REVIEW
Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature

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ABSTRACT

Objective

Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals.

Method

We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search.

Results

We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, ā€œget high,ā€ or to experiment.

Conclusions

The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.

Section snippets

METHOD

We conducted a systematic literature search of all of the available studies looking at patterns of misuse and diversion of prescription ADHD medications. We searched journal articles through PubMed at the National Library of Medicine using misuse, diversion, stimulants, illicit use, and ADHD medications as key words and searched from 1995 to 2006. These data were supplemented with data from one presentation at a national scientific meeting, obtained outside the systematic literature search

RESULTS

In all, using our search parameters, we identified 21 studies including 113,145 study participants. Nineteen studies were survey studies, one study was by direct structured interviews of the subjects, one study included data collected using survey and direct interviews, and one study was a chart review. Studies included participants from elementary, junior, or senior high school students (n = 4), college students (n = 12), or mixed age groups (n = 6). Ascertainment of studies was from school or

DISCUSSION

The results of our systematic evaluation of the literature appears to suggest that despite the well-documented safety profile of the stimulants used in the treatment of ADHD,10, 11 consistent evidence of misuse of stimulants in older adolescent and college-age students with and without ADHD exists.20, 23, 25, 26, 29, 36, 37, 44, 45, 46 Minimal literature exists on the diversion of medication from those with ADHD to others.23, 36 There is a higher risk for stimulant misuse and diversion in

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    This study was funded by grants fromthe National Institute of Drug AbuseU10 DA15831 and U10 DA13046, (Dr. Roger Weiss, PI); R01 DA012945 and K24 DA016264 (Dr. Timothy Wilens, PI).

    Disclosure: Dr. Wilens has received research support from, has been a speaker for and served on the advisory boards of Abbott, Ortho-McNeil, Eli Lilly, GlaxoSmithKline, Merck, National Institute on Drug Abuse, Neurosearch, Novartis, Pfizer, and Shire. Dr. Adler receives and has received research support from, is and has been a speaker for, or is and has been on the advisory boards of Abbott, Bristol-Myers Squibb, Cephalon, Cortex, Eli Lilly, National Institute of Drug Abuse, Neurosearch, Novartis, McNeil/J & J, Merck, Organon, Pfizer, and Shire. The other authors report no conflicts of interest.

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