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Key points
- In the US, prescription stimulant use is on the rise, mostly due to adult usage.
- This reflects an increase in ADHD, whether due to changes in diagnostic criteria or over-diagnosis.
- Although psychosis with prescription stimulants is rare, the risk may increase as more adults use them.
The use of prescription stimulants like Ritalin (methylphenidate), Adderall (mixed amphetamine/dextroamphetamine), Dexadrine (dextroamphetamine), and Vyvanse (lisdexamfetamine), ostensibly to treat attention-deficit hyperactivity disorder (ADHD), has shot up over the past two decades here in the US, an increase driven mostly by adults. From 2005 to 2019, the number of US adults prescribed stimulants increased fivefold, and during the first year of the COVID-19 pandemic, prescriptions increased another 10% among women 15- to 49-year-old and men 25 to 49 years old.1 As of the past few years, that amounts to as many as 4% of commercially insured US adults taking prescription stimulants.
Adult ADHD Is on the Rise
Why the increase? Part of the answer is that the diagnosis of adult ADHD has also gone up over the past two decades, though how to explain that has been debated going back years without clear resolution
As with rising rates of autism, it could be that the detection of adult ADHD has gone up due to loosened diagnostic criteria for ADHD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013, clinicians increasingly diagnosing the condition on the “soft” end of the illness spectrum, and greater public awareness and destigmatization of the diagnosis thanks to social media. It’s also possible that the biological effects of COVID-19 and the fact that many of us are increasingly living our lives online are taxing our brains at home and work like never before, taking a toll on our ability to focus and making it increasingly obvious that human brains aren’t particularly good at multitasking.3 Notably, about half of US adults with ADHD were diagnosed as adults, even though the DSM-5 diagnosis requires symptom onset before the age of 12.3
It could also be that ADHD is increasingly “over-diagnosed,” a longstanding claim that has been rekindled of late by Robert F. Kennedy Jr’s Make America Health Again (MAHA) Commission. In certain sectors like finance and the tech industry, employees often work long hours and view stimulants as a way to make it through the day, pull all-nighters, and keep up or compete with co-workers who take them.4 Other people may be engaging in inaccurate self-diagnosis due to the popularity of ADHD on social media where misinformation about and misrepresentations of the disorder abound.5
All of these explanations have some teeth and are by no means mutually exclusive. ADHD may be accurately diagnosed in an increasing number of adults, underdiagnosed (e.g., among women and minority groups) or untreated (only about a third of people with a diagnosis of ADHD report receiving treatment in the past year) in others, and overdiagnosed in still others
Obtaining Prescription Stimulants Is Easier Than Ever
Diagnosis aside, the increase in stimulant use for ADHD reflects how little effort it can take to obtain a prescription these days, especially here in the US, which consumes some 68% of the world’s prescription stimulants.6 For individuals who are distracted or forgetful; struggle with attention, organization, and multi-tasking; don’t always pay attention to what people are saying; and find themselves being forgetful or losing things—symptoms that almost all of us experience from time to time—it’s easy to get a stimulant prescription by filling out an online questionnaire, seeing a mental health provider via telepsychiatry (note that one of the sharpest rise of stimulant prescriptions in recent years has been by nurse practitioners7), and “doctor shopping” when they get turned down.
Unlike some medications, stimulants tend to sharpen focus regardless of whether someone has ADHD or not so that people seek them out and psychiatrists end up prescribing them for what amounts to “neuroenhancement,” similar to the use of performance-enhancing drugs (PESs) like anabolic steroids to enhance physical performance.8 Others—including as many as 46% of college students in one study—obtain stimulant medications without a prescription or an ADHD diagnosis, noting that they help to “stay awake longer, have a more enjoyable time, and to party longer.”9
More Stimulants, More Psychosis Risk
The potential upsides of receiving prescription stimulants for properly diagnosed ADHD include associations with lower mortality, suicidal behavior, substance misuse, and criminality.10,11 Meanwhile, rates of prescription stimulant misuse have decreased to just 1.9% of US adults in recent years.12 So why fret about growing rates of prescription stimulants?
