Amphetamine Aspartate/Amphetamine Sulfate/Dextroamphetamine Saccharate/Dextroamphetamine Sulfate

(This story is from our new Health Tech newsletter. If you’d like to sign up, just click here .) Stimulants prescribed during telehealth visits rose dramatically during the Covid-19 pandemic, when relaxed US regulations made it easier for patients to get the controlled substances online, a new study found. Between 2019 and 2022, total stimulant prescriptions grew 37.5%, and the share that came from a telehealth visit rose from 1.4% in 2019 to 38.1% in 2022, according to a research letter published Friday in JAMA Network Open . There’s a big caveat to the study — and it suggests that the sharp rise might actually be an undercount. Researchers from UCLA and analytics company Trilliant Health analyzed nationwide pharmacy fills associated with a medical visit filed through insurance. But any prescriptions written by direct-to-consumer companies or those paid out of pocket weren’t represented, and those businesses boomed during that period. The data suggest that online prescriptions were a huge part of the increase. Prescriptions dispensed over the internet made up more than half — about 52% — of all stimulant prescriptions in the second quarter of 2020. Stimulants such as Adderall are commonly used to treat ADHD. Previous studies have also shown that stimulant prescriptions increased during the pandemic. Federal law typically requires that patients have an initial in-person evaluation before they’re prescribed a controlled substance online, but that rule was temporarily suspended during the public health emergency, opening the door for more telehealth prescriptions. Some startups like Cerebral and Done Global capitalized on that flexibility to prescribe stimulants online. The DOJ in June said it had charged Done executives peddling easy access to stimulants , at times when they weren’t medically necessary. Done did not immediately respond to a request for comment. Those prescribing flexibilities are set to expire at the end of 2024, and hundreds of organizations have urged the federal government to extend them, arguing that millions of patients are poised to lose access to critical treatments. The study in JAMA also looked at other types of drugs. It found that prescriptions for antidepressants grew 20.9% during the study period. The share from a telehealth visit grew from 1.5% in 2019 to 31.4% in 2022. Total opioid prescriptions decreased 17.2% during the period, with the proportion from a telehealth visit rising from 0% in 2019 to 24.1% in the second quarter of 2020, and then dropping to 8.4% in 2022. For each category of drugs, nearly all telehealth prescriptions were for individuals in non-rural areas.

THURSDAY, Sept. 12, 2024 -- Prescriptions for amphetamine stimulants to treat ADHD have increased significantly in recent years, particularly during the pandemic. Unfortunately, high doses of stimulants like Adderall can increase the risk of psychosis or mania by more than fivefold, a new study finds. Patients had a nearly 63% increased risk of psychosis or mania if they took any prescription amphetamine within the past month, researchers reported Sept. 12 in the American Journal of Psychiatry . Those on heavy doses of amphetamines were at even greater peril of a psychotic episode, with an 81% increased risk, results show. The highest risk occurred in patients taking 30 milligrams or more of dextroamphetamine, which corresponds to 40 milligrams of Adderall, the study says. “Stimulant medications don’t have an upper dose limit on their labels, and our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants,” said lead investigator Dr. Lauren Moran , a pharmacoepidemiology researcher at McLean Hospital in Belmont, Mass. “This is a rare but serious side effect that should be monitored by both patients and their doctors whenever these medications are prescribed,” Moran added. Moran said she pursued this study based on her experiences as an inpatient psychiatrist. She and her Mclean colleagues would regularly see patients experiencing their first episode of psychosis. Medical records would reveal the patients had been prescribed high doses of stimulants by their doctors. For the study, researchers analyzed data on nearly 1,400 patients admitted to Mass General Brigham Hospital between 2005 and 2019 who were in the throes of their first episode of psychosis or mania. They compared those patients against more than 2,700 people hospitalized for other psychiatric conditions like depression or anxiety. They found that people taking amphetamines had a higher risk of psychosis and mania, and that the risk was greatest with heavy doses. This link could be explained by the fact that amphetamines prompt the release of dopamine, a brain hormone also implicated in psychosis, researchers said. People taking amphetamines for ADHD shouldn’t be alarmed, Moran said, but they might want to talk with their doctor about the dosage they’ve been prescribed. There also are alternative drugs to treat ADHD that don’t increase mental health risk. For example, this study found no increased risk of psychosis or mania in prescriptions for methylphenidate (Ritalin), Moran noted. “There’s limited evidence that prescription amphetamines are more effective in high doses,” Moran said in a Mass General Brigham news release. “Physicians should consider other medications our study found to be less risky, especially if a patient is at high risk for psychosis or mania.” Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.