Misuse of ADHD Medications Linked to Other Drug Issues

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Amelia Arria, PhD

The pressure to excel academically in college has led many students and their families to link low grades to Attention Deficit Hyperactivity Disorder (ADHD) and seek stimulants as a treatment. A Saturday Symposium will examine the issues related to stimulant misuse among adolescents and college students, including sharing and/or selling prescribed stimulants.

“Many clinicians are looking for guidance on the management of individuals with ADHD who may be at risk for diverting their medications. We will talk about how to detect individuals who may be at risk for diversion, and we will urge physicians to have that discussion with their patients about diversion and its risks,” said Amelia Arria, PhD.

Dr. Arria is one of the presenters at Symposium 7, “Prescription Stimulant Use and Misuse Among Youth: Review and Practice Implications,” which will be presented from 2 to 4 pm Saturday in Orange Ballroom A, Lower Level.

Speakers will discuss the epidemiology and risk factors associated with prescription stimulant misuse, the pharmacology and efficacy evidence of stimulants for the treatment of ADHD in youths and young adults, potential risks and negative consequences of the misuse of stimulants, the utility of stimulant medication for substance-abusing ADHD populations, and clinical strategies to prevent and minimize diversion and misuse.

There are two concerns when patients divert their medications—it disrupts the patient’s ADHD treatment and the person receiving the medication without a physician’s guidance can be problematic, said Dr. Arria, Associate Professor of Public Health and Director of the Center on Young Adult Health and Development, both at the University of Maryland.

“Nonmedical use of prescription drugs is a serious problem and has become part of the drug landscape for young people,” she said. “But
we have made progress. It does not look like the nonmedical use of prescription stimulants is rising. It appears to be falling in every group other than high school seniors.

“Through our research, we found that one of the purported motives for using these prescription stimulants is to improve academic performance—to improve focus, to stay awake longer to study. But use does not result in better academic performance. It’s not a ‘smart drug.’”

When prescribed by a physician, stimulants are effective for the treatment of ADHD, but nonmedical use of prescription stimulants is problematic.

“When you look at nonmedical users, what you find is a higher likelihood of a history of excessive drinking and other drug involvement, in particular marijuana,” Dr. Arria said. “What has probably led to a decrease in academic performance is the use of other drugs, not sleeping, and not going to class. Students are staying up, trying to cram, and as a result of their declining academic performance they might be using prescription stimulants as a shortcut to compensate for that behavior.”

Another speaker, Timothy Wilens, MD, will talk about his experiences managing students with ADHD. He is an Associate Professor of Psychiatry at Harvard Medical School and Director of Substance Abuse Services in Pediatric Psychopharmacology and the Center for Addiction Medicine, both at Massachusetts General Hospital.

Drug testing is good clinical practice for students who are prescribed ADHD medications because you want to rule out that their attention problems might be related to other drug use.

“On the flip side, if a student not previously diagnosed with ADHD is asking for prescription stimulants, a comprehensive assessment is required  to find out whether there are signs of academic performance difficulties, and the extent of drinking and other drug use. In that way, the physician is better informed when making clinical decisions about how to best help their patients.”