Not long ago, most people thought of attention deficit hyperactivity disorder, or ADHD, as a childhood condition that would eventually be outgrown. Now it’s everywhere.

TikTok videos describe “ADHD moments” that feel instantly familiar, clinics are booked out for months, and adults are finally getting diagnoses that explain years of chaos and exhaustion.

This visibility has helped people understand ADHD. However, it has also led to a shift in how medicines intended to alleviate symptoms are being used and, in some cases, misused.

What is ADHD? How does medication treat it?

ADHD affects how the brain handles attention, motivation and self-control. For some, this means racing thoughts, missed deadlines and constant restlessness. For others, it feels like a fog of distraction that makes following through on tasks frustratingly difficult.

Brain imaging studies in people with ADHD show subtle differences in how attention and reward circuits communicate. These systems rely on chemical messengers such as dopamine and noradrenaline. When the signalling of these messengers is less efficient, even simple, everyday tasks become harder to start and sustain.

Medicines such as methylphenidate (Ritalin) and lisdexamfetamine (Vyvanse) boost dopamine and noradrenaline activity in the brain, enhancing focus, motivation and impulse control.

Large clinical reviews also show wider benefits, including reduced risks of depression, substance misuse, and even criminal behaviour in people with ADHD.

How many people take ADHD medications?

Stimulant prescriptions more than quadrupled between 2013 and 2023, from about 800,000 to more than 4 million scripts per year.

More people getting diagnosed and treated is a positive step. But it also means far more medication is circulating in the community and it’s easier for these drugs to be shared, sold, or used by someone they weren’t prescribed for.

The most recent National Drug Strategy Household Survey estimates roughly 400,000 Australians – about one in 48 people – used prescription stimulants non-medically in the past year. Among those in their 20s, this figure rises to about one in 20.

Why do people without ADHD use these drugs?

Some people use stimulants to stay awake studying or working long hours.

Others use them recreationally, seeking a “high” or to suppress their appetite.

Online, they’re often touted as “smart drugs” – or cognitive enhancers – promising to enhance productivity and brainpower. This isn’t a new idea. In the 1970s, psychologist Corneliu Giurgea coined the term “nootropic” arguing “man is not going to wait passively for millions of years before evolution offers him a better brain”. But more than 50 years later, the science doesn’t support that dream.

Research shows much of the “boost” people feel from stimulants comes from expectation rather than actual improvement. In one experiment, university students who believed they had taken Ritalin reported feeling more focused and euphoric even when they had a placebo – a sugar pill with no active drug.

For those without ADHD, stimulants can make you feel more awake and confident, but they don’t actually make you smarter. A controlled trial found that while stimulants led people to work longer and try harder, the quality of their work dropped, especially for those who performed well without the drugs.

So, these medications might push you to put in more effort, but that effort doesn’t always translate into better results.

What are the risks?

Medications such as Ritalin and Vyvanse are made to strict pharmaceutical standards, so many people assume they are safer than illicit drugs.

But their safety depends entirely on careful medical supervision, including appropriate dosing and regular health monitoring. Without this oversight, and when mixed with alcohol and other substances, risks increase sharply.

When people misuse these drugs – taking higher or more frequent doses – they risk developing a tolerance, meaning they need increasingly larger amounts to feel the same effects.

The high also wears off sharply, leading to a “crash” of fatigue, irritability and low mood, which can push people to take more.

Over time, this cycle may trigger anxiety, insomnia and heart problems.

Reflecting this, a study of emergency department presentations for stimulant-related problems from 2004 to 2014 found visits rose alongside greater availability.

How are these medications controlled?

In Australia, ADHD stimulants are Schedule 8 controlled drugs, meaning their prescribing is tightly regulated, however rules differ by state and territory.

New national ADHD guidelines recommend more consistent oversight, shared care between specialists and GPs, and better follow-up to reduce misuse and diversion.

Policy is evolving, but harm reduction hasn’t yet caught up. Compared with alcohol, tobacco or cannabis, public education on prescription stimulant misuse remains minimal.

Australia’s history offers a cautionary tale about responding to the misuse of prescription medications. When opioid and benzodiazepine prescribing surged in previous decades, supply restrictions alone failed to curb misuse.

Instead, people turned to black markets and unregulated online sources, where counterfeit and high-potency products fill the gap.

If stimulant policy follows a similar path – focusing on control but neglecting prevention and education – we risk repeating those mistakes.

In the United States, rising stimulant prescriptions have been accompanied by sharp increases in misuse and stimulant use disorder – the clinical term for addiction.

In response, health agencies adopted more balanced approaches – integrating prescription drug monitoring programs, clinician training on safer prescribing and community-based education campaigns.

As awareness and diagnosis of ADHD continue to rise in Australia, adopting these measures – including real-time prescription monitoring – could reduce harms while preserving access for those who genuinely need treatment.

Blair Aitken, Postdoctoral Research Fellow in Psychopharmacology, Swinburne University of Technology and Amie Hayley, Rebecca L. Cooper Al & Val Rosenstrauss Fellow and Senior Research Fellow, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.