Prescription Stimulant Use for ADHD Rising Among U.S. Teens, While Misuse Declines: 2005–2023 Study Findings
A new analysis published in JAMA has revealed a clear shift in how U.S. adolescents are using prescription stimulants meant for attention-deficit/hyperactivity disorder (ADHD). Between 2005 and 2023, the medical (prescribed) use of these medications has gone up, while nonmedical (misuse) has notably gone down. The findings come from a large-scale examination led by Dr. Sean Esteban McCabe and his team at the University of Michigan, offering an important update on stimulant use patterns among teenagers.
The study drew data from 259,623 students in 8th, 10th, and 12th grades, collected as part of the ongoing Monitoring the Future project — a nationally recognized annual survey of adolescent behavior and health trends.
The Numbers: How Stimulant Use Has Changed
The research team looked at both medical and nonmedical stimulant use over 18 years. Here’s what they found:
- Current medical use of prescription stimulants (use within the past 30 days under a doctor’s direction) showed a gradual upward trend. The highest point was in 2022, when 4.46% of surveyed teens reported taking prescription stimulants for ADHD. The adjusted odds ratio (aOR) for this increase over time was 1.016, showing a modest but steady rise.
- Lifetime medical use, meaning teens who had ever been prescribed and used stimulants, peaked in 2022 at 9.30%.
- In contrast, nonmedical use — taking stimulants without a prescription or for reasons other than medical treatment — fell steadily. The lowest rate was recorded in 2023, at 4.69%, with a significant downward trend (aOR 0.971).
This pattern indicates that although more adolescents are being prescribed ADHD medication, fewer are misusing or experimenting with it. That’s an encouraging sign for public health experts who’ve been monitoring stimulant misuse closely, especially given the rise in overall ADHD diagnoses.
Co-Use and Duration of Medical Use
One particularly interesting finding from the study was the trend in co-use — teens who both had a legitimate prescription and also used stimulants nonmedically. Over time, this overlap declined (aOR 0.980), meaning that fewer teens who were prescribed medication were also using it outside medical directions.
The study also shed light on how long adolescents had been using prescribed stimulants:
- 14.5% had been using them for less than one year
- 18.6% had been using them for one to two years
- 66.9% had been using them for three years or longer
This long-term usage pattern suggests that most teens on stimulant therapy are receiving continuous treatment, which aligns with ADHD’s chronic nature and the need for ongoing management.
Age Differences: Older Teens, Bigger Shifts
When researchers compared grade levels, they found clear differences. 10th and 12th graders reported higher rates of nonmedical use compared to 8th graders — but these older students also showed the largest declines in misuse over time.
In the mid-2000s, nonmedical use actually exceeded medical use among older adolescents. Fast forward to the 2020s, and the situation has reversed: more teens are taking these medications as prescribed, and fewer are using them recreationally or for academic performance enhancement.
What Could Explain These Trends?
Researchers point to several potential factors. One major influence could be the COVID-19 pandemic, which disrupted normal school and social routines. With students learning remotely and spending less time in peer settings, opportunities for drug sharing or diversion decreased significantly.
Another factor may be better awareness and regulation around ADHD treatment. Doctors have become more careful with stimulant prescribing, and schools and parents are more informed about medication management and the risks of misuse. Additionally, improvements in digital monitoring of prescriptions and electronic health records have likely made it harder to obtain stimulants without legitimate medical need.
It’s also worth noting that many adolescents who misuse stimulants don’t get them from strangers—they get them from friends or their own leftover medication. The study notes that while some misuse still happens this way, it has become less common.
Why This Matters
The increase in legitimate stimulant prescriptions has raised questions about whether society is overprescribing ADHD medications. This study provides some reassurance that the rise in prescribing hasn’t led to a corresponding rise in abuse.
However, researchers caution against complacency. Just because misuse rates are declining doesn’t mean the issue has disappeared. The authors emphasize the need for continued monitoring, particularly since stimulant availability is still increasing.
Another point to consider: while stimulant medications like Adderall, Ritalin, Vyvanse, and Concerta can be highly effective for ADHD when used properly, they are also controlled substances because of their potential for dependence and misuse. Balancing access for those who truly need them with efforts to prevent abuse remains a delicate public health challenge.
A Quick Refresher: What Are Prescription Stimulants and How Do They Work?
Prescription stimulants are a class of medications designed to improve attention, focus, and impulse control in people with ADHD. They work by increasing dopamine and norepinephrine activity in the brain — chemicals linked to alertness and executive function.
The most common medications include amphetamine-based drugs (like Adderall and Vyvanse) and methylphenidate-based drugs (like Ritalin and Concerta).
When used under proper medical supervision, these medications are generally safe and effective. Side effects can include sleep problems, reduced appetite, and increased heart rate, but these are usually manageable. Misuse, on the other hand, can cause serious health risks — from addiction and anxiety to heart complications.
The Bigger Picture: ADHD Diagnosis and Treatment
The rising medical use of stimulants likely reflects a broader increase in ADHD diagnoses among adolescents. This doesn’t necessarily mean ADHD is becoming more common; rather, awareness and detection have improved. Schools and healthcare providers now screen more effectively for symptoms, leading to earlier intervention.
While this is good news, it also underscores the importance of responsible prescribing and parental oversight. Stimulant therapy should always be part of a comprehensive treatment plan — which may also include behavioral therapy, counseling, and academic support.
Looking Ahead
The study’s findings highlight a positive shift: responsible medical use is up, and misuse is down. But the authors, including Dr. McCabe, stress that long-term monitoring remains crucial. Trends can change as social behaviors and prescribing practices evolve.
This data offers both reassurance and a reminder. As more teens receive help for ADHD, the goal should be to ensure that medications are used safely, stored securely, and monitored closely — not just by doctors, but by families and communities too.
Research Source:
McCabe SE, et al. Trends in Medical and Nonmedical Use of Prescription Stimulants Among US Adolescents, 2005–2023. JAMA. 2025;334(12):1110–1112. https://doi.org/10.1001/jama.2025.11260
