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

J Am Acad Child Adolesc Psychiatry

Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.

Published: January 2008

AI Article Synopsis

  • This systematic review examines the misuse and diversion of stimulant medications among adolescents and young adults, focusing on both those with ADHD and without.
  • Researchers analyzed 21 studies with over 113,000 subjects, revealing nonprescribed stimulant use rates ranging from 5% to 35%, with 16% to 29% of students with prescriptions reported to divert their medications.
  • Key risk factors for misuse include demographic traits like being white, involvement in fraternities/sororities, and having lower academic performance, all of which highlight the importance of monitoring and educating high-risk individuals about the dangers of stimulant misuse.

Article Abstract

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.

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http://dx.doi.org/10.1097/chi.0b013e31815a56f1DOI Listing

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