As ADHD medicine use surges and prescribing pathways evolve, pharmacists are increasingly acting as a clinical safety net and health system navigator.
‘Treating ADHD is easy,’ says psychiatrist and ADHD researcher Professor David Coghill. ‘Treating ADHD well is hard. But it’s only hard if you don’t know what you’re doing.’
But as diagnosis rates climb, Schedule 8 psychostimulant dispensing reaches record levels,¹ and prescriptions come from a wider range of clinicians – knowing what to do is becoming more complex. Meanwhile, medicine shortages have required pharmacists to provide greater support around treatment continuity, missed doses and switching between formulations.
‘There has been a marked rise in interest in ADHD across the healthcare sector, requiring pharmacists, GPs and other healthcare professionals to rapidly upskill as evidence, models of care and prescribing arrangements continue to evolve,’ says pharmacist and Board Member of the Australasian ADHD Professional Association, Kate Tognarini MPS.
The changing face of ADHD
A neurodevelopmental condition, ADHD is characterised by inattentive and/or hyperactive-impulsive symptoms.² Since 2017, the rate of Australian adults filling ADHD medicine prescriptions has risen by almost 600%.³ In the 2025 financial year, 2.36% of adults aged between 20 and 65 filled a prescription for at least one ADHD medicine – close to the estimated adult prevalence of 2.5% to 3%.³
While stereotypes typically associate ADHD with school-aged boys, more women in their 30s, 40s and 50s are being diagnosed, often after decades spent masking or compensating for unrecognised symptoms.
‘More women are getting a diagnosis of ADHD than men now, and more women in Australia are being treated for ADHD as adults than men,’ Prof Coghill says. ‘Part of the reason is that ADHD in women has for many years been underrecognised.’
Paediatric medicine use has also increased. An Australian population study found treatment initiation rose across every age group and sex between 2013 and 2020, with a particularly marked increase among adolescent girls.⁴
There are striking geographic differences hidden in the numbers. Analysis by the University of New South Wales Medicines Intelligence Research Program for the ABC’s Four Corners found that dispensing rates of ADHD medicines were well above expected rates in some parts of the country and close to zero in others.³
Prof Coghill says two things are happening at once: ‘We have a combination of missed diagnosis and misdiagnosis.’
‘There are still people for whom ADHD is underrecognised, where the diagnosis has been missed, and there’s a fairly sizeable group who are getting treated for ADHD who probably shouldn’t be,’ he says. ‘We think some of the responsibility for that is the ADHD mega-clinics that have popped up, which will give you a diagnosis and a recommendation for treatment after a short telehealth appointment.’
Expanding GP-led care could make access to diagnosis and treatment less dependent on a patient’s postcode and income. In New South Wales, more than 800 GPs have been trained to provide repeat prescriptions, and more are training to assess and diagnose ADHD and initiate treatment.⁵
GP and ADHD specialist Dr Will Errington describes the geographic disparity as ‘an absolute access question’.
‘If you don’t have access to a specialist in terms of proximity or finances, then you aren’t going to get diagnosed or prescribed,’ he says.
‘If you make it more accessible, I should imagine there’s going to be a bit more democratisation.’
Work is also underway to reduce inconsistency between jurisdictions. Pharmacists currently navigate different prescriber permissions, permits, supply requirements and real-time prescription-monitoring systems. Former Department of Health, Disability and Ageing Deputy Secretary Penny Shakespeare – who is now Acting Deputy Commissioner of the National Anti-Corruption Commission – told Senate estimates earlier this year that a working group led by the NSW Chief Pharmacist was examining how to ‘harmonise who can prescribe medicines across Australia’.⁶
The work began with ADHD medicines, she said, because requiring people to see psychiatrists had created ‘significant patient blocks’ in access.
From this month, the Victorian Virtual Emergency Department will offer another access route. People aged 6 and over with an existing ADHD diagnosis and treatment plan who can’t see their regular clinician and urgently need a replacement prescription will be able to access a free online consultation. The service will provide a one-off supply but won’t initiate treatment or change doses.⁷
When a prescription raises questions
As prescribing rates rise, pharmacists are dispensing larger volumes of S8 stimulants alongside add-on medicines such as clonidine and melatonin. They are also encountering doses near – and sometimes beyond – approved ranges.
