Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.

OBJECTIVE Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals. METHOD We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. RESULTS We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. CONCLUSIONS The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.

[1]  S. McCabe,et al.  Sources of prescription drugs for illicit use. , 2005, Addictive behaviors.

[2]  S. McCabe,et al.  Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs , 2006, Journal of American college health : J of ACH.

[3]  Joseph Biederman,et al.  The worldwide prevalence of ADHD: is it an American condition? , 2003, World psychiatry : official journal of the World Psychiatric Association.

[4]  R. Barkley.  A review of stimulant drug research with hyperactive children. , 1977, Journal of child psychology and psychiatry, and allied disciplines.

[5]  Darin D Dougherty,et al.  PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short- and long-acting oral methylphenidate. , 2006, The American journal of psychiatry.

[6]  W. Stoops,et al.  Reinforcing, subject-rated, and physiological effects of intranasal methylphenidate in humans: a dose-response analysis. , 2003, Drug and alcohol dependence.

[7]  Kathryn A. Becker-Blease,et al.  Stimulant Medication Use, Misuse, and Abuse in an Undergraduate and Graduate Student Sample , 2006, Journal of American college health : J of ACH.

[8]  S. Pliszka,et al.  Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  B. Vitiello.  Long-term effects of stimulant medications on the brain: possible relevance to the treatment of attention deficit hyperactivity disorder. , 2001, Journal of child and adolescent psychopharmacology.

[10]  K. Brady,et al.  Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults. , 2005, Journal of child and adolescent psychopharmacology.

[11]  C. Poulin.  Medical and nonmedical stimulant use among adolescents: from sanctioned to unsanctioned use. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[12]  T. Spencer,et al.  The stimulants revisited. , 2000, Child and adolescent psychiatric clinics of North America.

[13]  R. Klein,et al.  Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. , 1993, Archives of general psychiatry.

[14]  W. Schlenger,et al.  Psychostimulant Dependence in a Community Sample , 2003, Substance use & misuse.

[15]  M. Monuteaux,et al.  Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. , 2006, Journal of the American Academy of Child and Adolescent Psychiatry.

[16]  M. Ernst,et al.  Problems in the management of attention-deficit-hyperactivity disorder. , 1999, The New England journal of medicine.

[17]  S. McCabe,et al.  Illicit Use of Specific Prescription Stimulants Among College Students: Prevalence, Motives, and Routes of Administration , 2006, Pharmacotherapy.

[18]  Stephen P. Hinshaw,et al.  A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. , 1999, Archives of general psychiatry.

[19]  R. Pihl,et al.  Characteristics of Methylphenidate Misuse in a University Student Sample , 2005, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[20]  S. Kollins,et al.  Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review , 2001, Pharmacology Biochemistry and Behavior.

[21]  L. Greenhill,et al.  Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents, and Adults , 2002 .

[22]  J. Swanson,et al.  Relationship between blockade of dopamine transporters by oral methylphenidate and the increases in extracellular dopamine: Therapeutic implications , 2002, Synapse.

[23]  S. Broste,et al.  Stimulant Use and the Potential for Abuse in Wisconsin as Reported by School Administrators and Longitudinally Followed Children , 1998, Journal of developmental and behavioral pediatrics : JDBP.

[24]  C. Poulin.  From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: connecting the dots. , 2007, Addiction.

[25]  K. G. Low,et al.  Illicit use of psychostimulants among college students: A preliminary study , 2002 .

[26]  R. Kessler,et al.  The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. , 2006, The American journal of psychiatry.

[27]  Sean Esteban McCabe,et al.  The Use, Misuse and Diversion of Prescription Stimulants Among Middle and High School Students , 2004, Substance use & misuse.

[28]  J S Fowler,et al.  Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain. , 1995, Archives of general psychiatry.

[29]  Nora D Volkow,et al.  Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. , 2003, The American journal of psychiatry.

[30]  J. Swanson,et al.  Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. , 1999, Archives of general psychiatry.

[31]  J. Key,et al.  Methylphenidate Misuse in Substance Abusing Adolescents , 2000 .

[32]  S. McCabe,et al.  Illicit Methylphenidate Use in an Undergraduate Student Sample: Prevalence and Risk Factors , 2003, Pharmacotherapy.

[33]  A. Straughn,et al.  Advances in the Pharmacotherapy of Attention‐Deficit‐Hyperactivity Disorder: Focus on Methylphenidate Formulations , 2003, Pharmacotherapy.

[34]  L. Greenhill,et al.  Ritalin: Theory and Practice , 2000 .

[35]  D. Jewett,et al.  Illicit Use of Prescribed Stimulant Medication Among College Students , 2005, Journal of American college health : J of ACH.

[36]  C. Gillberg,et al.  Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. A randomized, double-blind, placebo-controlled trial. , 1997, Archives of general psychiatry.

[37]  N. Volkow,et al.  Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. , 1998, The American journal of psychiatry.

[38]  G. Weiss,et al.  Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[39]  D. Jasinski.  An evaluation of the abuse potential of modafinil using methylphenidate as a reference , 2000, Journal of psychopharmacology.

[40]  B. Horta,et al.  The worldwide prevalence of ADHD: a systematic review and metaregression analysis. , 2007, The American journal of psychiatry.

[41]  L. Kroutil,et al.  Nonmedical use of prescription stimulants in the United States. , 2006, Drug and alcohol dependence.

[42]  S. Jaffe,et al.  Intranasal abuse of prescribed methylphenidate by an alcohol and drug abusing adolescent with ADHD. , 1991, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  Randy M. Page,et al.  Perceptions of the Prevalence of Marijuana Use Among College Students: A Comparison Between Current Users and Nonusers , 2000 .

[44]  J. McClellan,et al.  Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[45]  S. McCabe,et al.  Prevalence and Motives for Illicit Use of Prescription Stimulants in an Undergraduate Student Sample , 2005, Journal of American college health : J of ACH.

[46]  W. Klein-Schwartz,et al.  Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  H. Wechsler,et al.  Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. , 2005, Addiction.

[48]  Q Babcock,et al.  Student Perceptions of Methylphenidate Abuse at a Public Liberal Arts College , 2000, Journal of American college health : J of ACH.

[49]  Rodney J. Moore,et al.  Abuse liability assessment of atomoxetine in a drug-abusing population. , 2008, Drug and alcohol dependence.

[50]  E. Garland.  Intranasal abuse of prescribed methylphenidate. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[51]  Myron Genel,et al.  Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents , 1998 .