Background: Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder marked by excessive hyperactivity, impulsivity, or inattention. Although these disorders are typically diagnosed in childhood, symptoms may persist into adulthood. About 66% of children aged 4 to 17 diagnosed with ADHD took medication for the disorder in 2007. Stimulant medications remain the first-line treatment for these disorders in both children and adults. ADHD stimulant medications can be misused to suppress appetite, enhance alertness, or cause feelings of euphoria. Whether ADHD stimulant medications are misused or adverse reactions occur when the medication is taken as prescribed, monitoring dangerous health effects that require immediate medical attention can help guide intervention efforts. Methods: National estimates of Emergency Department (ED) visits involving ADHD stimulant medication were analyzed using data from the 2011 Drug Abuse Warning Network (DAWN). Results: Between 2005 and 2010, the estimated number of ED visits involving ADHD stimulant medications increased from 13,379 to 31,244 visits. The number of these visits increased significantly for adults aged 18 or older. No significant increases were seen among children younger than 18. Visits that involved nonmedical use increased from 5,212 to 15,585 visits; those involving adverse reactions increased from 5,085 to 9,181 visits. Other pharmaceutical drugs were involved in 45% of ED visits involving ADHD stimulant medications, illicit drugs were involved in about 21% and alcohol in about 19%. Conclusion: ED visits for nonmedical use of ADHD stimulant medications have not increased among children and adolescents, but they have increased among adults aged 18 or older. This suggests a need for increased attention toward efforts to prevent diversion and misuse among adults. Even when taken as directed, ADHD stimulant medications entail some risk. Data in this report show that the number of ED visits involving adverse reactions increased between 2005 and 2010, especially for adults aged 18 and older. As treatment for ADHD among adults becomes more widespread, prescribing physicians (including psychiatrists and other mental health professionals) may carefully consider associated risks among those who have chronic health conditions and/or take other medications that may interact with ADHD stimulant medications.

Introduction

Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder marked by excessive hyperactivity, impulsivity, or inattention.¹ Although these disorders are typically diagnosed in childhood, symptoms may persist into adulthood.¹ About two thirds (66 percent) of children aged 4 to 17 diagnosed with ADHD took medication for the disorder in 2007,² and stimulant medications remain the first-line treatment for these disorders in both children and adults.³ When used as directed, ADHD stimulant medications can be effective treatment, but they can also have negative side effects, such as nervousness, insomnia, dizziness, and cardiovascular or psychiatric problems.^4,5 ADHD stimulant medications can also be misused to suppress appetite, enhance alertness, or cause feelings of euphoria.⁶ Past year nonmedical use of Adderall^®, a common ADHD stimulant medication, increased among adults from 2006 to 2010, particularly among young adults aged 18 to 25.⁷ Whether ADHD stimulant medications are misused or adverse reactions occur when the medication is taken as prescribed, monitoring dangerous health effects that require immediate medical attention can help guide intervention efforts.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States and can be used to track ED visits related to ADHD stimulant medications. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. This issue of The DAWN Report examines trends in ED visits involving ADHD stimulant medications, including methylphenidate (e.g., Ritalin^®, Concerta^®), amphetamine-dextroamphetamine (e.g., Adderall^®), dexmethylphenidate (e.g., Focalin^®), and dextroamphetamine (e.g., Dexedrine^®).

Overview and Demographic Characteristics

The number of ED visits involving ADHD stimulant medications increased between 2005 and 2010 from 13,379 to 31,244 visits (Figure 1). The number of ED visits involving ADHD stimulant medications increased among both males and females: visits among females increased between 2005 and 2010 from 4,315 to 14,068 visits, and visits among males nearly doubled from 9,059 to 17,174 visits.

Figure 1

Emergency Department (ED) Visits Related to Attention Deficit/Hyperactivity Disorder (ADHD) Stimulant Medications, by Gender*: 2005 to 2010

Although the number of ED visits involving ADHD stimulant medications did not increase significantly for children younger than 18 between 2005 and 2010, increases were seen among multiple age groups for persons aged 18 or older (Figure 2). Specifically, visits increased from 2,131 to 8,148 visits among persons aged 18 to 25, from 1,754 to 6,094 visits among persons aged 26 to 34, and from 2,519 to 7,957 visits among adults aged 35 or older.

