Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication

Substance Abuse Research Center, University of Michigan, Ann Arbor 48105-2194, USA.
Journal of psychoactive drugs (Impact Factor: 1.1). 04/2006; 38(1):43-56. DOI: 10.1080/02791072.2006.10399827
Source: PubMed


The objective of this study was to examine the prevalence and factors associated with the illicit use of prescription stimulants and to assess the relationship between the medical and illicit use of prescription stimulants among undergraduate college students. A Web survey was self-administered by a random sample of 9,161 undergraduate students attending a large public midwestern university in the spring of 2003. A total of 8.1% reported lifetime illicit use of prescription stimulants and 5.4% reported past year illicit use. The number of undergraduate students who reported illicit use of prescription stimulants exceeded the number of students who reported medical use of prescription stimulants for ADHD. The leading sources of prescription stimulants for illicit use were friends and peers. Multivariate logistic regression analyses revealed several risk factors for illicit use of prescription stimulants such as being male, White, member of a social fraternity or sorority, Jewish religious affiliation, and lower grade point average. All of these characteristics were also related to medically prescribed use of prescription stimulants. Those who initiated medically prescribed use of prescription stimulants for ADHD in elementary school were generally not at increased risk for illicit use of prescription stimulants or other drugs during college as compared to those who were never prescribed stimulant medication. The present study provides evidence that the illicit use of prescription stimulants is a problem among undergraduate college students, and certain subgroups appear to be at heightened risk.

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Available from: Sean Esteban McCabe, Mar 16, 2014
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    • "The potential for abuse of pharmaceutical stimulants has led to concerns regarding the risk for diversion and misuse.103–105 Several studies have investigated the prevalence of non-prescribed use of stimulants in postsecondary students with and without ADHD.35,87,104,106–117 Within the college and university student population, life-time prevalence rates of non-prescribed stimulant use is in the range 5%–43%, and past-year prevalence rates in the range 5%–6% have been reported, with prevalence rates peaking in those aged 16–24 years.87,117,118 "
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    ABSTRACT: A PubMed review was conducted for papers reporting on attention-deficit/hyperactivity disorder (ADHD) in postsecondary students. The review was performed in order to determine the prevalence and symptomatology of ADHD in postsecondary students, to examine its effects on academic achievement, and discuss appropriate management. The prevalence of ADHD symptoms among postsecondary students ranges from 2% to 12%. Students with ADHD have lower grade point averages and are more likely to withdraw from courses, to indulge in risky behaviors, and to have other psychiatric comorbidities than their non-ADHD peers. Ensuring that students with ADHD receive appropriate support requires documented evidence of impairment to academic and day-to-day functioning. In adults with ADHD, stimulants improve concentration and attention, although improved academic productivity remains to be demonstrated. ADHD negatively impacts academic performance in students and increases the likelihood of drug and alcohol problems. Affected students may therefore benefit from disability support services, academic accommodations, and pharmacological treatment.
    Neuropsychiatric Disease and Treatment 09/2014; 10:1781-91. DOI:10.2147/NDT.S64136 · 1.74 Impact Factor
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    • "We also found that a small number of subjects were responsible for a disproportionately large number of shopping episodes, which likely also represents diversion of ADHD medications. A survey of undergraduate students found that their leading source of ADHD medications for non-medical use was friends and peers [20]. "
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    ABSTRACT: Objective Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as ‘doctor shopping’, may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior. Methods This was a retrospective cohort study in a pharmacy database—LRx—covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings. Results We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10–39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants. Conclusions Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.
    Drugs in R & D 08/2014; 14(3). DOI:10.1007/s40268-014-0058-4 · 1.71 Impact Factor
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    • "In order to examine the expectancy challenge as a prevention effort, inclusion criteria required that participants report lifetime nonuse of any prescription stimulant medication, though they also were required to endorse at least two relevant risk factors for NPS. These risk factors included involvement in a fraternity or sorority (McCabe et al., 2005; Shillington et al., 2006), GPA below 3.5 (Teter et al., 2005; McCabe et al., 2006), at least one episode of binge drinking in the past 2 weeks (Herman-Stahl et al., 2007; McCabe et al., 2005; Shillington et al., 2006), and past-month cannabis use (McCabe et al., 2005). The remaining eligibility criteria included age between 18 and 25 years and current enrollment in college, which are additional risk factors for NPS (Johnston et al., 2005; Kroutil et al., 2006). "
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    ABSTRACT: Background: College students continue to report nonmedical prescription stimulant use to enhance alertness and concentration. Despite increasing prevalence of this behavior, techniques for preventing or treating it are lacking. An intervention that focuses on challenging positive consequence-oriented beliefs about prescription stimulants may be efficacious in preventing use. Methods: The current study examined the efficacy of a randomized controlled expectancy challenge intervention to prevent nonmedical prescription stimulant use among 96 at-risk, stimulant-naïve college students (i.e., low grade point average, Greek involvement, binge drinking, cannabis use). Forty-seven participants completed a brief expectancy challenge intervention aimed at modifying positive expectancies for prescription stimulants, to consequently deter initiation of use. The remaining participants received no intervention. Results: The expectancy challenge successfully modified expectancies related to prescription stimulant effects. Nevertheless, this intervention group and a control group showed comparable rates of nonmedical prescription use at 6-month follow-up. However, negative expectancies were significant predictors of reduced odds of future use. Conclusions: A challenge session appears to modify stimulant-related expectancies, which are related to nonmedical prescription stimulant use. Nevertheless, a more potent challenge or booster sessions might be essential for longer-term changes.
    Drug and alcohol dependence 04/2013; 132(1-2). DOI:10.1016/j.drugalcdep.2013.03.003 · 3.42 Impact Factor
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