In recent years, there has been increasing concern about the misuse and abuse
of stimulant medication prescribed to treat ADHD, and this issue has been
widely reported in the media. For example, the following headlines
recently appeared during a single week in newspapers across the country:
"School Officials Note Student Prescription
"Survey: 1 In 5 Teens Getting High On Medications,
"Students Abuse Adderall To Improve Concentration"
"Emory Limits Prescriptions Of ADHD Drugs"
"Some U. Miami Students Use Drugs To Focus
"Grades By The Milligram"
Such articles provide an important service by drawing attention to a problem
that parents, educators, and healthcare professionals should be aware of.
Many such articles provide little actual data, however, and often contain
nothing more than case histories and include quotes from students along the
lines of "nearly everyone I know is doing this." Anecdotal reports
like these may convey incorrect information about the actual rate of illicit
stimulant medication use and thus scare parents from pursuing what may be
an appropriate treatment option for their child.
How widespread is the problem of illicit stimulant medication use?
How often are students with a prescription for ADHD medication approached
by peers to sell or give away their medication? How often are students
prescribed ADHD medication also taking such medication illicitly, i.e., taking
someone else's medication in addition to their own, or using their own medication
for purposes other than for which it has been prescribed?
Answers to these important questions are found in two recent studies that
surveyed middle, high, and college students about their use of stimulant
medication, as well as other drugs and alcohol. The first study - "The
use, misuse, and diversion of prescription stimulants among middle and high
school students" by McCabe, Teter, and Boyd was published in the journal
Substance Use and Misuse (vol 39, pp. 1095-1116) and examined these issues
in an ethnically diverse sample of 1536 middle and high school students from
a Midwestern public school district. This represented approximately
90% of enrolled students, which is an excellent participation rate.
Data was obtained using an anonymous, web-based survey so that participants
could feel free to respond in an honest manner. Students were asked
specifically about the use of Ritalin, Dexedrine, and Adderall. Because
Concerta, a commonly prescribed stimulant was not included on the list, the
results are likely to somewhat underestimate rates of both prescribed and
illicit stimulant medication use. It is also important to note that
the rate of stimulant medication prescriptions often varies widely from one
area to the next, and because the results were obtained in only a single
location, they cannot be considered nationally representative.
Here is what the authors found:
- Just under 6% of students were either taking
stimulant medication under a doctor's prescription, or had been prescribed
medication in the past. This figure is consistent with current estiamates
of the prevalence of ADHD.
- The illicit use of stimulant medication was reported
by approximately 4.5% of students. This included students who used
stimulants that had not been prescribed as well as students with a prescription
who were also using the medication inappropriately. Unfortunately,
information on the frequency of illicit use, means of administration (swallowing
the pill vs. crushing and snorting), and reasons for use (to study better
vs. to "get high") was not obtained.
- The rate of illicit stimulant medication use
was about 2.5 times higher among males than females. Rates were also
higher among white students compared to black students and among those without
college plans compared to those planning to attend college.
- Of the 99 students who reported taking stimulant
medication prescribed by a physician, 26 also reported the illicit use of
stimulant medication. This is a concerning finding in that it indicates
that more than 1 in 4 students prescribed ADHD meds were either taking other
stimulants in addition to their own, or were misusing the medication they
had been prescribed. Unfortunately, specific details on the nature
of this illicit use were not provided.
- Of students who were prescribed medication, 23.3%
reported being approached to sell, give away, or trade their medication.
Females (29.6%) were more likely than males (20.6%) to be approached in this
manner, as were high school students (46.4%) compared to middle school students
(13.1%). Students without college plans were nearly twice as likely
to report being approached as students with college plans (32.4% vs. 17.9%).
The authors were also interested in learning about other types of substance
use and risky behavior that were associated will illicit stimulant medication
use. Here is what the authors reported:
- Approximately 50% of illicit stimulant medication
users reported smoking cigarettes in the past month or binge drinking in
the prior 2 weeks compared to only 10% of non-illicit users.
- About 50% of illicit stimulant users reported
marijuana use in the past year and more than 25% reported ecstacy use.
In contrast, less than 10% of non-illicit users reported marijuana use and
fewer than 1% reported ecstasy use.
- Nearly 50% of illicit stimulant users reported
being a passenger in a car with a driver who had 5 or more drinks before
driving. The figure for non-illicit users was less than 25%
Although these results clearly indicte that illicit stimulant medication
use often co-occurs with other risky behavior, two points are important to
emphasize. First, there is no way to determine whether the illict use
of stimulants played any role in "causing" increased rates of other alcohol
and substance use. Instead, it is quite likely that students predisposed
to substance use will include stimulant medications in the substances they
Second, the increased rates of drug and alcohol use were only found among
illicit stimulant medication users - both those with and without prescriptions.
Students using their prescribed medications as intended did not differ from
students not receiving stimulant medication on any type of substance use
or risky behavior. Thus, there is absolutely no indication that the
proper medical use of prescription stimulants is associated with greater
use of other substances.