Figure 2

Emergency Department (ED) Visits Related to Attention Deficit/Hyperactivity Disorder (ADHD) Stimulant Medications, by Age Group: 2005 and 2010

Reasons for ED Visits

In 2010, half of ADHD stimulant medication-related ED visits involved nonmedical use of pharmaceuticals⁸ (50 percent), and nearly one third involved adverse reactions⁹ (29 percent) (Figure 3). The number of ED visits related to ADHD stimulant medications involving nonmedical use of pharmaceuticals increased significantly from 5,212 visits in 2005 to 15,585 visits in 2010 (Table 1). Among demographic subgroups, ED visits involving nonmedical use of pharmaceuticals increased significantly among males, females, and adults aged 18 or older.

Figure 3

Emergency Department (ED) Visits Related to Attention Deficit/Hyperactivity Disorder (ADHD) Stimulant Medications, by Reason for Visit: 2010

Table 1

Reason for Emergency Department (ED) Visits Related to Attention Deficit/Hyperactivity Disorder (ADHD) Stimulant Medications, by Gender and Age Group*: 2005 and 2010.

The number of ED visits related to ADHD stimulant medications involving adverse reactions increased significantly from 5,085 visits in 2005 to 9,181 visits in 2010 (Table 1). Among demographic subgroups, ED visits for adverse reactions increased significantly among females and adults aged 18 or older.

Drug Combinations with ADHD Stimulant Medications

Of the 31,244 ED visits involving ADHD stimulant medications in 2010, one quarter (25 percent) involved one other drug, and nearly two fifths (38 percent) involved two or more other drugs (Table 2). Other pharmaceutical drugs were involved in nearly half (45 percent) of visits; one quarter (26 percent) involved anti-anxiety and insomnia medications, and about one sixth (16 percent) involved narcotic pain relievers.¹⁰ About one fifth involved illicit drugs (21 percent), and 14 percent involved marijuana. Nearly one fifth involved alcohol (19 percent).

Table 2

Number and Percentage of Selected Drugs Involved in Emergency Department (ED) Visits Related to Attention Deficit/Hyperactivity Disorder (ADHD) Stimulant Medications: 2010.

Drug combinations involved in ED visits related to ADHD stimulant medications varied across age groups. Marijuana was the most common drug combined with ADHD stimulant medications among adolescents aged 15 to 17 (32 percent), and alcohol was the most common drug combined with ADHD stimulant medications among young adults aged 18 to 25 (30 percent) (data not shown). Anti-anxiety and insomnia medications were the most common drug combined with ADHD stimulant medications among adults aged 26 to 34 (44 percent) and those aged 35 or older (31 percent). Visits for children aged 14 or younger did not yield statistically reliable estimates for drug combinations with ADHD stimulant medications.

Discussion

Because ADHD stimulant medications have historically been prescribed for developmental disorders in children, nonmedical use among adolescents and young adults has received much attention.¹¹ This report shows that ED visits for nonmedical use have not increased among children and adolescents, but they have increased among adults aged 18 or older. This suggests a need for increased attention toward efforts to prevent diversion and misuse among adults.

Even when taken as directed, ADHD stimulant medications entail some risk,⁴ and the data in this report show that the number of visits involving adverse reactions increased between 2005 and 2010, especially for adults aged 18 and older. As treatment for ADHD among adults becomes more widespread,³ prescribing physicians (including psychiatrists and other mental health professionals) may carefully consider associated risks among those who have chronic health conditions and/or take other medications that may interact with ADHD stimulant medications. A variety of treatment options, both pharmaceutical and nonpharmaceutical, are available for adults with ADHD.^3,12

Suggested Citation

Mattson, M.E. Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant Medications. The CBHSQ Report: January 24, 2013. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD. [PubMed: 27631057]