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How to address nonmedical stimulant use among college-aged patients

Anthony Rostain

SAN FRANCISCO — In a session presented here, Anthony L. Rostain, MD, MA, professor of psychiatry and pediatrics and Adult ADHD Treatment and Research Program Perelman School of Medicine, University of Pennsylvania medical director, spoke about the non-medical use and abuse of prescription stimulant medications.

“This is not a new problem. Stimulants are risky, and especially in the hands of individuals who are going to misuse/abuse them or use illicitly prepared formulations,” he said. “This is not to say we shouldn’t be using them with patients – of course we should – but we should be aware of the variety of difficulties.”

Rostain discussed the prevalence, patterns and impact of non-medical use of prescription stimulants among college students in the United States and strategies for the clinical management of patients at risk for misuse.

Stimulant medications – such as amphetamine, methylphenidate and modafinil – are FDA approved for ADHD, narcolepsy and binge eating disorder. Some of the negative outcomes associated with stimulant nonmedical use are consistent with the mechanism of action of prescription stimulants – such as sleep disturbance, irritability, agitation, paranoia and mania, Rostain explained.

“College is a facilitating environment for stimulant misuse,” he said.

Among college students, he said that the main motivation for taking non-medical stimulants was performance enhancement, but also euphoria seeking. Rostain said that factors contributing to the rise in prevalence in nonmedical use of prescription stimulants included the increasing availability of these medications, higher rates of ADHD diagnoses and the perception that “everyone is doing it and therefore I have to do it.”

Rostain recommended using long-acting prescription stimulants that have less abuse potential. To curb the misuse, Rostain said it is important to educate patients about the medical, ethical and legal risks, ensure that they don’t share with their friends, instill safe storage practices and monitor them by doing pill counts and including family members in treatment plans. – by Savannah Demko

References:

Rostain A, et al. Facing the challenges of misuse and abuse stimulant medications for ADHD: from neurobiology to clinical care. Presented at: APA Annual Meeting; May 18-22, 2019; San Francisco.

Disclosures: Rostain reports royalties from St. Martin’s Press and Routledge/Taylor Francis Group; being on the advisory board for Arbor Pharmaceuticals and Shire/Takeda; and consulting for the National Football League.