Newswise —
A correlation has been found by researchers between the frequency of prescription stimulant treatment for attention-deficit/hyperactivity disorder (ADHD) and the incidence of prescription stimulant abuse (usage not in accordance with a clinician's instructions) by middle and high school students. The JAMA Network Open published the study today, emphasizing the necessity of evaluations and teaching in schools and neighborhoods to stop adolescents from sharing medication. This is especially significant since the misuse of prescription stimulants by teens continues to be more frequent than the abuse of any other prescription medication, such as opioids and benzodiazepines.
Funded by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health and the U.S. Food and Drug Administration, the research utilized information obtained from the Monitoring the Future (MTF) study, which collected data from 2005 to 2020. MTF is a broad, multi-cohort examination of legitimate and illegal drug use among American teens in the 8th, 10th, and 12th grades, also sponsored by NIDA.
According to NIDA Director Nora Volkow, M.D., "The drug supply has undergone a swift transformation, and what appears to be legitimate medication - obtained online or distributed among friends or family - may contain fentanyl or other potent illegal substances that can cause overdoses. It is critical to raise awareness of these new risks for teenagers." She adds, "It is also crucial to provide the appropriate resources and education to prevent misuse and assist teenagers during this crucial phase in their lives when they confront distinct experiences and new sources of stress."
Stimulant therapy is a proven treatment for ADHD, but it can be harmful if used without a prescription or guidance from a clinician. Continued stimulant misuse can result in numerous adverse health consequences, such as cardiovascular issues, depression, overdoses, psychosis, anxiety, seizures, and stimulant use disorder.
Research in the past has demonstrated that over 50% of adolescents who abuse prescription stimulants acquire them at no cost from friends or family. Despite the significant rise in ADHD diagnoses and stimulant prescription therapy in the United States during the last two decades, few studies have investigated the connection between stimulant therapy and prescription stimulant misuse in schools. This is the first comprehensive nationwide study to analyze the incidence of prescription stimulant misuse and the associated factors among eighth, 10th, and 12th-grade students in the United States.
The University of Michigan researchers investigated school- and individual-level factors linked to prescription stimulant misuse. In a survey of 231,141 student participants across 3,284 secondary schools, the prevalence of nonmedical usage ranged from 0% to over 25% of students at the school level. Schools where a greater proportion of students (12% or more) reported taking prescription stimulant therapy for ADHD had higher rates of prescription stimulant misuse among their student population (8% of total student body). In contrast, schools where a smaller proportion of students (0 to 6% of student body) reported taking stimulant therapy for ADHD were linked to lower levels of prescription stimulant misuse (4 to 5% of student body).
Various school characteristics were linked with elevated rates of prescription stimulant misuse, including a higher proportion of parents with advanced education, suburban location, being situated outside the Northeastern region, a greater proportion of non-Hispanic white students, and "medium-level" binge drinking (10-19% of total student body). Nevertheless, even after accounting for other types of substance use and numerous other individual- and school-level sociodemographics, the correlation between school prevalence of stimulant therapy for ADHD and prescription stimulant misuse remained substantial.
Additional research from the same team has explored further the connections identified in this study. For example, one study indicated that teenagers who have previously taken both stimulant and non-stimulant medications for ADHD are at elevated risk for prescription stimulant misuse, as well as cocaine and methamphetamine use. The researchers underscore that it is crucial to interpret these findings as correlations rather than causations, and that the primary aim of such studies is to guide effective preventative and support measures for adolescents.
According to Sean Esteban McCabe, Ph.D., one of the study's authors, the main takeaway from these findings is not that stimulant prescribing for students with ADHD should be reduced, but that we need improved methods to secure, supervise, and test for stimulant accessibility and use among adolescents to prevent misuse. Because stimulant misuse varies across different schools, it is necessary to evaluate schools and execute personalized interventions that are most effective for each school. Additionally, it is essential to treat and educate teenagers on prescription stimulants as the medications they are designed to be, and to restrict their availability as drugs of misuse.
With sadness, NIDA shares that study author and NIDA grantee Dr. John E. Schulenberg passed away in February. Dr. Schulenberg was a member of the Monitoring the Future study’s leadership team for 32 years and has made immense contributions to addiction science that will be remembered and honored.
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Reference: SE McCabe, et al. Prescription stimulant medical and nonmedical use among US secondary school students (2005–2020). JAMA Network Open. DOI: 10.1001/jamanetworkopen.20238707 (2023).
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