Stimulants generally safe for ADHD, but risk for misuse remains
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Stimulant use is generally safe and effective for treating ADHD among young people, but clinicians should be aware of the potential for misuse, according to a presenter at the Psych Congress 2020 Virtual Experience conference.
“Stimulant misuse is a significant public health problem, especially in college students, but there are a lot of inconsistencies, and I think that more and more, we're focusing on stimulant misuse, particularly in college settings,” Timothy E. Wilens, MD, chief of the division of child and adolescent psychiatry and co-director of the Center for Addiction Medicine at Harvard Medical School, said during a presentation.
Although misuse of stimulants is a possibility, their use does appear to overall decrease substance use disorders, according to Wilens. He highlighted results of a study of approximately 3 million people with ADHD in the United States, which suggested that periods of stimulant treatment were linked to a 35% and 30% lower risk for substance use disorders among males and females, respectively. Further, another study showed reduced marijuana use among high school seniors associated with early ADHD treatment.
A significant body of research also supported the notion that stimulant use was linked to decreased rates of mood disorders, suicidality, criminality, traumatic brain injury and motor vehicle accidents in treated vs. untreated groups.
Regarding stimulant use among those with ADHD and related academic outcomes, the association is more mixed, with some evidence of improvements in grade-point average but other evidence of worsened entrance examinations and academic outcomes, according to Wilens.
Although stimulant use is generally safe and effective when used in line with a clinical prescription, risks may arise regarding stimulant misuse, which peaks at age 21 and appears common among college students. Studies have shown 65% to 85% of stimulants are diverted from friends, with most of those misusing not obtaining stimulants by lying to their doctor. Stimulant misuse among college students has been linked to higher rates of substance use disorders, ADHD and executive dysfunction.
According to Wilens, clinicians can mitigate prescription drug misuse by educating adolescents, young adults and themselves about misuse; communicating with patients about the addictive, legal, medical and psychological factors related to misuse; promoting safe storage of prescription drugs; and avoiding overprescribing quantity.
“Stimulant misuse is more common with immediate vs. extended release, and non-oral routes are common, with 40% of misuse done intranasally,” Wilens said. “It's a myth that misuse of stimulants is benign. There are short- and long-term adverse effects associated with stimulant misuse.”