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As recently as 10-15 years ago, there was relatively little concern about ADHD medications being diverted, i.e., being given away or sold to those without prescriptions. Currently, however, the misuse and abuse of ADHD medications has become an important concern and it is clear that such diversion is not uncommon.  One setting where the widespread misuse of ADHD medications has been reported to occur is on college campuses, and you have probably seen a number of articles in the media about this issue.

In a prior issue of Attention Research Update - www.helpforadd.com/2007/december.htm - I summarized results from a study my colleagues and I conducted on the nonmedical use of ADHD medication by college students without a prescription.  Key findings from that study - which were based on survey results from over 3400 students attending two universities - included the following:

- Nearly 9% of students reported using ADHD medication without a prescription since beginning college and about 15% of this group had used it more than 10 times during the prior six months.  Most obtained it from peers who had a prescription.

- Use was higher among whites, among fraternity and sorority members, and among students who engaged in illicit substance use.  Students who used also had lower GPAs.

- The most important reason for taking ADHD medication was to enhance the ability to study outside of class.

- Although roughly 25% of non-medical users had used medication to "get high", this was identified as a frequent reason for use by only about 3% of nonmedical users.

- Most students who used ADHD medication non-medically believed that it was helpful.  Over 70% reported that the overall impact was "positive" or "very positive" and fewer than 5% rated the impact as negative. 

- Students who used reported higher rates of attention problems than non-users, suggesting that some students may have turned to ADHD medication to "self-medicate".


- What about misuse by students who have a prescription? -

Although this study is one of a growing number exploring nonmedical use by college students without prescriptions for ADHD medication, the issue of misuse by students with prescriptions has been less frequently examined.  This is unfortunate as such misuse is a concern for many parents of college age students with ADHD and is also an issue of importance to physicians who treat college students.  In a study published in a recent issue of the Journal of Attention Disorders [Rabiner et. al., (2009). The misuse and diversion of prescribed ADHD medication by college students. Journal of Attention Disorders, 13, 144-153] my colleagues and I sought to build on the limited research base in this area. 

Our sample consisted of 115 students participating in the survey study summarized above who reported having a current prescription for ADHD medication.  This represented 74% of the 156 students who reported a current diagnosis of ADHD.  These students responded to a number of questions pertaining to the potential misuse and diversion of their ADHD medication.  The survey was administered via the Internet and was completely anonymous so that students were free to respond in a straight forward, direct manner.

Key findings from this study included the following:


* Frequency of misuse *

- 36 (31%) of students with prescriptions reported using their meds in ways that deviated from how it was prescribed, i.e., taking it more frequently and/or at higher doses, since starting college, including 27 (nearly 25%) who reported doing so during the past 6 months.

- 15 students (13% of those with a prescription) reported using someone's medication in addition to their own.

- Especially concerning is that 8 students - nearly 7% of those with a prescription - reported having crushed and snorted their medication.  Fortunately, no student reported doing this more than twice during the prior 6 months.


* Reasons for misuse *

Students' reasons for misusing their medication were similar to reasons provided by students who used without a prescription.  The most important reasons focused on enhancing academic performance.  Fifty-one percent of students who misused reported doing so exclusively for academic reasons, e.g., to be able to concentrate better while studying, while 49% reported non-academic reasons as well, e.g., to lose weight, to get high.  However, even among these students, non-academic reasons were rarely reported to be a frequent reason for misuse and no student reported misusing their medication solely for non-academic reasons.  Interestingly, however, 22% of students who misused reported that they did so to help themselves 'feel better'.


* Perceived consequences of misuse *

Students who misused their medication to enhance their academic performance generally believed it was helpful.  For example, nearly 75% felt that it helped them to 'study longer', to 'concentrate better while studying', and to 'feel less restless while studying'. 

Despite these perceived positive consequences, students frequently reported adverse effects as a result of misusing.  For example, 51% reported that misusing their meds gave them headaches, 52% reported increased irritability, and 63% reported sleep difficulties.

Only 2 students reported that misusing their ADHD meds contributed to their misusing other prescription drugs, only 1 felt that it contributed to their using illegal drugs, and 1 reported that it resulted in having to visit the emergency room.


* Use of ADHD meds in conjunction with other substances *

Thirty percent of students with a prescription had taken it with alcohol in the past 6 months and most of these had done so multiple times.  Seventeen percent had used their medication along with marijuana but none reported using in conjunction with cocaine.


* Characteristics of students who misused their meds *

Students who misused their meds did not report higher levels of inattentive symptoms than students who used their medication as prescribed; however, they did report higher rates of hyperactive-impulsive symptoms.  They were also more likely to be users of alcohol and illicit drugs and had lower GPAs.  Misuse also tended to be more common among juniors and seniors then among freshmen and sophomores.


* Diversion of ADHD meds *

Over half of students with prescriptions - 56 of the 115 - reported being approached by a peer to give or sell them medication in the past 6 months; most said they had been approached multiple times.  Thirty students - over 25% - had given away or sold their medication at least once.  Diversion was more common among students who misused their medication than among students who used as prescribed.


- Summary and implications -

Result from this study indicate that a substantial minority of college students with a prescription for ADHD medication deviate from taking their medication as prescribed - by taking it at higher doses, at greater frequency, and even using another student's medication.  Although this is concerning, it is important to recognize that most students who misused their ADHD medication did so exclusively in an effort to boost their academic performance, and no students reported misusing their meds for exclusively nonacademic reasons. 

The fact that most misuse of prescribed ADHD medication is motivated by a desire to enhance academic functioning suggests that many students may perceive their treatment to be less helpful than they desire.  For example, students who believe their symptoms are compromising their ability to study effectively may be inclined to experiment with taking higher doses of medication.  Other students may take extra doses to assist with late night studying, as even long-acting medications taken during the day are likely to have worn off by this time, which is prime study time for many students.  In future research it will be important to learn whether physicians who treat college students with ADHD are taking the need for late night symptom coverage into account in their prescribing regime, and doing so in a way that would minimize potential adverse consequences for sleep.

Even though most students misused their medication to study more effectively, several aspects of students' misuse are particularly concerning.  Thus, nearly 8% of the students in our sample reported that they had snorted their medication in the past 6 months, nearly 30% had used it in conjunction with alcohol and 20% had used along with marijuana; these behaviors have potentially negative health consequences that students may not fully understand. 

A particularly concerning finding was that 25% of students had provided their medication to a peer and the majority had been approached to do so.  These findings underscore the need for physicians to discuss issues related to medication diversion with college students and to contract with them about not diverting their medication.  Of course, carefully monitoring what students are doing with their meds is extremely difficulty, particularly when prescribing physicians may often be located in students' home towns rather than where they attend school.

Overall, results from this study underscore that misuse of prescribed ADHD medication by college students is not uncommon, and that a small minority of students are misusing their meds in ways that are potentially dangerous.  These findings highlight the importance of educating college students about the importance of using their ADHD meds are prescribed, monitoring how they feel the medication is working so they are not tempted to experiment with med changes on their own, and cautioning them against diverting their medication to their peers.

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Thanks again to Cogmed for supporting this issue of Attention Research Update

(c) 2009 David Rabiner, Ph.D.

Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice.  Although newsletter sponsors offer products and services that I believe will be of interest to subscribers, sponsorship of Attention Research Update does not constitute a specific endorsement or guarantee of any company's product or services.