Simon Fraser University Researchers Highlight Urgent Need for Better Monitoring of Psychostimulant Use

A groundbreaking commentary published in Nature Mental Health by researchers led from Simon Fraser University (SFU) has spotlighted a critical public health challenge in Canada: the escalating use of psychostimulants amid a persistent overdose crisis. Psychostimulants, which include medications like methylphenidate (commonly known as Ritalin or Concerta) and amphetamines (such as Adderall), are primarily prescribed for attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. These drugs work by increasing dopamine and norepinephrine levels in the brain to enhance focus and alertness. The SFU-led team, including lead author Benedikt Fischer from the Faculty of Health Sciences, argues that psychostimulant involvement in overdose deaths is rising, yet interventions remain inadequate.

This research underscores SFU's pivotal role in addressing substance use and mental health through interdisciplinary studies. As Canadian universities like SFU advance pharmacoepidemiology—the study of drug effects in populations—the findings call for enhanced pharmacovigilance, defined as the science and activities related to detecting, assessing, understanding, and preventing adverse effects of pharmaceuticals. With prescriptions surging, particularly post-COVID-19, academic institutions are at the forefront of urging policy shifts to safeguard public health.

The Rapid Rise in Psychostimulant Prescriptions Across Canada

National data reveals a marked increase in psychostimulant dispensing. According to IQVIA reports, the prevalence of individuals receiving psychostimulants in community pharmacies climbed from 2.4% in 2019 to 3.7% in 2023, reflecting broader trends in mental health treatment. A comprehensive Ontario study using linked health administrative data showed incident stimulant prescriptions—new starts—jumped 157.2% from 275.2 per 100,000 in 2015 to 708.0 per 100,000 in 2023, with acceleration after 2020.

This surge is especially pronounced among adults. Research from the University of Toronto and ICES (Institute for Clinical Evaluative Sciences) indicates new adult prescriptions more than doubled since the pandemic's onset, reaching about 1 in 50 young adults (18-34) by mid-2024. Women drove much of this growth, comprising 59% of new adult users post-2020, with rates rising 421% in ages 25-44 and 369% in 18-24. Factors include heightened ADHD awareness via telehealth, social media, and pandemic-related stress amplifying symptoms.

Linking Prescription Trends to Canada's Overdose Crisis

Canada's toxic drug crisis, claiming over 7,000 lives annually, now frequently involves psychostimulants alongside opioids like fentanyl. Public Health Agency of Canada data shows apparent opioid toxicity deaths dipped slightly in 2024-2025, but stimulant co-involvement persists at high levels—around 70% of opioid deaths also feature stimulants. From 2018-2021, stimulant toxicity deaths rose from 0.4 to 1.0 per 100,000, totaling over 5,200 cases.

Illicit psychostimulants (cocaine, methamphetamine) dominate harms, but rising prescription use raises diversion risks—non-medical sharing or sale. Polysubstance use exacerbates dangers: stimulants mask opioid sedation, delaying overdose recognition. SFU researchers note neglected responses to this 'fourth wave' of the crisis. In BC, toxic drug deaths fell 21% in 2025, partly from supply shifts, but stimulants remain key.

Risks and Harms Associated with Psychostimulant Use

Therapeutically, psychostimulants improve ADHD symptoms in 70-80% of patients, but risks include cardiovascular effects (hypertension, arrhythmias), psychiatric issues (anxiety, psychosis), and dependency. Long-term use links to growth suppression in youth and tolerance requiring dose escalation. In overdose contexts, they heighten toxicity, especially combined with depressants.

• Cardiovascular: Increased heart rate and blood pressure; rare sudden death in youth with undiagnosed conditions.
• Neuropsychiatric: Insomnia, mania, hallucinations; higher psychosis risk with amphetamines.
• Dependency: Abuse potential high due to euphoria; diversion fuels street supply.
• Overdose Synergies: With fentanyl, elevates fatal respiratory depression risk.

Post-COVID prescribing boom amplifies these, particularly among women and young adults new to stimulants.ICES Ontario ADHD Medication Trends Report highlights need for vigilant monitoring.

Current Interventions and Gaps in Care

Harm reduction dominates opioid responses—naloxone, supervised consumption—but psychostimulants lack equivalents. No approved pharmacotherapies exist for stimulant use disorder (SUD); trials of modafinil, bupropion show modest results. Prescribing stimulants as SUD substitution (like opioids) gains traction in BC, reducing illicit use, but evidence is preliminary.

Gaps include:

• Limited SUD treatment access; waitlists exceed months.
• Poor pharmacovigilance; underreported adverse events via Canada Vigilance Program.
• Stigma barriers diagnosis/treatment, especially adults.
• Regional disparities; Western Canada sees higher methamphetamine harms.

SFU's Contributions to Substance Use Research

Simon Fraser University's Faculty of Health Sciences, via the Centre for Applied Research in Mental Health and Addiction (CARMHA), leads in substance use epidemiology. Benedikt Fischer's team tracks trends, evaluates interventions. Past studies on cannabis, opioids inform current calls. As a top Canadian research university, SFU trains future experts via graduate programs in health sciences, fostering evidence-based policy.

This Nature Mental Health piece exemplifies SFU's global impact, collaborating with U of T, Université de Montréal. AcademicJobs.com connects such researchers to opportunities in Canadian higher ed.

Recommendations for Enhanced Pharmacovigilance

The SFU commentary urges multifaceted strategies:

1. Surveillance: Real-time national databases tracking prescriptions, overdoses; link to Canada Vigilance for adverse signals.
2. Prescribing Guidelines: Risk assessments pre-start; monitor cardiac, mental health.
3. SUD Integration: Evidence-based psychostimulant prescribing for high-risk users.
4. Prevention: Education on risks/diversion; regulate telehealth.
5. Research Funding: RCTs for treatments; equity-focused studies.

Stakeholder Perspectives and Policy Implications

Health Canada, provinces prioritize opioids, but experts like Fischer advocate 'twin epidemic' approach. Physicians report diagnostic challenges; nurses fill gaps but need training. Patients value symptom relief yet fear stigma. CMAJ debates highlight substitution therapy promise/risks. Policy-wise, enhanced Health Canada monitoring, funded via overdose response budgets, could mirror opioid pharmacovigilance successes.

Case Studies: Real-World Impacts in Canada

In British Columbia, safer supply pilots prescribe dextroamphetamine for methamphetamine users, cutting illicit use 50% in participants. Ontario's post-pandemic surge saw young women prescriptions triple, prompting telehealth reviews. Quebec data mirrors national trends, with SUD clinics overwhelmed. These illustrate prescription-psychoactive intersections, validating SFU's warnings.

Photo by Annie Spratt on Unsplash

Future Outlook and University-Led Solutions

Projections: prescriptions may rise 20-30% by 2030 absent interventions, per IQVIA trends. Universities like SFU, via partnerships (e.g., CIHR grants), drive solutions—AI surveillance tools, longitudinal cohorts. Optimism lies in evidence-based pharmacovigilance scaling, reducing harms while sustaining ADHD care. Canadian higher ed's research prowess positions it centrally.

Explore research careers at AcademicJobs.com research jobs or SFU opportunities.