Prescription stimulant misuse, abuse prevalent among adults with ADHD

Stephen Faraone

Nonmedical use of prescription stimulant medications is highly prevalent in the U.S. and can lead to serious adverse health outcomes, especially when taken by nonoral routes, according to study data.

The data came from two studies presented by Stephen Faraone, PhD, from SUNY Upstate Medical University, at the 2019 American Professional Society of ADHD and Related Disorders Annual Meeting.

Abuse, misuse outcomes

In the first study, Faraone and colleagues reported the outcomes of nonmedical use (abuse and misuse) of prescription stimulants identified through a comprehensive literature review. They conducted a systematic search of relevant databases for studies containing data about nonmedical stimulant use, malingering of ADHD, diversion of prescription stimulants and outcomes of prescription nonmedical stimulant use.

Overall, 109 studies met inclusion criteria, 25 of which reported outcomes of nonmedical use of prescription stimulants. Faraone and colleagues found that the number of adult ED visits related to nonmedical use of prescription stimulants rose nearly 200% over a 5-year period, from 5,212 in 2005 to 15,585 in 2010.

Data from the American Association of Poison Control Centers (n = 15,876) showed that rates of health care facility admission were higher in cases of nonmedical stimulant use (IV, 68%; nasal, 49%; oral, 65%) compared with cases of correct stimulant use (22%) and that the risks of adverse medical outcomes were higher in cases of nonmedical stimulant use.

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In addition, the data revealed that the number of adverse clinical effects was highest in the IV group, and that the mortality risk was higher for nasal and IV groups vs. the nonabuse group. Prescription stimulant exposures (both intentional and unintentional) were linked to moderate medical effects in 8% to 36.5% of cases, major effects in 0.2% to 5.8% of cases and death in less than 0.1% of cases, according to the abstract.

Results from studies of college students revealed a high frequency of unwanted physiological effects relating to nonmedical stimulant use, including reduced appetite, sleep difficulties, irritability, headache, sadness, dizziness and stomach ache.

“Stimulant medications are clinically important for ADHD treatment, but when these medications are taken in ways not prescribed, both by oral and nonoral routes, they increase the risk of serious health complications, including death especially when taken intranasally or intravenously,” Faraone said in a press release. “It is critically important that we educate health care providers, patients, parents and the general public about the dangers of misusing and abusing prescription stimulants.”

Motivations, behaviors

In the second study, the investigators examined the prevalence of nonmedical use among U.S. adults and the level of associated risk using an online survey to characterize ADHD diagnosis, prescribed medications, nonmedical use of ADHD drugs, routes of administration and motivations for use.

Of 12,000 survey respondents, 1,207 reported an ADHD diagnosis; however, only 803 of these respondents had ever taken a prescription stimulant to prevent or treat their ADHD symptoms. In addition, 301 respondents reported nonmedical use of a prescription stimulant with or without their own prescription.

Of those diagnosed with ADHD, 9.2% had lied about symptoms to get a doctor to prescribe ADHD drugs and 19.1% intentionally took more ADHD medication than prescribed, according to the study findings. The main motivations for taking more than prescribed were to self-treat ADHD (30.1%) and to improve work/school performance (27.5%).

Of respondents who had ever taken a prescription ADHD stimulant, 18.1% modified their ADHD medication, including taking the medication nonorally (by chewing, dissolving, snorting, smoking or injection).

Participants reported chewing/dissolving the medication mainly due to difficulty swallowing whole pills (42.5% and 35.3%), but also because they were hoping to get a better/faster effect of the stimulant on ADHD symptoms and faster/more intense high than swallowing, according to the abstract data. In contrast, participants reported snorting the stimulants mainly to achieve a faster effect on ADHD symptoms (36.4%), faster high (33.3%), better effect on symptoms (27.3%) and more intense high (21.2%). Reasons for smoking the medication were similar to snorting and only a small number of respondents reported injecting to achieve a better/faster high and for a faster/more intense high.

“People are manipulating prescription stimulant medications for a range of reasons, including performance enhancement at work or school, faster onset or euphoric effects — that is, specifically to get high,” Faraone said. “But whatever the reason, these data confirm that prescription stimulant medications are being manipulated and support recent concern by the [FDA] and other regulatory agencies, which identify prescription stimulants as emerging drugs of abuse.” – by Savannah Demko

References:

Faraone S, et al. S26. Outcomes of nonmedical use of ADHD stimulants: Results of a comprehensive review.

Faraone S, et al. S27. Motivations and behaviors of non-medical use of attention deficit hyperactivity disorder (ADHD) medications among adults. Presented at: 2019 APSARD annual meeting; Jan. 18-20; Washington, D.C.

Disclosures: Faraone reports receiving income, potential income, travel expenses, continuing education support and/or research support from Akili Interactive Labs, Arbor, Enzymotec, Genomind, Ironshore, Otsuka, Shire, Sunovion, Supernus, Tris and VAYA. With his institution, he has a U.S. patent for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD.