Patterns of prescription stimulant initiation before and during the COVID-19 pandemic: a population-based time series analysis

Background — Some jurisdictions reported increased stimulant prescribing during the COVID-19 pandemic. We sought to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and during the pandemic.

Methods — We used population health administrative data to identify monthly rates of incident stimulant dispensations to adults in Ontario, Canada, between January 2016 and June 2024. We conducted an interrupted time-series analysis using piecewise regression to assess the immediate and sustained impact of the COVID-19 pandemic on stimulant dispensing rates.

Results — Among 327 053 adults who initiated stimulants, the median age was 31 years and 55.4% were female. Compared with before the COVID-19 pandemic, new recipients during the pandemic were more likely to be aged 25 to 34 years (26.5% v. 32.8%) and female (48.0% v. 59.0%), while stimulants were less likely to be initiated by psychiatrists (25.5% v. 18.0%). The rate of new stimulant dispensations was stable before the COVID-19 pandemic (change in monthly rate per 1000 people 0.0004, 95% confidence interval [CI] −0.0001 to 0.0009), declined immediately at the start of the pandemic (−0.067, 95% CI −0.092 to −0.043), and accelerated thereafter (0.0029, 95% CI 0.0018 to 0.004), rising from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024. Results were consistent when stratified by age, trends and were generally higher during the pandemic among females than males.

Interpretation — In Ontario, rates of new prescriptions for stimulants dispensed to adults accelerated rapidly during the COVID-19 pandemic. Monitoring and evaluation are needed to ensure appropriateness of use and safeguard against potential harms.