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One reason to worry is that even supervised prescription use can result in side effects. Although previous studies have yielded mixed results, a 2024 case-control study found that long-term exposure to stimulants for ADHD was associated with greater risks of cardiovascular disease, especially high blood pressure and arterial disease.13
And then there’s the psychosis risk. It’s been well-known since at least the 1950s that illicit or recreational stimulant use of drugs like methamphetamine can cause an acute, florid psychosis. Recreational use also substantially increases the risk of first-episode psychosis.The risk of psychosis with prescription stimulants taken at appropriate doses is much, much less but it’s not zero.14,15 A 2019 study found that the rate of new onset psychosis with prescription medications in a sample of adolescents and young adults was 1 in 660 patients.16 With some 2 million patients taking prescription amphetamines, that amounts to thousands of patients. A more recent case-control study also found that the chance of developing psychosis or mania was greater among those taking prescription stimulants than not with an adjusted odds ratio of 2.68.17 For high doses of prescription stimulants—more than 30 mg/day dextroamphetamine equivalents (i.e., 40 mg of Adderall and 100 mg of Vyvanse)—the risk of psychosis or mania was 5.3 greater compared to those not on stimulants with an attributable risk percentage of 81%.
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These days, I see a lot of patients hospitalized with psychosis who are taking prescription stimulants as outpatients. Association isn’t causation, so this could just reflect the fact that so many adults are now on stimulants—perhaps especially in the Bay Area where I work. But it’s always possible that the stimulants are worsening the psychosis or are being taken at non-prescribed doses, very likely that they’ll interfere with the effectiveness of antipsychotic medications, and uncertain—in the midst of hospitalization for psychosis—whether a patient really has ADHD or not. As a general rule, stimulants are therefore held, at least during the hospitalization and until resolution of psychosis.
The Drug Enforcement Agency (DEA) is deliberating whether and when to reinstate a previous law that required in-person visits for controlled substances including prescription stimulants. That law was suspended during COVID-19 to prevent people with ADHD from running out of medications, but the post-COVID spike in prescriptions for adult ADHD may result in its reinstatement sooner rather than later
1. Danielson ML, Bohm MK, Newsome K, et al. Trends in stimulant prescription fills among commercially insured children and adults — United States, 2016–2021. MMWR Morbidity and Mortality Weekly Report 2023; 72:327–332
2. Pearson H. ADHD diagnoses are growing. What’s going on? Nature 2025; 647:836-840
3. Staley BS, Robinson LR, Claussen AH, et al. Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults—National Center for Health Statistics Rapid Surveys System, United States, October-November 2023. MMWR Morbidity and Mortality Weekly Report 2024; 73: 890-895
4. Saeedy A. The drugs young bankers use to get through the day—and night. The Wall Street Journal; December 14, 2024
5. Neumann M, Rotherberg M, Mittmann G, et al. Quirky, relatable, misleading: ADHD’s viral identity on TikTok. Current Psychology 2026; 45:329
6. Bachhuber MA, Jordan AE, Piper BJ. Prescription stimulant consumption in the United States compared with 35 other countries. Health Affairs Scholar 2026; 4:1-6
7. IQVIA Government Solutions, Inc. Stimulant prescription trends in the United States 2012-2023. Report Prepared for the Drug Enforcement Agency (DEA); November 13, 2024
8. Cheung E, Pierre JM. The medical ethics of cognitive neuroenhancement. AIMS Neuroscience 2015; 2:105-122
9. Fairman RT, Vu M, Haardörfer R, et al. Prescription stimulants among young adult college students: Who uses, why, and what are the consequences? Journal of American College Health 2020; 69:767-774
10. Li L, Zhu Z, Zhang L, et al. ADHD pharmacotherapy and mortality in individuals with ADHD. JAMA 2024; 33:850-860
11. Zhang L, Zhu Z, Sjolander A, et al. ADHD drug treatment and risk of suicidal behaviors, substance misuse, accidential injuries, transport accidents, and criminality: Emulation of target trials. BMJ 2025; 390:e083658
12. Maglione MA, Batra J, Peterson BS, et a. Adult misuse of ADHD stimulant medication in the United States. Journal of Clinical Psychopharmacology 2026. DOI:10.1097/JCP.0000000000002202
13. Zhang L, Li L, Andell P, et al. Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA Psychiatry 2024; 81:178-187
14. Rodriguez-Toscano E, Alloza C, Fraguas D, et al. Differences in patterns of stimulant use and their impact on first-episode psychosis incidence: An analysis of the EUGEI study. Schizophrenia Bulletin 2023; 49:1269-1280
15. Jangra D, Tejwani R, Ahluwalia Y, et al. A comparative systematic review and meta-analysis of psychotic outcomes from therapeutic and non-therapeutic use of stimulants. Journal of Addiction Medicine 2026. DOI: 10.1097/ADM.0000000000001656
16. Moran LBV, Ongur D, Hsu J, et al. Psychosis with methylphenidate or amphetamine in patients in ADHD. New England Journal of Medicine 2019; 380:1128-1138
17. Moran LBVV, Skinner JP, Shinn AK, et al. Risk of incident psychosis and mania with prescription amphetamines. American Journal of Psychiatry 2024; 181:901-909
