Upstate Study Finds Misuse of Stimulant Medication When Snorted, Injected Has Most Severe Health Consequences

Newswise — A study evaluating the prevalence and clinical consequences of prescription amphetamine (AMP) misuse among adolescents and adults was presented Oct. 25 by Stephen Faraone, PhD, Distinguished Professor of Psychiatry and Neuroscience & Physiology at SUNY Upstate Medical University at the American Academy of Child and Adolescent Psychiatry’s (AACAP) 65th annual meeting in Seattle.

The study evaluated data from the U.S. National Poison Data System (NPDS) to assess the impact of exposure to a prescription AMP misuse via oral and non-oral routes of administration in 6,163 adolescents (aged 12-18 years) and 9,713 adults (aged ≥ 18 years). Administration route and reason for exposure were used to define three abuse groups (IV abuse, n=164; intranasal abuse, n=598; oral abuse, n=11,161) and a non-abuse control group who reported unintentional oral exposure to AMP (n=3,953).

“Stimulant medications, when used as prescribed, are very important treatment options for patients with ADHD, but they can be diverted and abused for non-medical use,” said Upstate’s Faraone, the lead author of the study. “Misuse by any route of administration can be dangerous but as this study suggests, severe medical outcomes occur when people snort or inject stimulant medication. For example, this study demonstrated that those who intentionally abused AMP by injecting were at increased risk to be admitted to the critical care unit or die.”

Results from the study demonstrated that oral and non-oral abuse of AMP were associated with higher odds of morbidity and mortality. AMP abusers had higher odds of admission to a health care facility as compared to non-abusers (IV: odds ratio [OR] 7.8 [Standard Error (SE) 0.17]; Intranasal: OR 3.48 [SE 0.09]; Oral: OR 6.6 [SE 0.043]; p<0.0001).  Odds of admission to critical care units and psychiatric units were also increased for abusers versus non-abusers.

Additionally, IV abusers had the greatest mean number of adverse clinical effects (2.95), followed by Intranasal (2.46) and Oral (2.17) abusers. IV abusers followed by intranasal abusers had a higher incidence of major medical outcomes reported vs Oral abusers (13.41%, 5.52% and 4.48% respectively). IV and Intranasal abusers were approximately 21.9 and 13.2 times more likely to die respectively versus the nonabuse group (P=0.014 and P=0.03). Oral abusers had a significantly greater risk of suicide attempts (71.4%), compared with IV (20.7%) and Intranasal (15.6%) abusers (p<0.0001).

The study was funded by Arbor Pharmaceuticals, LLC.

About Stimulant Abuse

Current guidelines and expert opinion emphasize the clinical importance of treating ADHD and the role of stimulant medications in the treatment paradigm. While therapeutically effective, stimulants, such as amphetamine, have the potential for abuse, misuse, dependence and diversion.  Data suggest that the rates of abuse and misuse are rising, carrying risks of serious medical outcomes. The National Surveys on Drug Use and Health (NSDUH) indicate that the majority of prescription stimulant misuse occurs during adolescence and young adulthood.1 While oral abuse is most common, non-oral use, including intranasal (snorting) and intravenous use, occurs with intranasal administration reported as high as 40% among those who misuse/abuse.2,3,4 The most commonly reported primary source for abused stimulants is generally family or friends.4, 5, 6,7

1.    Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Detailed Tables. 2017. Substance Abuse and Mental Health Services Administration, Rockville, MD.
2.    Teter CJ et al. Pharmacotherapy. 2006;26:1501-10.
3.    White BP et al. J Am Coll Health. 2006;54:261-8.
4.    Cassidy TA et al. J Atten Disord. 2015;19:275-83.
5.    Novak SP et al. Subst Abuse Treat Prev Policy. 2007;2:32.
6.    Arria AM et al. Pharmacotherapy. 2008;28:156-69;
7.    DeSantis AD et al. J Am Coll Health. 2008;57:315-24