{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T19:57:40Z","timestamp":1781899060308,"version":"3.54.5"},"reference-count":26,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,26]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their medical and\/or neurological conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Annual US Medical Expenditure Panel Survey, a stratified random sample of approximately 30 000 persons designed to produce national population estimates. It focuses on reported medical spending, medical services used, health status and prescription medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults age 19 years and older who reported obtaining one or more prescriptions for amphetamine or methylphenidate products during two survey years, 2013 and 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes measures<\/jats:title>\n                    <jats:p>Prescriptions obtained, the specific stimulant product and annual treatment days of drug supplied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2018, an estimated 4.1 million US adults (95% CI 3.4 million to 4.8 million) reported prescriptions for CNS stimulants, having filled a mean of 7.3 (95% CI 6.8 to 7.8) prescriptions with a mean of 226 (95% CI 210 to 242) days\u2019 supply. Compared with 2013, the estimated number of adults reporting using CNS stimulants in 2018 increased by 1.8 million (95% CI 1.0 million to 2.7 million) or 79.8%. Most 2018 adult stimulant users reported taking psychoactive medication for one or more mental, behavioural or neurodevelopment disorders. Overall, 77.8% (95% CI 72.6% to 83.0%) reported some medication for adult attention deficit disorder, 26.8% (95% CI 22.2% to 31.5%) took medication for anxiety, 25.1% (95% CI 19.9% to 30.3%) for depression and 15.3% (95% CI 9.8% to 20.8%) indicated drug treatment for other mental or neurological disorders. Adult CNS stimulant use was higher in females, in younger age cohorts and among individuals of white race\/ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adult medical use of prescription stimulants increased markedly in 5 years and occurred in a population often reporting multiple mental or neurological disorders. Further action is needed to understand and manage this new resurgence in drugs with high risks of dependence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048528","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T13:03:22Z","timestamp":1628859802000},"page":"e048528","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-836X","authenticated-orcid":false,"given":"Thomas J","family":"Moore","sequence":"first","affiliation":[{"name":"Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Department of Epidemiology, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip W","family":"Wirtz","sequence":"additional","affiliation":[{"name":"Department of Decision Sciences, The George Washington University School of Business, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan P","family":"Kruszewski","sequence":"additional","affiliation":[{"name":"Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G Caleb","family":"Alexander","sequence":"additional","affiliation":[{"name":"Center for Drug Safety and Effectiveness, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Divison of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"2025121422484554000_11.8.e048528.1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.110593"},{"key":"2025121422484554000_11.8.e048528.2","doi-asserted-by":"crossref","unstructured":"Myers RL . The 100 Most Important Chemical Compounds : A Reference Guide. Westport, CT: Greenwood Press, 2007.","DOI":"10.5040\/9798400605284"},{"key":"2025121422484554000_11.8.e048528.3","unstructured":"Brunton L , Knollmann B , Hilal-Dandan R . Goodman and Gilman\u2019s The Pharmacological Basis of Therapeutics. New York: McGraw-Hill Education \/ Medical, 2017."},{"key":"2025121422484554000_11.8.e048528.4","doi-asserted-by":"publisher","DOI":"10.1080\/10673220802167782"},{"key":"2025121422484554000_11.8.e048528.5","unstructured":"ADDERALL XR . Dextroamphetamine sulfate, Dextroamphetamine saccharate, amphetamine sulfate and amphetamine aspartate capsule, extended release. Lexington, MA: Shire LLC, a Takeda company, 2019."},{"key":"2025121422484554000_11.8.e048528.6","unstructured":"CONCERTA . Methylphenidate hydrochloride tablet, extended release. Titusville, NJ: Janssen Pharmaceuticals, Inc, 2013."},{"key":"2025121422484554000_11.8.e048528.7","unstructured":"VYVANSE . Lisdexamfetamine dimesylate capsule. Lexington, MA: Shire LLC, a Takeda company, 2019."},{"key":"2025121422484554000_11.8.e048528.8","first-page":"3","article-title":"Use of cognitive enhancers: methylphenidate and analogs","volume":"23","author":"Carlier","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025121422484554000_11.8.e048528.9","unstructured":"International Drug Control Conventions . United Nations : Office on Drugs and Crime, 2013. Available: https:\/\/www.unodc.org\/unodc\/en\/commissions\/CND\/conventions.html [Accessed 14 Dec 2020]."