Study 2 - Non-medical use of prescription stimulants
among US college students
How prevalent is the non-medical use of prescription stimulants among college
This question was addressed in a sample of nearly 11,000 students attending
119 nationally representative 4-year colleges in the US (McCabe, et al.,
2005, Non-medical use of prescription stimulants among US college students:
Prevalence and correlates from a national survey. Addiction, 99, 96-106.
The data from this study was collected in 2001.
Two hundred and fifteen students from each college were randomly selected
and sent a 20-page survey to complete. The survey asked questions about
students' use of prescription stimulants, use of other substances, and other
health behaviors. The response rate across the entire sample was 52%,
and ranged from 22-86% at individual colleges. Participants were assured
that their responses would remain completely confidential so that they could
respond in an open and honest manner.
Results of the survey indicated the following:
- Approximately 6.9% of college students reported
non-medical use of prescription stimulants during their lifetime, 4.1% reported
non-medical use in the past year, and 2.1% in the past month.
- Non-medical use was twice as high among males,
and was also substantially higher among white students compared to African
Americans or Asians.
- Fraternity/sorority members reported more than
double the use of non-members.
- Use was higher among those with a GPA of B or
below compared to those with a B+ or above.
- The rate of non-medical use of prescription stimulants
varied dramatically across colleges, ranging from 0% to 25%. At twenty
schools, the reported past-year use was 0; at 12 schools, the rate exceeded
10%. This clearly illustrates how much variability there is across
- Use was highest at colleges with the most competitive
admissions standards and lowest at the least competitive schools. More
than 80% of schools with a past year prevalence rate exceeding 10% had highly
competitive admissions standards and were located in the Northeast or South.
Among all students attending three historically black colleges, not a single
one reported non-medical use of prescription stimulants in the past year.
As with middle and high school students, the illicit use of stimulant medication
was associated with other substance use. Thus, when reporting on their
behavior during the past 30 days, students who used non-prescribed stimulants
were more likely than other students to:
- use cigarettes (67% vs. 24%)
- engage in frequent binge drinking (69% vs. 21%)
- use ecstasy (19% vs. 1%)
- use cocaine (17% vs. 1%)
- drive after binge drinking (35% vs. 9%)
- be the passenger of a drunk driver (66% vs. 21%)
Clearly, the non-prescribed use of stimulant medications is associated with
a range of other substance use and dangerous behavior. As noted above,
there is no way to determine whether stimulant use has any causal relation
to the use of other substances, or whether students who are inclned to use
substances simply choose stimulants as one of the substances that they use.
Although not reported in this paper, another paper by the same research group
indicates that over 50% of non-medical users stated that they use prescription
stimulants to get high. Improving concentration and enhancing alertness
were the other two most commonly cited reasons.
SUMMARY AND IMPLICATIONS
Data from these studies indicate that the illicit use of stimulant medications
is a significant problem among students from middle school through college.
Although the rate of non-prescribed use may be lower than what some articles
in the popular press suggest, the rates found in these studies are alarming
and would translate into thousands and thousands of students nationwide who
are engaging in this behavior.
Several findings seem to be especially noteworthy:
- Middle and high school students with a prescription
for stimulants are at risk for being approached to sell, give, or trade their
medication. Many students may not be able to resist these overtures,
and getting caught engaging in such behavior could have serious consequences.
- Individuals who use stimulants illicitly are
far more likely than others to use other substances. At this point,
we don't know whether illicit stimulant use facilitates the use of other
substances, or is simply part of a general pattern of substance use.
Longitudinal studies will be required to determine this and need to be conducted.
- The rate of illicit stimulant use is quite high
at competitive colleges and many students report using stimulants in order
to get high. It is thus worth noting that some medications used to
treat ADHD are far more difficult to abuse in this way than others.
- Among middle and high school students using stimulant
medications as prescribed, there is no evidence of increased rates of substance
- Approximately 25% of middle and high school students
with a prescription for stimulants were also using medication in inappropriate
ways. This is an especially concerning finding. However, the
extent to which it is representative of the general population of students
with a prescription for stimulants is unclear, as it reflects results obtained
in a single school district. Additional research on this issue should
Perhaps the most important implication of these results is that parents,
educators, and professionals need to be aware that the risk for the misuse
and abuse of ADHD medications is quite real. The authors of the middle
and high school student study note that "Physicians prescribing medication
can play an important role in explaining the abuse potential of diverting
medication to other children." Given the findings reported above, this
should be a routine part of what is conveyed to children and teens who are
prescribed such medication.
Parents, educators, and professionals can and should also educate children/teens
about the appropriate steps to take if they are approached by peers asking
for medication so that they are prepared to deal appropriately with this
situation should it arise. Parents may also with to speak with their
child's physician about medications for ADHD that have the lowest potential
for misuse and abuse and take appropriate steps to make sure that their child's
medication is carefully monitored and is not freely available to their child.
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