Prescription Stimulant Dispensing to US Children: 2017–2023

OBJECTIVE To evaluate changes in prescription stimulant dispensing to children aged 5 to 17 years associated with the COVID-19 pandemic and the shortage of immediate-release mixed amphetamine salts (Adderall), which was announced in October 2022. METHODS We analyzed the 2017 to 2023 IQVIA Longitudinal Prescription Database, which captures 92% of US prescriptions. Using an interrupted time series design, we evaluated level and slope changes in the monthly stimulant-dispensing rate (number of children with stimulant dispensing per 100 000 children) in March 2020 and October 2022. RESULTS In March 2020, the monthly stimulant-dispensing rate to children declined −454.9 children per 100 000 (95% CI, −572.6 to −337.2), an 18.8% decrease relative to January 2017. After March 2020, this rate increased to 12.7 children per 100 000 per month (95% CI, 6.6–18.8). In October 2022, there was no level change (−39.7 children per 100 000; 95% CI, −189.9 to 110.5) or slope change (−12.1 children per 100 000 per month; 95% CI, −27.5 to 3.3), although estimates were negative. During October 2022, there was a level decrease in the monthly dispensing rate for immediate-release mixed amphetamine salts and a level increase in the monthly dispensing rate for dexmethylphenidate. CONCLUSIONS Stimulant dispensing to children declined after the pandemic began. Dispensing may also have declined after October 2022, but estimates were not significant, partly because decreased dispensing of immediate-release mixed amphetamine salts was offset by increased dispensing of other stimulants. Findings suggest the shortage may have prompted children to switch to alternative stimulants. Future research should evaluate whether any switches led to adverse events.