},{"key":"2025121422484554000_11.8.e048528.10","unstructured":"Misuse of drugs legislation, 2015. Available: https:\/\/www.health-ni.gov.uk\/articles\/misuse-drugs-legislations"},{"key":"2025121422484554000_11.8.e048528.11","unstructured":"Consolidated Federal Laws of Canada . Controlled drugs and substances act. government of Canada justice laws website, 2019. Available: https:\/\/laws-lois.justice.gc.ca\/eng\/acts\/c-38.8\/ [Accessed 14 Oct 2020]."},{"key":"2025121422484554000_11.8.e048528.12","unstructured":"October PS . Australian government federal register of legislation, 2017. Available: https:\/\/www.legislation.gov.au\/Details\/F2017L01285\/Html\/Text, http:\/\/www.legislation.gov.au\/Details\/F2017L01285 [Accessed 10 Dec 2020]."},{"key":"2025121422484554000_11.8.e048528.13","unstructured":"Controlled Substance Schedules . U.S. department of justice, drug enforcement administration, diversion control division, 2020. Available: https:\/\/www.deadiversion.usdoj.gov\/schedules\/#define [Accessed 23 Sep 2020]."},{"key":"2025121422484554000_11.8.e048528.14","unstructured":"RITALIN . Methylphenidate hydrochloride tablet. East Hanover, NJ: Novartis Pharmaceuticals Corporation, 2019."},{"key":"2025121422484554000_11.8.e048528.15","unstructured":"Medical Expenditure Panel Survey Background . Medical expenditure panel survey, agency for healthcare research and quality, 2019. Available: https:\/\/meps.ahrq.gov\/mepsweb\/about_meps\/survey_back.jsp [Accessed 23 Sep 2020]."},{"key":"2025121422484554000_11.8.e048528.16","unstructured":"MEPS HC-204 2018 Full Year Population Characteristics . Medical expenditure panel survey, agency for healthcare research and quality, 2020. Available: https:\/\/meps.ahrq.gov\/mepsweb\/data_stats\/download_data_files_detail.jsp?cboPufNumber=HC-204 [Accessed 3 Apr 2021]."},{"key":"2025121422484554000_11.8.e048528.17","unstructured":"MEPS HC-206A: 2018 Prescribed Medicines . Medical expenditure panel survey, agency for healthcare research and quality, 2020. Available: https:\/\/meps.ahrq.gov\/mepsweb\/data_stats\/download_data_files_detail.jsp?cboPufNumber=HC-206A [Accessed 3 Apr 2021]."},{"key":"2025121422484554000_11.8.e048528.18","unstructured":"U.S RO . National library of medicine unified medical language system (UMLS) web site, 2018. Available: https:\/\/www.nlm.nih.gov\/research\/umls\/rxnorm\/ [Accessed 17 Apr 2018]."},{"key":"2025121422484554000_11.8.e048528.19","unstructured":"MEPS Topics: Prescription Drugs . Medical expenditure panel survey, agency for healthcare research and quality, 2019. Available: https:\/\/meps.ahrq.gov\/mepsweb\/data_stats\/MEPS_topics.jsp?topicid=14Z-1 [Accessed 23 Sep 2020]."},{"key":"2025121422484554000_11.8.e048528.20","unstructured":"Machlin S , Yu W , Zodet M . Computing standard errors for MEPS estimates. Medical expenditure panel survey, agency for healthcare research and quality, 2005. Available: https:\/\/meps.ahrq.gov\/mepsweb\/survey_comp\/standard_errors.jsp [Accessed 10 May 2021]."},{"key":"2025121422484554000_11.8.e048528.21","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.14344","article-title":"Trends in the prevalence and incidence of attention-deficit\/hyperactivity disorder among adults and children of different racial and ethnic groups","volume":"2","author":"Chung","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2025121422484554000_11.8.e048528.22","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1177\/1087054717698815","article-title":"Prevalence of ADHD in publicly insured adults","volume":"22","author":"Zhu","year":"2018","journal-title":"J Atten Disord"},{"key":"2025121422484554000_11.8.e048528.23","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.1152","article-title":"Prevalence of and factors associated with long-term concurrent use of stimulants and opioids among adults with attention-deficit\/hyperactivity disorder","volume":"1","author":"Wei","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2025121422484554000_11.8.e048528.24","doi-asserted-by":"publisher","DOI":"10.1177\/1087054716688534"},{"key":"2025121422484554000_11.8.e048528.25","doi-asserted-by":"crossref","unstructured":"Tisdale JE , Miller DA . Drug-Induced diseases: prevention, detection, and management. 3rd Edition. Bethesda, Maryland: Amer Soc of Health System, 2018.","DOI":"10.37573\/9781585285310"},{"key":"2025121422484554000_11.8.e048528.26","unstructured":"Lipari RN . Key substance use and mental health indicators in the United States: results from the 2018 national survey on drug use and health. Rockville. MD: Substance Abuse and Mental Health Services Administration, 2018. https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/cbhsq-reports\/NSDUHNationalFindingsReport2018\/NSDUHNationalFindingsReport2018.pdf"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-048528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:48:58Z","timestamp":1765781338000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-048528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,13]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bmjopen-2020-048528"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-048528","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}