Prescription Stimulant Dispensing to US Children: 2017-2023
Sijia He1, Sean Esteban McCabe2, Rena M Conti3
1Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
Insights
COVID-19 pandemic led to a decline in prescription stimulant dispensing for children. Following a shortage of Adderall in October 2022, dispensing rates shifted to alternative stimulants, though overall changes were not statistically significant.
Area of Science:
- Pediatric pharmacology
- Public health
- Epidemiology
Background:
- The COVID-19 pandemic and subsequent drug shortages have impacted healthcare access and treatment for children.
- Understanding prescription patterns for medications like stimulants is crucial for pediatric care.
- Immediate-release mixed amphetamine salts (Adderall) experienced a significant shortage in October 2022.
Purpose of the Study:
- To analyze changes in prescription stimulant dispensing rates for children aged 5-17 years.
- To assess the impact of the COVID-19 pandemic onset (March 2020) on stimulant dispensing.
- To evaluate the effects of the Adderall shortage (October 2022) on stimulant prescribing patterns.
Main Methods:
- Utilized the IQVIA Longitudinal Prescription Database (2017-2023), covering 92% of US prescriptions.
- Employed an interrupted time series design to examine dispensing rate changes.
- Analyzed monthly dispensing rates per 100,000 children at key time points: March 2020 and October 2022.
Main Results:
- A significant decline of 18.8% in monthly stimulant dispensing was observed in March 2020.
- Post-March 2020, dispensing rates showed a monthly increase of 12.7 children per 100,000.
- In October 2022, no significant level or slope change in overall stimulant dispensing occurred, but immediate-release mixed amphetamine salts decreased while dexmethylphenidate increased.
Conclusions:
- Prescription stimulant dispensing to children decreased following the onset of the COVID-19 pandemic.
- The Adderall shortage in October 2022 may have led to a shift towards alternative stimulants, though overall dispensing changes were not statistically significant.
- Further research is recommended to investigate potential adverse events associated with these medication switches.
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.
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