ADHD Prescription Trends in Scotland

Scotland has experienced a significant surge in Attention Deficit Hyperactivity Disorder (ADHD) diagnoses over the past decade, affecting both adult and youth populations.

Increasing Numbers Tell the Story:

Dramatic Growth: NHS data reveals a steep upward trajectory. Precise comparisons to early data can be tricky due to changes in the way diagnoses are reported
Adult Referrals for ADHD assessments have soared and overwhelming specialist services
Continued Rise in Young People: Diagnoses in children and adolescents also continue to climb, though the rate of increase in referrals for this group has been even more dramatic. Greater awareness among parents, teachers, and GPs means more young people are being identified and referred for assessment

Absolute data on diagnosed patient numbers is not generally available. However, data on prescriptions is accurate and readily available and thus makes an excellent surrogate to track the increase on ADHD diagnosis.

For an overview of the background behind this surge in ADHD diagnosis see The Surge in ADHD Diagnosis on this website.

Prescription Data Analysis

This analysis examines prescription data spanning nine years, encompassing five primary therapeutic agents: methylphenidate, lisdexamfetamine, atomoxetine, dexamfetamine, and guanfacine. The data provides unprecedented insight into prescribing trends, cost implications, and the evolution of clinical practice in ADHD management.

Key Findings

Analysis of Scottish ADHD prescription data from January 2016 to February 2025 reveals significant shifts in prescribing patterns, with total monthly prescriptions increasing by 190% and costs rising by 180%. This comprehensive review examines the evolving landscape of ADHD pharmacotherapy, highlighting the emergence of newer therapeutic options and their impact on clinical practice and healthcare economics.

ADHD prescriptions in Scotland demonstrated remarkable growth over the study period:

Total monthly prescriptions: Increased from 9,397 (January 2016) to 27,241 (February 2025) See Figure 1.
Monthly costs: Rose from £465,753 to £1,313,553

This growth trajectory indicates both increased diagnosis rates and expanded treatment accessibility, reflecting improved awareness and clinical guideline evolution.

Figure 1: Monthly Prescriptions for ADHD Drugs in Scotland
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Drug-Specific Trends

See Figure 2 (prescription numbers) and Figure 3 (prescription costs)

Methylphenidate
Methylphenidate maintained its position as the cornerstone of ADHD treatment throughout the study period:

Market dominance: Consistently represented 60-75% of total prescriptions
Volume growth: Monthly prescriptions increased from 7,404 to 16,108 (117% increase)
Cost efficiency: Demonstrated the most favourable cost-per-prescription ratio
Stability: Showed consistent prescribing patterns with minimal seasonal variation

Lisdexamfetamine
Lisdexamfetamine exhibited the most dramatic growth trajectory:

Exponential increase: Monthly prescriptions rose from 786 to 6,868 (774% increase)
Market penetration: Grew from 13% to 37.% of total market share by value
Cost implications: Higher per-prescription costs contributed significantly to overall expenditure growth
Clinical acceptance: Rapid adoption suggests strong clinical efficacy and tolerability profile

Atomoxetine
Atomoxetine demonstrated a complex prescribing pattern with notable phases:

Initial stability (2016-2021): Maintained consistent prescription volumes around 1,000 monthly rising to 1,500
Mid-period decline (2021-2023): Significant reduction likely due to patent expiry and generic competition
Recent recovery (2023-2025): Resurgence suggesting renewed clinical interest or formulation improvements

Dexamfetamine
Dexamfetamine showed consistent, moderate growth:

Steady increase: Monthly prescriptions grew from 268 to 1,079 (303% increase)
Niche positioning: Maintained approximately 4-8% market share
Cost considerations: Demonstrated favourable cost-effectiveness profile

Guanfacine
Guanfacine, introduced mid-2016, established a specific clinical niche:

Gradual adoption: Reached peak usage around 2023-2024
Specialized application: Lower volumes suggest targeted use for specific patient populations
Recent plateau: Stabilization around 1,700 monthly prescriptions indicates market maturation

Figure 2: Prescriptions of Individual Classes of ADHD Drugs in Scotland[notmobile]
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Figure 3: Cost of Individual Classes of ADHD Drugs in Scotland
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Economic Impact Analysis

The financial implications of ADHD treatment evolution are substantial:

Cost Distribution (February 2025)

Methylphenidate: £490,808 (36.5% of total costs)
Lisdexamfetamine: £490,726 (36.5% of total costs)
Guanfacine: £127,779 (9.5% of total costs)
Atomoxetine: £105,451 (7.8% of total costs)
Dexamfetamine: £98,789 (7.3% of total costs)

Cost Per Prescription Analysis

Average monthly costs per prescription (February 2025): – Guanfacine: £74.42 – Atomoxetine: £71.79 – Lisdexamfetamine: £71.42 – Dexamfetamine: £91.56 – Methylphenidate: £30.47

This analysis reveals methylphenidate’s continued cost-effectiveness advantage, while newer agents command premium pricing reflecting their extended-release formulations and patent protection.

Prescribing Pattern Evolution

The data suggests several important clinical trends:

First-line treatment stability: Methylphenidate’s continued dominance reflects its established efficacy and safety profile
Second-line diversification: Growing adoption of lisdexamfetamine indicates expanding treatment algorithms
Specialized applications: Guanfacine and atomoxetine finding specific patient niches
Cost-conscious prescribing: Generic competition influencing atomoxetine utilization patterns

Treatment Accessibility

The 146% increase in total prescriptions suggests:

Improved diagnostic recognition
Enhanced service capacity
Reduced treatment barriers
Expanded clinical guidelines implementation

Conclusions

The Scottish ADHD prescription landscape has undergone remarkable transformation between 2016 and 2025, characterized by substantial growth in both treatment volume and diversity. Methylphenidate remains the therapeutic cornerstone, while lisdexamfetamine has emerged as a significant second-line option. The evolution reflects improved clinical recognition, enhanced treatment accessibility, and expanding therapeutic options.

Healthcare systems must prepare for continued growth while balancing clinical effectiveness, patient access, and economic sustainability. The data suggests a maturing market with established treatment patterns, providing a foundation for evidence-based clinical practice and informed healthcare policy development.

The remarkable 180% increase in prescription volume represents not merely statistical growth, but reflects improved lives, enhanced educational outcomes, and expanded opportunities for individuals with ADHD across Scotland. This transformation underscores the critical importance of continued investment in ADHD services and research to ensure optimal patient outcomes while maintaining healthcare system sustainability.

Methods

Prescription Data
https://www.opendata.nhs.scot/dataset/prescriptions-in-the-community

Drug Codes

The dataset gives full BNFItemCodes which are fifteen characters long and include dosage variations. The chemical substances (i.e. the main drug substance can be extracted from the data by using the left-most nine characters as follows:
‘0205020G0’,
‘0404000L0’,
‘0404000M0’,
‘0404000S0’,
‘0404000T0’,
‘0404000U0’,
‘0404000V0’