BC’s ADHD Diagnoses Skyrocketed During and After the Pandemic

The number of British Columbians getting diagnosed with ADHD skyrocketed during the pandemic, jumping from around nine people per 100,000 in 2013 to around 35 people per 100,000 in 2023.

That’s a nearly fourfold increase in the rate of diagnoses, with more females recently being diagnosed than males, according to a new study on adult ADHD published in the Lancet Regional Health — Americas journal. The study looked at patients 17 and older because childhood diagnoses are different.

This increase worries substance use researchers because there’s a strong link between people with ADHD and people with substance use disorder, said Heather Palis, senior author of the study, senior scientist with Harm Reduction and Substance Use Services at the BC Centre for Disease Control and assistant professor at the University of British Columbia’s school of population and public health.

Palis said it’s not clear if one causes the other, but she’s worried an increase in the number of diagnoses could mean more people are at risk of using drugs or developing substance use disorder.

People with a diagnosed substance use disorder are 10 times more likely to have ADHD than the general population.

Some people may self-medicate their ADHD using cocaine or methamphetamines, Palis said. “In the context of the unregulated drug supply we know the risk of drug poisoning is high, not just for opioids but for stimulants too.”

Last year just over half of the British Columbians killed by unregulated drugs had methamphetamines or amphetamines in their system and just under half had cocaine, according to the BC Coroners Service.

Kali Rufus-Sedgemore, a youth harm reduction and stimulant user advocate, told The Tyee they self-medicate their ADHD with unregulated methamphetamine because their doctor isn’t able to prescribe them a strong enough stimulant to “calm” their brain so they can get out the door in the morning.

“Without stimulants I’m a depression sack,” they said.

Rufus-Sedgemore worked with researchers for the study to help provide some context and “humanize” the data.

Rufus-Sedgemore said doctors are extremely hesitant to prescribe high doses of stimulants because they don’t want to be flagged or get pushback from regulatory colleges.

That forces people who need a high dose of stimulants to be “functional” to the black market, Rufus-Sedgemore said, adding they know doctors and lawyers who self-medicate with methamphetamines and are stable.

The study defines ADHD as a “neuro-developmental psychiatric disorder defined by impaired levels of attention and hyperactivity-impulsivity.”

Rufus-Sedgemore said their ADHD means they’ve struggled to sit still and finish tasks since childhood. But they can also become hyper-fixated on a task and forget to eat.

“I have to set reminders to eat,” they said, adding they’re always starting craft projects but rarely finishing them.

Substance use researchers at the BC Centre for Disease Control wanted to look at ADHD because prescription stimulants used to treat it could potentially also be prescribed as treatment for stimulant use disorder, Palis said.

The study was led by Kevin Hu, first author and PhD student in the school of population and public health at UBC.

Bump in cases caused by the pandemic

The study says it’s estimated that 2.5 to 2.9 per cent of Canadians have ADHD.

Why are cases spiking?

Palis said it’s likely because people were less aware of their ADHD symptoms before the pandemic, or had routines that helped them cope with their symptoms.

And then the pandemic happened, and people were knocked out of their routines and suddenly isolated at home, trying to work, sometimes managing increased family duties, adjusting to isolation and dealing with financial stress.

At the same time people were learning about mental health, either through social media or their own struggles, according to the study. This could have helped people notice their symptoms and seek diagnoses, especially if they were struggling when they tried to return to work and their regular routines.

Palis said she thinks more people are being diagnosed now because doctors had previously been under-diagnosing people. Males tend to be diagnosed when they’re younger because their ADHD symptoms tend to make them disruptive, whereas females tend to be quieter and therefore get overlooked, she said.

Rufus-Sedgemore said it feels like ADHD is “trending” on social media, where lots of people who seem to function normally are announcing they have been diagnosed with ADHD.

They worry this heightened awareness could be pushing people to self-diagnose or pay out of pocket to be assessed by a private online clinic.

This could be leading to an over-diagnosis of ADHD or confusing the disorder with something like autism. Both ADHD and autism exist on a spectrum, so not everyone will be affected or present the same, Rufus-Sedgemore added.

Both Palis and Rufus-Sedgemore said this study’s findings could be used to better protect people from the unregulated drug supply.

Rufus-Sedgemore said regulatory colleges should support doctors to “listen to and trust” their patients, so doctors and patients can work together to find a prescription that works, regardless of how strong it might be.

Being hesitant to prescribe just pushes people to the unregulated supply, they added.

Palis said more research is needed to figure out what’s going on, but that the study shows the province could work to integrate substance use and mental health services to improve care for patients who fall into both groups.

The study also found having a mental disorder in the last five years meant a person was five times more likely to be diagnosed with ADHD, and recommended health-care providers expand their capacity to assess and treat ADHD.