Annually, the National Drug and Alcohol Research Centre at UNSW Sydney surveys hundreds of individuals who frequently use drugs in Australia to track trends in substance use nationwide. The 2024 report, released today, surveyed 740 individuals from Australian capital cities who regularly use ecstasy or other illegal stimulants. While this research primarily focuses on illegal drugs and markets, it also observes trends in the non-prescribed use of pharmaceutical stimulants, like ADHD medications. This year, 54% of respondents reported using non-prescribed pharmaceutical stimulants in the past six months, the highest percentage recorded since the question was first posed in 2007.
Pharmaceutical stimulants include drugs like methylphenidate (marketed as Concerta and Ritalin), dexamphetamine, and lisdexamfetamine (Vyvanse), which are typically used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy, a neurological disorder causing excessive daytime sleepiness and sudden sleep attacks. These medications operate differently depending on the type but generally treat ADHD by increasing key neurotransmitter levels in the brain, such as dopamine and noradrenaline. However, people often use these stimulants non-prescribed for various reasons. Studies indicate university students frequently use them to enhance alertness, concentration, and memory, while broader population studies suggest reasons like experimentation or recreation.
Globally, including in Australia, prescriptions for ADHD medications have risen recently, likely due to better ADHD identification and diagnosis. As prescriptions increase, the likelihood of these drugs entering illegal markets rises. Non-prescribed use of pharmaceutical stimulants has tripled since monitoring began, from 17% of surveyed individuals in 2007 to 54% in 2024, remaining similarly high in recent years (52% in 2022 and 47% in 2023). Usage frequency remains low, with respondents typically using them monthly or less frequently. Survey participants most frequently reported using dexamphetamine, followed by methylphenidate and lisdexamfetamine, with 79% saying it was “easy” or “very easy” to access these drugs—similar to findings in 2022 and 2023.
Since the research targets regular drug users, non-prescribed pharmaceutical stimulant use does not reflect the general population. The 2022–23 National Drug Strategy Household Survey, a general population survey of Australians aged 14 and older, revealed 2.1% (about 400,000 people) reported non-medical use of these stimulants in the past year—comparable to ecstasy use. Pharmaceutical stimulants are seen to have a relatively safe toxicity profile. However, like all stimulants, they activate the sympathetic nervous system, increasing heart rate, blood pressure, and breathing rate, which can cause acute cardiac issues (like irregular heartbeat) and chronic heart changes with repeated high-dose use.
Recent Australian studies have noted an increase in poisonings involving these substances, with many cases seemingly intentional. When poisoning involved only pharmaceutical stimulants, drugs were primarily ingested orally at median doses over ten times typical prescriptions, causing symptoms like high blood pressure, increased heart rate, and agitation. In our survey, participants usually swallowed these stimulants in tablet form at slightly higher than typical prescribed doses, but about one in four chose snorting. Snorting can harm the sinuses and increase drug risks since it acts more quickly in the body.
Some pharmaceutical stimulants are “long-acting,” gradually releasing into the body over a day. There is a risk of unintended re-dosing if these formulations are unknowingly used more than once daily. If desired effects aren’t felt in the expected timeframe, additional doses may be taken, increasing adverse effects risk. Non-prescribed stimulant use can have side effects when combined with other drugs, such as masking alcohol intoxication signs. These stimulants are crucial for ADHD and narcolepsy treatment and are generally safe when prescribed. Nonetheless, non-prescriptive use adds risks. Campaigns addressing these risks, including differences among formulations, could be beneficial. Ongoing monitoring and deeper research into related harms are essential.