Sultan Lab for Mental Health Informatics

ADHD Stimulant Prescribing Patterns: National IQVIA Analysis

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurobehavioral disorder in childhood, affecting an estimated 5-10% of children and adolescents in the United States, with a growing recognition of its persistence into adulthood. Stimulant medications -- amphetamines and methylphenidate -- remain the cornerstone of evidence-based ADHD pharmacotherapy, with effect sizes approaching 1.0 for symptom reduction. Yet how these medications are prescribed in practice, who receives them, and whether prescribing patterns align with clinical guidelines remain critically important questions for public health.

The Sultan Lab for Mental Health Informatics at Columbia University Irving Medical Center is conducting a comprehensive national analysis of stimulant prescribing trends using the IQVIA longitudinal prescription database. This project, led by Dr. Ryan Sultan in collaboration with investigators at Rutgers University, represents one of the most thorough examinations of how stimulant prescribing has evolved across the United States over a nine-year period that spans pre-pandemic, pandemic, and post-pandemic eras.

Why Stimulant Prescribing Patterns Matter

The landscape of ADHD treatment in the United States has undergone dramatic transformation. Between the pre-COVID era and the present, multiple forces have reshaped who receives stimulant medication, how it is prescribed, and by whom. Understanding these shifts is essential for several reasons.

The COVID-19 Inflection Point

The COVID-19 pandemic fundamentally altered ADHD diagnosis and treatment delivery. Lockdowns and disruptions to school and work schedules exacerbated ADHD symptoms and inhibited coping strategies that many individuals relied upon. Simultaneously, the use of telehealth services expanded rapidly, including specifically for the initiation of stimulant medication. This expansion was made possible when the Drug Enforcement Administration relaxed requirements for an in-person visit to prescribe Schedule II controlled substances during the public health emergency.

These changes in mental health care delivery were largely beneficial, lowering treatment barriers such as stigma and facilitating access to care in under-resourced areas and populations. However, multiple telehealth companies emerged during this period focused on providing remote assessment and treatment of ADHD, and several of these services have since come under clinical and legal scrutiny based on concerns that their practices led to overprescribing of stimulants.

Demographic Shifts in ADHD Treatment

Historical data reveals that ADHD diagnosis and treatment have concentrated among young males. Over the past two decades, however, clinical understanding of ADHD has evolved into a broader, more inclusive construct that spans the lifespan. This shift is reflected in updated diagnostic criteria and increased awareness among clinicians and the public. Many individuals who would have been overlooked in previous eras -- including greater numbers of adults and females -- are now being diagnosed with ADHD and receiving medication.

Whether these demographic shifts represent appropriate correction of historical undertreatment or potentially concerning expansion of stimulant use is a central question that the IQVIA analysis aims to address.

The IQVIA Database: Scope and Coverage

The IQVIA longitudinal prescription database captures dispensed prescription data from the vast majority of U.S. retail pharmacies. Unlike claims databases that are limited to specific insurance populations, IQVIA provides all-payer data, meaning it captures prescriptions regardless of whether patients are covered by commercial insurance, Medicaid, Medicare, or pay out of pocket. This comprehensive coverage makes it uniquely suited for examining national prescribing trends.

Previous Sultan Lab studies have utilized other large-scale databases, including the MarketScan Commercial Claims database and Medicaid claims data, to examine ADHD treatment patterns. The IQVIA analysis extends this work by providing the broadest possible view of actual dispensed stimulant prescriptions at a national level.

Study Design and Methodology

Research Aims

The study, titled "Trends and Characteristics of Incident Stimulant Prescriptions in the U.S. from 2016-2024," has three primary aims:

Study Population

The study focuses on incident (new) stimulant prescriptions, defined as a new fill for amphetamine or methylphenidate following a one-year washout period with no prior stimulant fills. This new-user design is a methodological strength: by focusing on treatment initiation rather than prevalent use, the study can characterize the clinical context and prescriber behavior at the point of medication initiation, when prescribing decisions are most consequential.

Key Measures

For each incident stimulant prescription, the study captures:

• Drug class: Amphetamine-based (e.g., Adderall, Vyvanse) versus methylphenidate-based (e.g., Ritalin, Concerta)
• Formulation: Immediate-release (IR) versus extended-release (ER) -- a clinically important distinction, as IR formulations carry higher diversion and misuse potential
• Dosage ranges: Low (15 mg or less), moderate (greater than 15 mg to 30 mg), and high (greater than 30 mg)
• Supply duration: Less than 30 days, 30 days, or more than 30 days
• Prescriber specialty: Psychiatry, pediatrics, primary care, advanced practice providers, and other specialties
• Payer type: Commercial insurance, Medicaid, Medicare, cash pay

Hypotheses and Expected Findings

Based on preliminary data analysis and existing literature, the research team hypothesizes:

Preliminary Observations from IQVIA Data

Initial analyses of the IQVIA data have generated descriptive statistics on total stimulant fills stratified by sex and age group across the study period. These analyses reveal shifts in the demographic composition of stimulant recipients, with an increasing proportion of fills going to females and to adults rather than children and adolescents. The data also show changes in prescribing rates by provider specialty over time, a trend that may reflect the growing role of non-psychiatrist prescribers, including those operating through telehealth platforms.

Connection to Sultan Lab ADHD Research Program

The IQVIA prescribing analysis is part of a broader program of ADHD research within the Sultan Lab that spans multiple databases and research questions.