Prof Coghill draws an important distinction between titrating towards the upper end of the approved range and exceeding it. Some people need doses close to the maximum to achieve an optimal response. ‘Within the doses that are licensed, there is no high dose, there is no low dose; there’s just the dose that’s right for you,’ he says. ‘And in order to find the dose that’s right, we need to try a wide range of doses.’
Doses outside approved limits should be uncommon and supported by a clear clinical rationale, appropriate monitoring and transparent communication between the prescriber and pharmacist. ‘If I was a pharmacist and I was seeing doses that were above the limits registered with the TGA [Therapeutic Goods Administration], I would be asking why,’ Prof Coghill says.
If a prescription raises questions, Ms Tognarini reviews the medicine history, prescription and any relevant legal or authority requirements. ‘It’s also important to remember that what constitutes a “maximum dose” depends on the context, as TGA-approved maximum doses, PBS [Pharmaceutical Benefits Scheme] restrictions, and state or territory prescribing regulations are not always aligned,’ she says. ‘Higher-than-usual doses can sometimes be appropriate as part of an individualised treatment plan or during titration, so I approach the prescriber with curiosity rather than judgement to clarify the clinical rationale.’
How the query is explained to the patient also matters. Many people with ADHD have experienced years of misunderstanding or invalidation, which may make a routine clinical query feel like an accusation of wrongdoing or drug-seeking behaviour. There is also evidence to suggest that people with ADHD are prone to rejection sensitivity dysphoria – an intense, painful vulnerability to perceived criticism or judgement.⁸
Ms Tognarini recommends language that separates the person from the concern. For example, ‘I’m not questioning whether you need this medication. I just need to clarify one safety or regulatory point before I supply it’.
‘My goal is for patients to feel that the conversation is about ensuring safe, appropriate care rather than questioning their diagnosis or need for treatment,’ she says.
If dispensing has to be delayed, pharmacists should explain the legal or safety issue, what they will do next and, where relevant, the earliest date supply can occur.
Pharmacists should also remain alert to cardiovascular effects and interactions without presenting medicines as inherently unsafe. Where there is a personal or family history of significant cardiovascular disease, Ms Tognarini recommends asking about persistent tachycardia, palpitations, chest pain or syncope. Pharmacists should consider additive stimulant effects from caffeine, nicotine, energy drinks, decongestants, recreational stimulants and other sympathomimetics and reinforce the importance of blood pressure and heart rate monitoring.
‘While these medicines require appropriate monitoring, it’s equally important to reassure patients that ADHD medications have been used for decades and there is a substantial body of evidence supporting their long-term safety when prescribed appropriately and reviewed regularly.’
Safety at home
The rise in adult diagnoses, particularly among women in midlife, means ADHD medicines are entering more family homes. Between 2014 and 2023, 17,299 exposures to ADHD medicines were reported to the NSW Poisons Information Centre. Exposure rates increased by 16.5% annually, with one of the steepest rises among teenage girls. Sixty per cent were unintentional, and more than half involved referral to hospital or occurred in hospital.⁹
Prof Coghill cautions against treating the trend as evidence that appropriate ADHD treatment is itself harmful. ‘Teenage girls are the largest group of people that overdose on any medication,’ he says. ‘We’re prescribing more ADHD medications, so it’s not unexpected that we would see an increase in the number of teenage girls that are overdosing on them.’
Families should be encouraged to keep medicines in a secure location, while keeping in mind that a medicine hidden too well might be forgotten. ‘We can usually find a storage solution that balances both safety and practicality,’ Ms Tognarini says. ‘If there are teenagers in the home, I encourage open conversations about privacy, medication safety and responsible use, without assuming misuse unless there is reason for concern.’
Practical adherence support
ADHD creates an adherence paradox: medicines may help with attention, planning and memory, but those same skills are needed to fill prescriptions and take them consistently.
‘Supporting adherence is about designing ADHD-friendly systems that work with the way people think, rather than relying just on willpower and memory,’ Ms Tognarini says.
Pharmacists should work with patients to identify their treatment goals and barriers and develop practical strategies together. These might include linking doses to an existing daily routine like brushing teeth, setting smartwatch reminders, writing down key counselling points, recording the prescription expiry date and the next available supply date on the dispensing label if applicable, scheduling reminders for repeat prescriptions and encouraging patients to store medicine in a consistent, visible but secure location.
