Diagnoses of attention-deficit/hyperactivity disorder (ADHD) and the prescribing of stimulants as treatment for it have increased substantially in the U.S. over the past two decades. Recent estimates indicate that one in every nine 12th graders report lifetime stimulant therapy for ADHD. As diagnoses and prescriptions rise, so does prescription abuse. A recent study shows that more middle and high school students are misusing ADHD drugs.
The study (published in the JAMA Network Open journal) was based on survey results. Researchers at the University of Michigan examined data collected from 2005-2020 by Monitoring the Future, a federal survey measuring drug/alcohol use in schools. It surveyed more than 231,000 students in 8th, 10th, and 12th grades, across more than 3,200 American schools. Questionnaires were given to students to determine levels of non-medical use of prescription stimulants (NUPS).
Respondents were told that stimulant medications are prescribed for people with ADHD who have problems concentrating, with being too active or disruptive (hyperactive), or both. They were given a list of stimulant medications: amphetamine, methylphenidate, Ritalin, Adderall, Concerta, Metadate, Dexedrine, Focalin, and Vyvanse. They were asked: “On how many occasions (if any) have you taken amphetamines or other prescription drugs on your own — that is, without a doctor telling you to take them…in your lifetime? During the last 12 months? During the last 30 days?”
The researchers accounted for self-reported demographic data like race, sex, ethnicity, GPA and parental education. In addition to NUPS, the researchers also identified factors like substance use (binge drinking, cigarette smoking). They examined previously neglected factors like school size and geographic location, as well as school “urbanicity” (rural, urban, suburban, etc.).
“This is the first national study to look at the nonmedical use of prescription stimulants by students in middle and high school, and we found a tremendous, wide range of misuse,” said lead author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan. As much as 25% of students admitted misuse of stimulants.
The results were sobering, finding a wide variation in rates of prescription usage. At some schools, up to 25% of students reported misusing ADHD drugs. Schools surveyed in more recent years — from 2015 to 2020 — had higher rates of misuse than those surveyed in earlier years. This indicates that stimulant abuse is rising over time (which coincides with a nationwide shortage of drugs like Adderall).
At schools where more of the student body was being treated for ADHD, non-medical use also increased. Students at schools with the highest rates of ADHD prescription treatment had a 36% greater chance of misusing stimulants. Suburban schools (in every region but the Midwest) had higher rates of misuse. And schools with higher population of white students also reported higher rates of non-medical use (NUPS).
Students who had used marijuana in the past 30 days were four times more likely to use stimulant drugs non-medically. Higher prevalence of binge drinking was also correlated with increased NUPS. Prior studies indicate that students may use stimulants in conjunction with alcohol or other drugs to boost a high.
But students largely use stimulants to improve academically. Dr. Robert Bassett, the associate medical director of the Poison Control Center at the Children’s Hospital of Philadelphia, said there’s a misperception that prescription stimulants can “help garner an advantage and help improve academic performance or memory or stamina.” They will “use a pill that someone gave them due to a sense of stress around academics — they are trying to stay up late and study or finish papers,” said pediatrician Dr. Deepa Camenga.
But that usage comes with risks. Stimulants are safe and effective treatments when used properly. But non-medical use over time can result in stimulant use disorder, leading to anxiety, depression, psychosis and even seizures. Dr. Bassett also warned that NUPS can also lead to increased heart rate and blood pressure, along with neuropsychiatric complications.
“This study is a major wake-up call,” Dr. McCabe said. He added that parents of children with ADHD should talk to them about how to properly manage their medication, including talking with them about what to do if someone else asks to use their prescription.
“It’s important to intervene while kids are still looking at these as medications rather than drugs of misuse,” he said.