A major concern regarding the use of stimulant medications to treat attention-deficit hyperactivity disorder (ADHD) in adolescents and young adults has been the risk that they will be misused or diverted to those for whom they have not been prescribed. A new study from Massachusetts General Hospital (MGH) researchers has found that, while the great majority of young people with ADHD use their medications appropriately, a small percentage are likely to abuse or to sell prescribed stimulants. The report, appearing in the April 2006 Journal of the American Academy of Child and Adolescent Psychiatry, also identifies factors that may characterize those most likely to misuse their drugs and suggests potential strategies to reduce the risk.
"In finding that misuse of stimulants prescribed for ADHD typically takes place in the context of abuse of other substances, our results show remarkable convergence with previous surveys of stimulant abuse among college students," says Timothy Wilens, MD, director of Substance Abuse Services in MGH Pediatric Psychopharmacology, who led the study. "By putting a face on these patients, we can start to address the problem with targeted strategies."
The current investigation enrolled participants in a long-term study of young men treated with medications for a variety of behavioral and psychiatric disorders. Ten years after originally joining that study, 98 participants -- 55 with ADHD and 48 who did not have ADHD -- were interviewed about their overall progress and current symptoms. The young men, with an average age of 21, also completed a confidential questionnaire asking whether they had sold their medications or had misused them -- including taking too much, getting high on their medications, or taking them in combination with alcohol or other substances of abuse -- during the past four years. Of the 98 surveyed participants, 46 also met the criteria for substance use disorder and 21 for conduct disorder.
The results showed that participants with ADHD were more likely than those without ADHD to report misusing their medication, with 11 percent admitting selling their drugs, 22 percent reporting they took too much, 10 percent getting high and 31 percent admitting they had taken their medication along with alcohol or other drugs. Among those without ADHD, none reported selling their medications, 5 percent said they had taken too much or had gotten high, and 25 percent admitted using their medication with other drugs.
All of the ADHD participants who sold their medications also had either substance use disorder or conduct disorder, and 83 percent of those who reported misusing also had one of the other disorders. Another key finding was that immediate release stimulant formulations were most likely to be misused or diverted, while no participant reported misuse or diversion of extended release stimulant medications.
"Now that we know who misuses those drugs and which are most likely to be misused, we can pursue efforts to make sure they are appropriately prescribed and monitored," says Wilens. "Our results strongly signal that we should be more careful about what we prescribe to patients who also have conduct disorder and substance use disorder and also support a higher risk of misuse of immediate release stimulants, which is consistent with other recent studies.
"While we need additional research to make definitive recommendations, from my own experience I'd suggest that physicians prescribe extended release formulations and consider non-stimulant drugs for those at increased risk. And I suggest to my college-age patients that they store their drugs securely, don't advertise that they're taking stimulants and never make them available to others."
Wilens is an associate professor of Psychiatry at Harvard Medical School. His co-authors are Michael Monuteaux, ScD, Allison Swezey, and Joseph Biederman, MD, all of MGH Pediatric Psychopharmacology; and Martin Gignac, MD, of the University of Montreal. The study was supported by grants from the National Institute on Drug Abuse.
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