‘It’s also important to explore whether apparent non-adherence reflects side effects, medication cost, supply shortages, stigma, or simply forgetting, rather than assuming a lack of motivation,’ Ms Tognarini says. ‘Adherence support needs to reduce friction, not add another task for the patient to fail at.’
Supporting patients with ADHD extends beyond medicines supply. Pharmacists can support the whole person by discussing sleep, nutrition and exercise, and sharing useful resources, Prof Coghill says. ‘For example, we know that stimulant medications interfere with diet, so it’s appropriate to discuss supplements.’
A 2024 systematic review of dietary interventions and supplements for ADHD found evidence for supplements like vitamin D and magnesium was mixed and inconsistent, reinforcing that supplementation should be considered on an individual basis rather than routinely.10 Pharmacists are therefore best placed to flag reduced intake and weight change for review, rather than recommending supplements directly.
As GP-led care expands, communication between pharmacists and prescribers will become even more important. Pharmacists can support GPs by clearly explaining the clinical or regulatory reason for a query and sharing relevant dispensing or adherence information. Regular communication can also surface adverse effects, dose escalation or repeated early supply requests before they become problems.
Dr Errington welcomes calls from pharmacists. ‘We’re all working around the patient. Just keeping on talking to each other is really important.’
References
- Australian Institute of Health and Welfare. ADHD medications dispensed 2004–05 to 2023–24. 2025. At: www.aihw.gov.au/mental-health/topic-areas/community-based-services/mental-health-prescriptions/adhd-medications-dispensed-overtime
- Healthdirect. Attention deficit hyperactivity disorder (ADHD). 2025. At: www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd
- Swan N, Ting I, Donaldson A, et al. ADHD rates in adults are skyrocketing — but by how much depends where you live. ABC News. 20 Apr 2026. At: www.abc.net.au/news/2026-04-20/adhd-diagnosis-rates-adults-australia-data-four-corners/106557646
- Bruno C, Havard A, Gillies MB, et al. Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: a population-based study among Australian children and adults (2013–2020). Aust N Z J Psychiatry 2023;57(5):675–85.
- NSW Health. Reforms to enable GPs to diagnose ADHD from March. 2026. At: www.health.nsw.gov.au/news/Pages/20260211_00.aspx
- Commonwealth of Australia, Senate Community Affairs Legislation Committee. Estimates, 11 February 2026 (Penny Shakespeare, p. 81). At: www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=committees/estimate/29370/&sid=0000
- Government of Victoria. Urgent ADHD top-up prescriptions even easier and cheaper. 2026. At: www.premier.vic.gov.au/urgent-adhd-top-prescriptions-even-easier-and-cheaper
- Rowney-Smith A, Sutton B, Quadt L, et al. The lived experiences of rejection sensitivity in ADHD – a qualitative exploration. PLoS One 2026;21(1):e0314669.
- Thomson A, Cairns RF, Magotra H, et al. Exposures to attention deficit hyperactivity disorder medications reported to the New South Wales Poisons Information Centre (2014–2023): a retrospective study. Aust N Z J Psychiatry 2026;60(2):136–47.
- Kaur G. Dietary interventions and supplements for managing attention-deficit/hyperactivity disorder (ADHD): a systematic review of efficacy and recommendations. Cureus 2024;16(9):e69804.
- ISMP Canada. Alert: clonidine compounding errors continue to harm children. 2023. At: https://ismpcanada.ca/bulletin/alert-clonidine-compounding-errors-continue-to-harm-children/
- Barbuto AF, Burns MM. Clonidine compounding error: bradycardia and sedation in a pediatric patient. J Emerg Med 2020;59(1):53–5.
- Pharmacy Board of Australia. Compounding error – incorrect strength of ingredient [case study]. 2021. At: www.pharmacyboard.gov.au/News/Professional-Practice-Issues/Case-studies-learnings.aspx
- Therapeutic Goods Administration. Clonidine – importance of dosing compliance and safe storage [safety update]. Canberra: TGA. 29 Apr 2021. At: www.tga.gov.au/news/safety-updates/clonidine-importance-dosing-compliance-and-safe-storage
