The problem of non-medical use of prescription stimulants such as amphetamine and methylphenidate crosses numerous age groups and affects a variety of individual profiles—even in some cases patients who are under a physician's care for attention-deficit/hyperactivity disorder (ADHD). Data presented this month at the annual meeting of The American Professional Society of ADHD and Related Disorders offer a look at the extended reach of a problem that is increasingly capturing federal regulators' attention.
A poster presentation based on a survey of adults ages 18 to 49 showed that among 1,207 adults reporting an ADHD diagnosis, nearly one-quarter reported non-medical use of stimulants. Among individuals with ADHD who had been prescribed a stimulant by a physician, 18% modified the drug they were taking in at least one way, either to experience a high or to try to relieve symptoms more effectively, says Stephen Faraone, PhD, Professor of Psychiatry and Neuroscience & Physiology at SUNY Upstate Medical University.
A second poster presentation, on a review of 20 studies reporting medical outcomes from non-medical use of stimulants, reported significant increases across several age groups in emergency department visits involving prescription stimulants from 2005-2010. Increases were actually higher among adults ages 35 and older than among youths under 18, says Faraone.
Faraone presented both posters at this month's conference. The two studies were funded by Arbor Pharmaceuticals, for which Faraone serves as a consultant. Arbor Pharmaceuticals is the maker of a brand-name version of dextroamphetamine for the treatment of ADHD in children and adolescents.
All misuse a concern
Faraone tells Addiction Professional that any non-medical use of prescription stimulants offers cause for concern. Certainly those who might inject the drugs to experience a high may create greater alarm because they may be headed toward an addiction. But even college students who occasionally use a stimulant as an all-night study aid could be at serious risk because they have not been screened for medical conditions that could be exacerbated by use of the drugs, he says.
The adult survey data came from a YouGov survey encompassing 12,000 individuals. In the group of 1,207 adults who reported an ADHD diagnosis, 9.2% said they had lied about or exaggerated symptoms in order to convince their physician to prescribe medication.
Among those with stimulant prescriptions for ADHD who modified the drug, the three most commonly used modifications were chewing the drug prior to swallowing it, dissolving it in liquid prior to use, and snorting it. Those who alter the drug in ways such as chewing might report that this relieves their symptoms faster or is just more effective overall.
The review of studies of outcomes from non-medical use of stimulants found increases in healthcare facility utilization and adverse medical outcomes. Data from the American Association of Poison Control Centers covering the 2012-2016 period showed that non-medical use of amphetamine stimulants led to higher rates of hospital admission. Faraone says that 60% of people who called a poison control center regarding a prescription stimulant required some form of admission.
Adverse outcomes were most prevalent among those who injected a stimulant, followed by those who snorted the drug, Faraone says.
Drug Abuse Warning Network (DAWN) data found steep increases in emergency department visits involving stimulants between 2005 and 2010. The increase among adults ages 18 to 25 was nearly 450%.
Prescribers of ADHD medication need to remain mindful that some of their patients may be misusing or diverting, Faraone says. An important stage at which to think about this occurs when a young adult is leaving home, transitioning from having medication secured by a parent to having control over how the medication is stored and used, he says.