Background: Chronic cannabis use can present with cognitive impairments that resemble ADHD. Our objective was to determine if medical cannabis (MC) legalization increased prescription stimulant distribution. Methods: We extracted distribution of methylphenidate, amphetamine, and lisdexamfetamine from the comprehensive database published by the Drug Enforcement Administration for 2006 to 2021 and compared the three-year population-corrected slopes of stimulant distribution before and after MC program implementation. Results: We found a very large main effect of time (p<0.001), but, contrary to the hypothesis not MC sales status, on slopes of distribution (p=0.391). There was a significant and large interaction effect of time and MC sales status on slopes of distribution (p<0.001). Discussion: These findings suggest that medical cannabis program legalization may have contributed to some states having more rapid increases in Schedule II stimulant distribution rates over time.

Introduction: Paroxetine is an older selective serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in a cholinergic adverse-effect profile, especially among older adults (65+). Methods: Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. Annual prescription rates, corrected per thousand Part D enrollees, of states outside 95% confidence interval were considered significantly different from the average. Results: There was a steady decrease in paroxetine prescriptions (-34.52%) and spending (-16.69%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequent elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the largest amount of paroxetine prescriptions, relative to the number of providers in that specialty, from 2015-2020. Discussion: Despite the American Geriatrics Society prohibition against paroxetine use in the older adults and many effective treatment alternatives, paroxetine was still commonly used in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.

Introduction: Citalopram and escitalopram are among the most used medications and are key treatments for many psychiatric disorders. Previous findings suggest citalopram and escitalopram prescription rates are changing because of the patent for citalopram ending as opposed to evidence of a clear therapeutic advantage, which is called evergreening. This retrospective study focuses on characterizing the chronologic and geographic variation in the use of citalopram and escitalopram among US Medicaid and Medicare patients. We hypothesized that prescription rates of citalopram will decrease with a concurrent increase in escitalopram, consistent with evergreening. Methods: Citalopram and escitalopram prescription rates and costs per state were obtained from the Medicaid State Drug Utilization Database and Medicare Provider Utilization and Payment Data. Annual prescription rates outside a 95% confidence interval were considered significantly different from the average. Results: Overall, a decreasing trend for citalopram and an increasing trend for escitalopram prescription rates were noted in both Medicare and Medicaid patients. Cost differences between generic and brand were noted for both drugs, with generic forms being cheaper compared to the brand version. Discussion: Despite limited evidence suggesting that citalopram and escitalopram have any meaningful differences in therapeutic or adverse effects, there exists a noticeable decline in the use of citalopram that cooccurred with an increase in escitalopram prescribing, consistent with our hypothesis. Moreover, among these general pharmacoepidemiologic trends exists significant geographic variability. There was disproportionate spending (relative to their use) on the brand versions of these medicines compared to their generic forms.

Objective: The objectives of this report were to characterize the regional and state differences in prescription methamphetamine and amphetamine distribution in the US. Methods: Prescription methamphetamine and amphetamine distribution was obtained from the Drug Enforcement Administration for 2019. Results: Total per capita drug weight distribution of amphetamine was 4,000 times higher than methamphetamine. Regionally, total per capita drug weight for methamphetamine was highest in the West (32.2% of total distribution) and lowest in the Northeast (17.4%). The total per capita drug weight for amphetamine was highest in the South (37.0% of total distribution) and lowest in the Northeast (19.4%). Distribution of methamphetamine was 16.1% while amphetamine was 54.0% of its production quota. Conclusion: Overall, prescription amphetamine distribution was common while prescription methamphetamine distribution was rare. The patterns observed in distribution are likely the result of stigmatization, differences in accessibility, and the efforts of initiatives such as the Montana Meth Project.

Introduction: Methamphetamine is a highly addictive psychostimulant and controlled substance that has detrimental health consequences for chronic users. Amphetamine is a structurally-related stimulant commonly used to treat ADHD, however, it also has a high risk for substance misuse. The objectives of this report were to characterize the regional differences in prescription methamphetamine and amphetamine distribution in the US, and examine potential reasons for variations in distribution. Methods: Data for prescription methamphetamine and amphetamine distribution was obtained from the US Drug Enforcement Administrations Automation of Reports and Consolidated Orders System (ARCOS) Retail Drug Summary Report for 2019. Quarterly, state, and regional differences in distributions of the two controlled substances were analyzed and. Results: The preponderance (97%) of retail drug distribution for both drugs in 2019 were made through pharmacies. In the same year, prescription methamphetamine (+6.8%) and amphetamine (+5.8%) saw increases in drug distribution from Quarter 1 to Quarter 4.. Across the entire US, total per capita drug weight distribution of amphetamine was exactly 4,000 times higher than methamphetamine. Regionally, total per capita drug weight for methamphetamine was highest in the West (32.2% of total distribution) and lowest in the Northeast (17.4%). The total per capita drug weight for amphetamine was highest in the South (37.0% of total distribution) and lowest in the Northeast (19.4%). The ratio between the 90th and 10th percentiles of per capita drug weight by state was 4.39 for methamphetamine and 2.45 for amphetamine. Distribution of methamphetamine only measured 16.1% of its production quota, while distribution of amphetamine measured 54.0% of its production quota. Discussion: Overall, prescription amphetamine distribution was common while prescription methamphetamine distribution was rare. Regional disparities were also present with lowest distribution of both substances in the Northeast region. The patterns observed in distribution are likely the result of stigmatization, differences in accessibility, and the efforts of initiatives such as the Montana Meth Project. This cycle will likely also change in response to physician recommendation and public opinions surrounding issues for pharmacotherapies for ADHD management.