JMIR Publications

ABSTRACT

Background:

Popular discourse often frames prescription stimulants Ritalin and Adderall as drugs for teens and emerging adults with greater financial resources (e.g. students or young professionals), while illicit stimulants such as crack or methamphetamine are often considered drugs for older adults with lower incomes. Crack and methamphetamine are also frequently used in combination with opioids to offset the sedating effects of adulterants such as fentanyl and xylazine in the unregulated drug supply. While conducting formative research to develop an intervention designed to encourage protection against overdose among people in New York City who use drugs, our team noticed increased Ritalin / Adderall use reported by lower income and older participants.

Objective:

After identifying this trend in our initial data, we conducted a series of qualitative interviews to examine participants’ experience with Ritalin / Adderall. Interviews examined why people use these prescription stimulants, when they started, and how they currently obtain them. We also sought to implement a novel AI-assisted coding methodology.

Methods:

We collected interview data and substance use screenings during three waves of data collection in 2025, n=102 participants. In March of 2026 we conducted an additional 16 qualitative interviews with people who reported using Ritalin / Adderall. We then conducted mixed-methods analyses to examine reported substance use including use of opioids and Ritalin / Adderall in combination, as well as potential relationships between using opioids with prescription stimulants and reporting a desire to stop using drugs. After conducting the interviews we employed a new hybrid methodology that used AI tools to generate and code interview transcripts, augmenting the work of our larger research team.

Results:

Participants described using Ritalin / Adderall to manage the negative effects of increasingly powerful opioids, including oversedation and withdrawal symptoms. Many described being prescribed the drugs during their youth, and then continuing to obtain the drugs illicitly.

Conclusions:

The use of prescription stimulants appears to be increasingly common among new populations of people who use opioids, including those who report very low incomes and even homelessness. Additional research is warranted to examine how this type of polysubstance use may require different types of prevention strategies.