Wealthier adults in England are driving a sharp rise in demand for drugs used to treat a neuro-developmental condition previously associated with children, at a time when the medicines are in short supply globally.
The number of prescriptions for attention deficit hyperactivity disorder (ADHD) medications grew at twice the rate for the least deprived 20 per cent of the population as for the most deprived 20 per cent, between May 2020 and September 2023, according to a Financial Times analysis.
The NHS describes the condition as affecting people’s behaviour, which may make them seem restless, have trouble concentrating and have sleep and anxiety disorders.
Patients on lower incomes are more likely to have ADHD, but the growing strain on NHS services has meant more affluent patients, who can afford private services with shorter waiting times, are getting quicker access to diagnosis and treatment, according to health experts.
“Lengthy waits push many towards private assessment,” said Mike Smith, clinical lead of the Leeds NHS Adult ADHD service, adding that this had been partially influenced by social media platforms like TikTok, where videos tagged with #adhd have gone viral.
“The apparent uptick in ADHD service use among the less deprived could be due to their higher awareness and financial means,” he added.
Demand for ADHD treatment is rising quickly in western countries as awareness and visibility of the condition improves, particularly among groups who have previously had very low diagnosis rates.
The number of prescriptions for ADHD drugs rose three times faster in England than expected over the past three years, according to data from the NHS Business Services Authority, a public body that provides support services to the NHS.
Total orders for ADHD and central nervous system stimulant drugs increased by 60 per cent between May 2020 and September 2023, compared to expected growth of 22 per cent given historical trends.
“There’s decades of unmet demand, which everyone is trying to meet now. It’s going to be really, really hard to ever get on top of it,” said Adam Joiner, medical director at Psychiatry UK, one of the largest providers of ADHD services.
He added that the organisation has received about 10,000 referrals a month across all their services for almost a year, nearly triple the number it can process.
Global shortages of the medication and a growing backlog of referrals are squeezing treatment provision just as demand is rising. Waiting times for new patients exceeded 10 years for some NHS England services in 2023, according to a Freedom of Information request by charity ADHD UK.
Beyond Britain, demand for ADHD medications is also going up. In the US, new prescriptions for the stimulant drugs commonly used to treat the condition, such as Ritalin and Adderall, rose 14 per cent and for non-stimulant drugs by 32 per cent between 2018 and 2022, according to the Food and Drug Administration.
Research by Deloitte in Australia found ADHD affected more than 500,000 adults and cost the economy $20bn in 2019, largely driven by reduced productivity from work absences and lower economic participation.
Despite the surge in people seeking diagnoses, ADHD remains underdiagnosed in the UK, according to health experts.
About 0.5 per cent of the UK population had a positive diagnosis in 2018, according to UCL research, far below official estimates that between 3 per cent and 4 per cent of adults have ADHD.
The drugs used to treat ADHD, usually stimulants such as amphetamines, are highly effective, according to Smith, making diagnosis and treatment an “economically smart” investment.
“Effective treatment means more productive workers and less strain on healthcare, welfare and the criminal justice system,” he said.
The Department of Health and Social Care has pledged to spend £2.3bn a year to expand mental health services in England by spring 2024. A spokesperson said it was committed to reducing delays, improving access to treatment and supporting the needs of patients. NHS England declined to comment.
The National Institute for Health and Care Excellence, which is responsible for ADHD guidelines, said it kept its recommendations under review.
Some clinicians have expressed concern that guidelines covering NHS and private services do not go far enough to ensure high standards of care. Specialists have called for an overhaul of the system, including a national ADHD strategy, waiting times targets and new assessment standards, alongside increased funding.
“A lot of the money used to fund private assessments could have been used to develop existing NHS adult clinics at a greater pace,” said Ulrich Müller-Sedgwick, spokesperson for the Royal College of Psychiatrists, referring to the “Right to Choose” system, which allows NHS patients to be seen by private clinics with NHS contracts. “There is not a proper top-down strategy.”
