Report: Distribution of Amphetamine-Based Prescriptions Varies Widely Across the U.S.
Regional disparities in prescription methamphetamine and amphetamine, commonly used to treat ADHD, were influenced by stigmatization and accessibility.
July 10, 2023
Distribution of amphetamine-based prescription medications varies considerably across the U.S., according to data obtained from the Drug Enforcement Administration (DEA) for 2019 that charted distribution of amphetamine, a common ADHD medication, and methamphetamine. The misuse of methamphetamine is a major public health concern; however, amphetamines play a mainstream therapeutic role in the effective treatment of ADHD. Stigmatization, differences in accessibility, and initiatives like the Montana Meth Project likely contribute to regional disparities in accessibility for both medications.1
The DEA’s Automation of Reports and Consolidated Orders System (ARCOS) was used to collect per capita drug weight distribution data (milligrams per 1,000 people) for prescription methamphetamine and amphetamine in a regional analysis published by the Journal of Attention Disorders. Distribution data was collected for every U.S. state and divided into four regions: West, Midwest, South, and Northeast.
When U.S. regions were compared for the highest and lowest distributions of each stimulant agent:
- Methamphetamine was higher in the West (32.2% of total distribution) compared to other regions
- Amphetamine was higher in the South (37% of total distribution) compared to other regions
- Distribution of both agents was lowest in the Northeast
When U.S. states were compared for the highest and lowest distributions of each agent:
- Washington had 16.8 times more distribution of methamphetamine than did Arkansas
- Louisiana had 4.92 times more distribution of amphetamine than did New Mexico
A key finding of the report was the under-distribution of both agents compared to their aggregate production quotas. Only 16.1% of prescription methamphetamine and 54% of prescription amphetamine were distributed compared to what could be produced for sale*. This is curious because amphetamine/dextroamphetamine sold as Adderall XR has been experiencing a U.S. shortage for nearly a year. The distribution of amphetamine was 4,000 times more common than that of methamphetamine.
Stigmatization of Stimulants
The high potential for abuse and harmful side effects of methamphetamines can cast a shadow on psychostimulants as a safe and effective ADHD treatment option. Stigmatization impacts not only a patient’s desire to take stimulants, but also a physician’s willingness to prescribe them.2
Methamphetamine is more commonly associated with recreational crystal meth, however, it is also the generic name for Desoxyn, a legal prescription medication used as a second-line treatment for ADHD and obesity.
“While Desoxyn was approved for the treatment of ADHD by the FDA in 1981, it is rarely used to treat ADHD,” Walt Karniski, M.D., told ADDitude. “It has a high abuse potential and diversion is more likely to occur with Desoxyn than with any of the other amphetamine-based medication. There seems to be no compelling reason to prescribe Desoxyn for the treatment of ADHD when so many other options are less likely to be abused or diverted, much less expensive, and more effective.”
Long-acting amphetamine formulations used in the treatment of ADHD include the name-brand and generic versions of medications including Dyanavel XR, Mydayis, Adzenys ER, Adderall XR, and Dexedrine Spanule, as well as the new Xelstrym transdermal patch. Short-acting amphetamine formulations for ADHD include Evekeo, Evekeo ODT, Zenzedi, Adderall, and ProCentra, as well as their generics where available. Vyvanse is considered an amphetamine pro-drug formulation comprising lisdexamfetamine.
One of the most common concerns associated with stimulant medication use is that it will lead to addiction. Substance use disorders (SUDs) co-occur in 10% to 24% of adults with ADHD, according to one study cited in the report.3 Yet, ADHD medication alone has not been found to cause SUDs.4 On the contrary, treating ADHD with stimulant medication starting in childhood can decrease the likelihood of developing an SUD.3, 5, 6
“Adults with ADHD are two to three times more likely to abuse drugs but less likely to abuse drugs if they’re taking medication for their ADHD,” Karniski said.
“The bottom line is that early onset treatment of ADHD doesn’t increase the risk for cocaine and methamphetamine use over the general population,” said Tim Wilens, M.D., in a recent ADDitude webinar on treatment options for people with SUD and ADHD.
However, according to the current report, large-scale prevention programs like the Montana Meth Project (MMP) inadvertently stigmatize stimulants’ licit and illicit use.
“The objective of the MMP was to educate and discourage youth from using illicit meth by stigmatizing use and making it socially unacceptable,” the researchers wrote. “As previously discussed, this stigmatization, in combination with heavy advertising against amphetamine use through stereotyped images of what people on meth look like, may be preventing health care providers from recommending it as ADHD treatment due to fear of public pushback.
In its state-by-state analysis, distribution of prescription methamphetamine in Montana (where the MMP initiative is located) was zero. It was the only state with a distribution of zero for either agent.
Additional Causes
Other potential causes of regional variations include the location of health care professionals; the age of prescribing physicians and their specialty; underdiagnosis and undertreatment of ADHD among minority populations; changing criteria for ADHD; and location of illicit meth labs. Variations in total distribution may be influenced by the popularity of telemedicine and the accessibility of controlled substances online.
Future research should aim to better understand the regional disparities demonstrated in this report and “… to quantify the effect that initiatives such as the Montana Meth Project have on health care provider recommendation of ADHD stimulant medications,” the researchers wrote.
*For sale, not for conversion
View Article Sources
1Lopera, S. D., O’Kane, V. M., Goldhirsh, J. L., & Piper, B. J. (2023). Regional disparities in prescription methamphetamine and amphetamine distribution across the United States. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231177467
2 Anderson D. M. (2010). Does information matter? The effect of the meth project on meth use among youths. Journal of Health Economics, 29(5), 732–742. https://doi.org/10.1016/j.jhealeco.2010.06.005
3 Mariani J. J., Levin F. R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. American Journal on Addictions, 16(Suppl 1), 45–56. https://doi.org/10.1080/10550490601082783
4Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current Psychiatry Reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6
5 Kooij J. J., Huss M., Asherson P., Akehurst R., Beusterien K., French A., Sasané R., & Hodgkins P. (2012). Distinguishing comorbidity and successful management of adult ADHD. Journal of Attention Disorders, 16(5 Suppl), 3S–19S. https://doi.org/10.1177/1087054711435361
6 McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E. (2016). Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 479–486. https://doi.org/10.1016/j.jaac.2016.03.011
