During the pandemic, attention deficit hyperactivity disorder diagnoses increased dramatically. So, too, did prescriptions of stimulant medications. Whether this is a helpful correction of historical under-diagnosis, evidence of harms from the attention economy, and/or a result of profiteering in the pharmaceutical and telemedicine industries remains to be seen.

This paper will present a case study of opioid prescribing across North America and specifically in British Columbia, Canada, with particular emphasis on lessons learned about the effects of prescription reduction efforts – in preparation for the possibility of a similar backlash against prescription stimulants. A central argument is that a decrease in prescribing is likely to help some and harm others, and therefore deciding on a course of action involves ethical decision-making. We will review some of the interventions deployed to decrease opioid prescribing (e.g. clinical guidelines, prescription drug monitoring programs) and discuss how they might apply to a change in direction in stimulant prescribing. The transition of some chronic pain patients to medications for opioid use disorder will be discussed in light of emerging evidence around prescription stimulants for stimulant use disorder. We will also discuss some potential levers that were not applicable to reducing opioid prescribing, e.g. regulation of attention-demanding social media. The paper will conclude by imagining a world in which stimulant prescribing was sharply decreasing. For example, would we observe a heightened demand for illegal stimulants? In order to inform preparedness efforts, we will consider what surveillance systems we might want to have in place to assess a change in prescribing and what programs and services might be necessary to manage unintended outcomes.