JAMA Network Open 2019: Antipsychotic Overprescribing in ADHD

Dr. Sultan's landmark 2019 study in JAMA Network Open, which has been cited over 411 times, revealed that among 187,563 youth with new ADHD diagnoses, 2.6% were prescribed antipsychotic medications in the first year. Critically, only 52.7% of these youth had an FDA-approved or evidence-supported indication for antipsychotic use, and less than half had received stimulant medication before initiating antipsychotic treatment. This study established a foundation for understanding how ADHD medications are prescribed in community practice -- and how often prescribing departs from evidence-based guidelines.

JAMA Psychiatry 2025: Protective Effects Under Scrutiny

In a 2025 editorial published in JAMA Psychiatry, Dr. Sultan and colleagues (Veenstra-VanderWeele, Saunders) examined a large Swedish study of 247,420 individuals with ADHD that found ADHD medication was associated with 30-50% lower rates of self-harm, accidental injuries, traffic accidents, and criminal arrests. However, as ADHD prescribing expanded in Sweden -- threefold in children and more than fivefold in adults between 2006 and 2020 -- the protective association between medication and these adverse outcomes attenuated. Dr. Sultan argued that broader prescribing may be reaching individuals with milder impairments who were less likely to experience these extreme outcomes in the first place, a finding directly relevant to interpreting the IQVIA trend data.

MarketScan ADHD Females Study

The Sultan Lab is also conducting a parallel analysis using the MarketScan commercial claims database to examine ADHD diagnosis and substance use patterns specifically in females -- a population where ADHD has been historically underrecognized. The IQVIA study provides the prescribing-level complement to this work by showing how stimulant receipt has changed among females over time.

Policy Implications

The findings from this study carry significant implications for clinical practice, regulatory policy, and public health.

Telehealth and Prescribing Quality

The rapid expansion of telehealth for ADHD assessment and stimulant prescribing during the COVID-19 pandemic raised legitimate questions about whether remote evaluation can adequately assess ADHD symptoms and rule out alternative explanations. Several telehealth ADHD companies have faced scrutiny for abbreviated assessments and high prescribing rates. The IQVIA data can help quantify whether telehealth-era prescribing patterns differ meaningfully from those seen in traditional clinical settings -- and whether any differences have persisted after the public health emergency ended.

DEA Scheduling and Access

Stimulant medications are classified as Schedule II controlled substances, subject to strict prescribing regulations including limits on refills and, historically, requirements for in-person evaluation. The pandemic-era relaxation of these requirements demonstrated that telehealth prescribing could expand access to care, but ongoing debates about whether to make these flexibilities permanent require evidence about prescribing quality. The IQVIA analysis provides the empirical foundation for these policy discussions.

Addressing Diagnostic Expansion

As ADHD diagnoses have expanded to include more adults, more females, and individuals with predominantly inattentive presentations, stimulant prescribing has followed. Whether this expansion represents appropriate treatment of a historically underdiagnosed condition or reflects diagnostic creep and supply-induced demand is a question with major implications for clinical training, insurance coverage, and public health surveillance.

Research Team

Frequently Asked Questions

What is the IQVIA database and why is it used for stimulant prescribing research?

The IQVIA database is a longitudinal prescription database that captures dispensed prescription data from approximately 90% of U.S. retail pharmacies, representing over 56 million patients. It provides de-identified, all-payer prescription data that allows researchers to track national trends in medication prescribing without requiring individual patient consent. The Sultan Lab uses IQVIA because it offers the most comprehensive view of actual dispensed stimulant prescriptions across the United States, including data on drug type, dosage, formulation, prescriber specialty, and payer type.

How has stimulant prescribing changed since the COVID-19 pandemic?

Stimulant prescribing increased substantially during the COVID-19 pandemic, driven by multiple factors: lockdowns exacerbated ADHD symptoms, telehealth services expanded rapidly, and DEA requirements for in-person visits to prescribe Schedule II medications were relaxed during the public health emergency. The Sultan Lab's IQVIA analysis examines whether prescribing patterns have normalized since the end of the public health emergency in March 2023, and whether post-pandemic prescribing reflects higher-risk characteristics such as higher dosages, longer durations, or shifts in prescriber type.

Are there demographic disparities in ADHD stimulant prescribing?

Yes, significant demographic disparities exist. The IQVIA analysis examines how stimulant prescribing varies by sex, age group, geographic region, and payer type. Recent trends show the largest increases in stimulant prescribing among young-to-middle adults and females, groups that were historically underdiagnosed and undertreated for ADHD. This demographic shift raises important questions about whether new prescribing reflects appropriate correction of historical undertreatment or potentially inappropriate expansion of stimulant use.

How does the IQVIA prescribing study connect to Dr. Sultan's other ADHD research?

The IQVIA prescribing study builds directly on Dr. Sultan's landmark 2019 JAMA Network Open study, which found that only about half of youth with ADHD who were prescribed antipsychotics had received stimulant medication first. It also connects to his 2025 JAMA Psychiatry editorial examining how protective effects of ADHD medications on real-world outcomes may attenuate as prescribing broadens to include individuals with milder impairment. Together, these studies form a comprehensive picture of how ADHD medications are prescribed in the United States and what the consequences of those patterns are.

Related Resources

• Sultan Lab for Mental Health Informatics - Full lab overview
• Research Overview - All active research projects
• ADHD Medications Guide - Clinical medication information
• Comprehensive ADHD Guide - Evidence-based ADHD resource
• ADHD in Females Study - MarketScan analysis of ADHD and substance use in females
• Complete Publication List - Peer-reviewed research
• Research Grants & Funding - Grant methodologies