Nonmedical Use of Stimulants Must Stop

By Arria, Amelia M.; Dupont, Robert L. | Clinical Psychiatry News, December 2009 | Go to article overview

Nonmedical Use of Stimulants Must Stop


Arria, Amelia M., Dupont, Robert L., Clinical Psychiatry News


We are intrigued by the work of investigators who recently reported a sharp increase in the number of calls to poison control centers related to attention-deficit /hyperactivity disorder medications, particularly amphetamine / dextroampheta-mine-related compounds.

The investigators, led by Dr. Jennifer Setlik, an emergency physician at Cincinnati Children's Hospital Medical Center, studied trends in calls related to ADHD medications for the years 1998-2005 (Pediatrics 2009 Aug. 24;doi: 10.1542/peds.2008-0931).They provided a compelling argument that the increase in calls to poison control centers is related to the increased availability of prescriptions. Furthermore, they speculated that the increase in availability points to the increased misuse of these medications ("Teen Abuse of ADHD Stimulants Climbed 76%," Sept. 2009, p. 27).

We believe that the findings of Dr. Setlik and her colleagues must be placed in context of an even larger problem: the ongoing escalation of nonmedical use of prescribed controlled substances.

There is a rapidly growing body of literature on the widespread nonmedical use of the medicines used to treat ADHD in adolescents and young adults who attend college. Recent evidence has documented the availability of these drugs, and research has consistently shown that most of the stimulants being used nonmedically originate from students being treated for ADHD, who then share and/or sell their medications to others who desire them for nonmedical use (J. Drug Issues 2008;38:1045-60).

Because of their ability to increase wakefulness, these medications are sought out by many college students, especially those with high task demands who arc experiencing academic difficulties (J. Am. Acad. Child Adolesc. Psychiatry 2008;47:21-31). The assumption among these young people is that taking stimulants nonmedically confers an "academic edge," and is therefore beneficial when it comes to taking final exams and completing other intense academic assignments. We fear that such notions have been perpetuated by the popular media with headlines referring to "smart drugs" and "smart doping" (The Economist, May 22, 2008).

On the contrary, nonmedical prescription stimulant use is associated, on average, with lower academic performance (Addiction 2005;100:96-106). In other words, it is not primarily the academically successful students who use prescription stimulants nonmedically, but the academically unsuccessful students. Nonmedically using stimulants as a "short cut" to compensate for not going to class, for example, does not appear to be an effective strategy.

The nonmedical use of prescription stimulants by lower-achieving students is also a marker for a set of related problems: excessive use of alcohol and use of illicit drugs such as marijuana and cocaine. In fact, nonmedical users of prescription stimulants are more likely to meet DSM-IV criteria for dependence on alcohol and marijuana, skip class more frequently, and spend less time studying.

This emerging research provides us with a solid foundation for crafting sensible responses. Reducing the problem will require the efforts of many parents, school administrators, the Food and Drug Administration, the pharmaceutical industry, and of course, adolescents and young adults themselves. Yet, in our view, physicians must shoulder an especially important set of responsibilities in our collective response to this problem.

Physicians must become aware of the extent to which their patients with legitimate prescriptions for controlled substances are sharing, selling, and trading their medications. It is also important for physicians to be alert to the extent of nonmedical use occurring among their patients who do not have prescriptions.

With respect to students without ADHD, there are anecdotal reports of parents being concerned about their child in college "succeeding at any cost," and who, therefore, enable the problem by turning a blind eye to nonmedical use or even encouraging the behavior. …

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