ADHD medication misuse and addiction risk: what the evidence shows

Stimulant medications for ADHD are controlled substances, and their FDA labels open with a warning about abuse, misuse and addiction. Many adults hesitate to start treatment because of that warning, and many others worry about it after they start. This page sets out what the label actually says, what large studies of people with ADHD have found, and what you and a prescriber can do to keep the risk low. It contains no dosing information and is not a substitute for advice from your own prescriber.

What the FDA boxed warning says

In May 2023 the FDA required a consistent boxed warning, its most prominent type of warning, across every prescription stimulant. The agency said the change was meant to address continuing concerns about misuse, abuse, addiction and overdose, and to make the information consistent across the whole class.

The current Adderall XR label is a typical example. It states that the medication has a high potential for abuse and misuse, which can lead to a substance use disorder, including addiction. It adds that misuse and abuse can result in overdose and death, and that the risk is higher with higher doses or with unapproved ways of taking it, such as snorting or injecting. The same warning appears on the Concerta and Vyvanse labels.

The warning also tells prescribers what to do:

• assess each patient's risk for abuse, misuse and addiction before prescribing
• teach patients about these risks, proper storage and disposal of unused medication
• reassess the risk throughout treatment and monitor for signs of misuse and addiction

Misuse, abuse and addiction are not the same thing

Stimulant labels define the terms, and the difference matters when you talk with a prescriber.

• Misuse is using a drug for a therapeutic purpose in a way other than prescribed, or using medication that was prescribed for someone else. Taking an extra tablet before a deadline counts.
• Abuse is non-therapeutic use, even once, to get a desired psychological or physical effect.
• Addiction is a cluster of behaviors and symptoms, such as a strong desire to take the drug, trouble controlling use and continuing despite harm.
• Physical dependence and tolerance are body adaptations that can happen with repeated use. The labels list them separately from addiction. Withdrawal is covered in stopping ADHD medication, and tolerance in tolerance and wearing off.

Does treating ADHD raise the risk of substance problems?

This is the question most people are really asking, and the strongest available evidence comes from large observational studies. Their results point the same way.

• US insurance claims, 2005 to 2014. A study of nearly 3 million adolescents and adults with ADHD compared each person with themselves over time. In months when they received ADHD medication, men had 35% lower odds and women 31% lower odds of an emergency visit related to substance use than in months without medication (Quinn and colleagues, 2017).
• Swedish national registers. Among 38,753 people with ADHD, those prescribed stimulant medication in 2006 had a 31% lower rate of substance abuse in 2009, and longer treatment was linked with lower rates (Chang and colleagues, 2014).
• A 2013 meta-analysis. Pooling 15 studies of people treated with stimulants in childhood, researchers found that treatment neither protected against nor increased the risk of later substance use disorders.

These studies cannot prove cause and effect, and they describe groups, not individuals. What they do not show is a general increase in substance problems among people treated for ADHD. The Swedish authors added that clinicians should still stay alert to misuse and diversion. The NY guide's page on ADHD and substance use covers the overlap between the two conditions.

How common is misuse among adults with prescriptions?

Misuse is more common than many people assume. A 2025 analysis of national survey data from 2021 and 2022, led by researchers at the National Institute on Drug Abuse, found that among adults aged 18 to 64 who used prescription stimulants in the past year:

The authors concluded that screening for use disorder matters for all adults prescribed stimulants, especially those taking amphetamines. An earlier national analysis found that the most common reason adults gave for misuse was to stay alert or concentrate (56.3%), and that friends or relatives were the most common source of misused stimulants (56.9%).

Diversion: the requests you may get

The FDA's 2023 communication says most people who misuse prescription stimulants get them from family members or peers, and that people with prescriptions are often asked to share. It notes that as many as half of young people with valid prescriptions are approached to sell or give away their medication. A 2008 systematic review found that 16% to 29% of students with stimulant prescriptions had been asked to give, sell or trade them.

Sharing is also a crime in New York and New Jersey. See New York law on sharing ADHD medication and New Jersey law on sharing ADHD medication.

What prescribers check, and why

Monitoring is built into the law in New York and New Jersey, not just into the label.

• New York. Before prescribing a controlled substance, a practitioner must check the state Prescription Monitoring Program Registry (10 NYCRR 80.63), and Schedule II prescriptions cannot be refilled (10 NYCRR 80.67). Details are in ADHD medication rules in New York.
• New Jersey. Before starting a controlled substance, prescribers take a history, examine the patient, try to obtain records, check the New Jersey Prescription Monitoring Program and write a treatment plan (N.J.A.C. 13:35-7.6). See ADHD medication rules in New Jersey.

The FDA also tells prescribers to watch for requests to renew more often than the prescribed amount would require. UK guidance from NICE lists a risk assessment for substance misuse and drug diversion as part of the assessment before any ADHD medication is started. None of this is an accusation. It is a standard part of safe prescribing.

Signs worth raising with your prescriber

Stimulant labels list effects seen with misuse and abuse, including a fast heart rate, raised blood pressure, sweating, dilated pupils, restlessness, insomnia, poor appetite, tremor and vomiting. Anxiety, psychosis, hostility and aggression have also been observed. Tell your prescriber promptly if you notice any of these patterns:

• taking more than prescribed, or taking it more often
• running out before the next prescription is due
• using it to stay awake for long stretches or to feel high
• crushing, snorting or injecting it
• combining it with alcohol or other drugs. The FDA warns this could increase the risk of overdose and death
• a strong urge to take it that is hard to control

Saying this out loud is the safest thing you can do. A prescriber can only adjust the plan if they know. Mixing medication with drinking is covered in ADHD medication and alcohol.

If you have a history of substance use

A past or current substance use problem is something to tell the prescriber during the evaluation, not something to hide. It shapes the choice of medication and the monitoring plan. Not all ADHD medications are controlled substances. The Strattera (atomoxetine) label states that atomoxetine is not a controlled substance and that, in an adult abuse-potential study, it was not associated with stimulant or euphoriant effects. Whether any option fits you is a decision for you and your prescriber. The differences between classes are set out in stimulant vs nonstimulant ADHD medication.

Storage and disposal

Stimulant labels tell prescribers to advise patients to store the medication in a safe place, preferably locked, and never to give it to anyone else. For leftover medication, the FDA recommends drug take-back options first, and gives instructions for disposal at home when take-back is not available.

When to get help now

• Emergency. Call 911 for chest pain, fainting, a seizure, very high body temperature, severe confusion or suspected overdose. The labels describe overdose effects that include dangerous heart rhythms, hallucinations, seizures and life-threatening high body temperature.
• Crisis. Call or text 988 at any hour for thoughts of suicide or a mental health crisis.
• Substance use help. SAMHSA's National Helpline (1-800-662-4357) is free, confidential and open 24/7. In New York, the OASAS HOPEline is 1-877-8-HOPENY, or text HOPENY (467369). In New Jersey, ReachNJ is 1-844-732-2465.

Dr. Shershow is a psychiatrist licensed in New York and New Jersey who focuses on adult ADHD and provides medication management when medication is appropriate. Learn more about adult ADHD treatment, or contact the office with questions.