The New Amphetamine Crisis

Chronic misuse of stimulants can result in mood swings, depression, irritability, and even psychosis. A notable case involved Amy (a pseudonym) in San Antonio, Texas. She misused Adderall, experiencing hallucinations and delusions, culminating in a near-tragic incident where she almost jumped off a bridge.

Over the past five years, increases in the misuse of psychostimulants have occurred among professionals in high-pressure industries in Wall Street and Silicon Valley. These medications are used to cope with demanding workloads and extended hours.

Recent studies estimate that approximately 15.5 million adults have a current diagnosis of ADHD. Some experts argue this number reflects better awareness and screening, while others suspect overdiagnosis and ADHD-medication-seeking for performance enhancement are underlying factors.

In the March 19, 2025, issue of JAMA, National Institute on Drug Abuse researcher Beth Han and colleagues examined prevalence and patterns of prescription stimulant use, misuse, and disorders among U.S. adults. Stimulant prescriptions surged 250% from 2006-2016, while ADHD diagnoses increased only minimally. The percentage of individuals with stimulant prescriptions filled at pharmacies rose from 3.6% in 2016 to 4.1% in 2021. Yet in 2020, nearly 7% of US adults used prescription stimulants in the last year, indicating some abuse of these drugs.

Amphetamine Use and Abuse in the Twentieth Century

From the 1950s to the 1970s, amphetamines were widely prescribed for weight loss, fatigue, depression, and even as energy boosts for housewives. Kitty Dukakis, wife of Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis, revealed her struggles with amphetamine addiction in her 1991 memoir, Now You Know. (Dukakis died recently at age 88.) Physicians prescribed these drugs liberally in past years to help patients (especially women) with symptoms that today might be identified as chronic stress, depression, or anxiety. By the 1960s, millions of amphetamine prescriptions were written yearly.

Why People Abuse Stimulants and How They Obtain Them

The primary reasons today for misusing prescription stimulants are to enhance alertness or concentration (56.3%), assist with studying (21.9%) or achieve euphoria, experiment, or modify effects of other substances (15.5%).

Most individuals misusing prescription stimulants obtain them from friends or relatives for free (56.9%) or purchase or steal them from friends or relatives (21.8%). These findings underscore a need for healthcare providers to monitor not only the therapeutic use of prescription stimulants but also potential misuse. Addressing these patterns is crucial.

Professionals Using Stimulants

A 2024 report highlighted young bankers on Wall Street frequently using stimulants like Adderall and Vyvanse to manage rigorous schedules. This trend is particularly prevalent among entry-level positions where individuals work long hours and face intense performance pressure. For example, John Femenia, a former investment banker at Wells Fargo, became addicted to Adderall, which contributed to his involvement in an insider trading scheme. His case underscores the potential for prescription drug misuse to lead to impulsivity, poor judgment, and even illegal activities.

Young professionals, particularly in finance, may resort to snorting crushed Adderall pills to cope with extremely intense and demanding work schedules as long as 22 hours. A recent report outlined Wall Street’s grinding office culture that has contributed to young bankers snorting lines of crushed Adderall pills from their desks. This misuse can lead to rapid onset of effects, increasing risks for dependency, burnout, depression, and other adverse outcomes.

Some clinics and online health services provide relatively easy ADHD stimulant access, contributing to a surge in new prescriptions, especially among adults. For instance, first-time Adderall prescriptions increased 27% for individuals aged 30-44 in 2024 compared to 2021.

Most Prescribed Stimulants

The top three most commonly prescribed psychostimulants are:

1. Methylphenidate (Ritalin, Concerta, Metadate, Quillivant XR)
2. Amphetamine/Dextroamphetamine (Adderall, Adderall XR, Mydayis)
3. Lisdexamfetamine (Vyvanse)

Vyvanse (lisdexamfetamine) is among the top-selling drugs in the U.S., with 2023 sales of $2.5–3B+ annually.

Risks of Stimulant Misuse

Stimulant misuse carries major health risks, including addiction, cardiovascular (heart attacks) and cerebrovascular (strokes) problems, arrhythmias, anxiety, depression, and paranoia. A study in the Journal of Addiction Medicine highlighted that individuals misusing stimulants may exhibit higher levels of impulsivity, problems with decision-making, and risk-taking behaviors.

ADHD Essential Reads

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Shortages Raise Alarms

In 2024, the U.S. faced a scarcity of over 300+ different drugs, including ADHD medications. This shortage was attributed to several factors, but increased adult demand was at the top of the list. Prescriptions for stimulants increased 14% from 2020 to 2022, especially among young adults. Patients with validated ADHD faced challenges in accessing their prescriptions, potentially leading to unmanaged symptoms. In response, the Drug Enforcement Administration (DEA) proposed new regulations in January 2025 to establish a framework for telemedicine prescribing of controlled substances, aiming to balance access to care with prevention of misuse.

Psychostimulant production delays and supply chain disruptions also exacerbated shortages. Another factor: the pandemic-induced relaxation of telehealth regulations allowed prescribing of controlled substances without in-person evaluations. Concerns arose regarding the number of prescriptions written by some telehealth companies like Cerebral and Done Global. In October 2022, Cerebral voluntarily ceased prescribing controlled substances following scrutiny of its practices. By November 2024, the company agreed to pay $3.6+ million to resolve allegations related to business practices concerning controlled substances. In addition, Silicon Valley’s Done Global faced federal investigations for allegedly operating an Adderall “pill mill.” In June 2024, its CEO and Clinical President were arrested on charges of unlawful distribution of controlled substances and healthcare fraud. The company was accused of exploiting telemedicine flexibilities to prescribe stimulants without proper medical oversight.

Increased Diagnoses of ADHD

ADHD is a clinical diagnosis based largely on subjective reports of behavior rather than objective tests. Clinicians rightly emphasize that untreated ADHD carries real risks: academic failure, accidents, substance abuse, and unemployment.

Over the past decade, the prevalence of ADHD diagnoses among children, adolescents, and adults in the United States has increased. In 2011–2013, approximately 9.5% of U.S. children aged 4–17 years had ever been diagnosed with ADHD. Most recently, CDC data shows around 11% of U.S. children aged 4–17 were diagnosed with ADHD, and rates in adults are climbing fast.

According to Morehouse School of Medicine's Child and Adolescent Psychiatrist Sarah Vinson, M.D., “When it comes to Black youth and ADHD, it’s not as simple as underdiagnosis or overdiagnosis. The core problem is misdiagnosis. Black youth shoulder a disproportionate amount of trauma and environmental exposures that lead to symptoms overlapping with those of ADHD. Black youth are actually less likely than white youth to be diagnosed with or treated for ADHD. This is of great concern given the negative impacts ADHD can have on academic, occupational and social success.”