The results of two new studies evaluating the non-medical use (NMU) of prescription stimulants were presented today by Stephen Faraone, PhD, Distinguished Professor of Psychiatry and Neuroscience & Physiology at SUNY Upstate Medical University at the 2019 American Professional Society of ADHD and Related Disorders Annual Meeting (APSARD) in Washington, D.C. The studies found that NMU of prescription stimulant medications is a growing problem in the U.S. and that using these medications in ways not prescribed can lead to serious adverse health outcomes, with the risk increasing if they are taken by non-oral routes.
Survey finds adults with ADHD are misusing prescription stimulants
The first presentation reviewed results from a survey of 12,000 US adults age 18 to 49 years, of which 1,207 reported a diagnosis of ADHD. The frequency and motivation for NMU of prescription stimulants among adults with ADHD was analyzed. Nearly 25 percent reported NMU of prescription stimulants and 9.2 percent said they had lied about or exaggerated their symptoms to get their doctor to prescribe medication.
Of the 66.5 percent that reported taking stimulant medication for their ADHD (n=803), 19 percent intentionally took more ADHD medication than prescribed and 18 percent modified their medications in at least one way. Modified use included chewing prior to swallowing (10.8%), dissolving in liquid prior to swallowing (8.5%), snorting (8.2%), smoking (4.2%) and injecting (1.7%). Motivations for modifying prescription stimulants for non-oral use included the intent for a better or faster effect on ADHD symptoms as well as a faster and more intense high than swallowing whole.
“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,” said Faraone. “But whatever the reason, these data confirm that prescription stimulant medications are being manipulated and support recent concern by the Food and Drug Administration and other regulatory agencies, which identify prescription stimulants as emerging drugs of abuse.”
Risk for serious adverse medical outcomes increases when prescription stimulants are taken non-orally
The second presentation reviewed data from 20 studies that reported medical outcomes of NMU of prescription stimulants. Healthcare facility utilization, clinical effects and adverse medical outcomes increased with prescription stimulant NMU. Adverse clinical effects were highest for intravenous, followed by intranasal, oral NMU and lowest for those that did not nonmedically use stimulants.
Data from the American Association of Poison Control Centers (AAPCC) from 2012 to 2016 showed that NMU of prescription amphetamine stimulants results in higher rates of in-patient admissions. The rate of admissions varies by route of drug administration and is highest with intravenous use. In addition, based on calls made to Poison Control Centers the odds of death were 13 times greater among those engaging in intranasal NMU (3 of 598 died) and 22 times greater among those engaging in intravenous NMU (2 of 164 died) of amphetamines than among those with no NMU (1 of 3,953 died).
Data from the Drug Abuse Warning Network (DAWN) showed an increase in the number of emergency department (ED) visits involving prescription stimulants for all age groups from 2005 to 2010, including an almost 450 percent increase among those age 18 to 25 (increasing from 1,310 to 5,766 visits) and nearly 420 percent among those 26 to 34 (from 851 to 3,556) and those 35 and older (from 1,014 to 4,248).
“Stimulant medications are clinically important for ADHD treatment, but when these medications are taken in ways not prescribed, both by oral and non-oral routes, they increase the risk of serious health complications, including death especially when taken intranasally or intravenously,” said Upstate’s Faraone, lead author of the studies. “It is critically important that we educate healthcare providers, patients, parents and the general public about the dangers of misusing and abusing prescription stimulants.”
About the Data Sources
The 12,000-person survey was conducted by Inflexxion, an IBH Company, that specializes in the collection, surveillance, monitoring and analysis of critical public health issues including prescription drug abuse, substance use, behavioral health, and pain management. The data were collected from participants registered for the YouGov survey panel.
The studies included in the literature review were identified by medical database searches from inception of the databases through May 2018. The search identified studies containing empirical data about NMU and diversion of prescription stimulants. Additional relevant references were assessed for inclusion if they were identified during investigators’ review of studies or suggested by authors. Studies evaluating medical outcomes of prescription stimulant NMU were identified by a separate search.