ADHD prescriptions skyrocket in Washington and nationwide

Prescriptions for attention deficit hyperactivity disorder (ADHD) have skyrocketed in Washington state and nationwide, driven largely by more adults and women seeking treatment.

Why it matters: Greater recognition of how symptoms show up differently in women and girls is shifting who receives treatment for ADHD, which has historically been diagnosed more often in boys, said Douglas Russell, a child and adolescent psychiatrist at Seattle Children's Hospital.

• Reduced stigma around mental health issues also is contributing to more adults getting treatment, particularly after many struggled with balancing work and home life during the pandemic, Russell told Axios.

The big picture: "Record-high rates of prescriptions" for ADHD-treating stimulants are a factor in the recent shortage of the drugs nationwide, the U.S. Food and Drug Administration and Drug Enforcement Administration wrote in a letter last month.

• Nationally, dispensing of stimulants increased by 45.5% from 2012 to 2021, according to the FDA and DEA letter.

Zoom in: In Washington state, the number of prescriptions for stimulants used to treat ADHD rose 55% from 2016 to 2022, totaling more than 2 million prescriptions last year, according to state health department data analyzed by Axios.

• Prescriptions for amphetamines — which include Adderall and several other ADHD drugs — jumped by more than 70% statewide.
• Meanwhile, the state's population increased by less than 9% during that time.

Between the lines: Adults 25 and over have been prescribed ADHD stimulants at increasing rates in recent years, according to a July report from Washington's health department.

• "Decades ago, we used to think of ADHD as just a childhood diagnosis," said Russell, who is also an assistant professor at the University of Washington.
• "The recognition that ADHD affects adults as well is an important one."

Plus: The trend of women getting treated for ADHD at higher rates took off in mid-2020, the health department wrote in its July report.

• In the last three months of 2022, Washington women were prescribed amphetamine stimulants at a rate of 4.6 per 100 people, compared to a rate of 3.8 per 100 among men.

What they're saying: Girls and women tend to have ADHD show up in the form of inattentiveness, which is less likely to be diagnosed in childhood than the hyperactivity often seen in boys, said Tobias Dang, medical director for mental health at Kaiser Permanente in Washington.

• In recent years, there seems to have been "a better recognition" of that difference across genders, Dang told Axios.

Yes, but: The rise in telemedicine during the pandemic might have increased "inappropriate stimulant prescriptions" due to patients not being evaluated adequately, per the Centers for Disease Control.

• Since the pandemic, Dang said he's seen a huge spike in patients complaining of symptoms of inattentiveness.
• But about half the time, something else — such as anxiety or depression — is the culprit, not ADHD, he said.

What we're watching: The FDA and DEA are asking drug manufacturers to ramp up production of ADHD-treating stimulants in the coming months to address the ongoing shortage.

• Meanwhile, medical organizations are developing better guidelines for how to treat ADHD in adults.