik? TW. DEA qualifying practitioners. Accessed September 21, 2023. https:\/\/www.deadiversion.usdoj.gov\/GDP\/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf"},{"key":"yoi230099r15","unstructured":"IQVIA. Home page. Accessed June 30, 2023. http:\/\/www.iqvia.com."},{"key":"yoi230099r23","unstructured":"US Food and Drug Administration. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class. Accessed May 22, 2023. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class"},{"key":"yoi230099r28","unstructured":"US Drug Enforcement Administration. DEA serves order to show cause on Truepill Pharmacy for its involvement in the unlawful dispensing of prescription stimulants. Accessed September 21, 2023. https:\/\/www.dea.gov\/press-releases\/2022\/12\/15\/dea-serves-order-show-cause-truepill-pharmacy-its-involvement-unlawful"},{"key":"yoi230099r29","unstructured":"Winkler? R. ADHD specialists worry stimulant drugs are overprescribed, push for treatment guidelines. Accessed March 4, 2023. https:\/\/www.wsj.com\/articles\/adhd-specialists-plan-new-u-s-guidelines-to-curb-irresponsible-prescriptions-11662033613"},{"key":"yoi230099r30","unstructured":"Forbes. Instagram pulls ads by mental health startup Cerebral for violating its rules. Accessed June 30, 2023. https:\/\/www.forbes.com\/sites\/katiejennings\/2022\/01\/21\/instagram-says-mental-health-startup-cerebral-violated-its-rules-with-adhd-ads-showing-disordered-eating\/?sh=347b758d7c6c."},{"key":"yoi230099r31","unstructured":"Centers for Disease Control and Prevention. Data and statistics about ADHD. Accessed June 30, 2023. https:\/\/www.cdc.gov\/ncbddd\/adhd\/data.html"},{"key":"yoi230099r37","unstructured":"Federal Register. Telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. Accessed May 22, 2023. https:\/\/www.federalregister.gov\/documents\/2023\/03\/01\/2023-04248\/telemedicine-prescribing-of-controlled-substances-when-the-practitioner-and-the-patient-have-not-had"},{"key":"yoi230099r41","unstructured":"US Food and Drug Administration. FDA drug shortages. Accessed May 22, 2023. https:\/\/www.accessdata.fda.gov\/scripts\/drugshortages\/default.cfm"},{"key":"yoi230099r42","unstructured":"US Food and Drug Administration. FDA announces shortage of Adderall. Accessed May 22, 2023. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-announces-shortage-adderall"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2813980\/jamapsychiatry_chai_2024_oi_230099_1711140327.71289.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T15:22:23Z","timestamp":1712157743000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2813980"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2023.5045","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}