Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students

Abstract

Background and Objectives The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co‐occurring substance use disorders (SUD) compared with those without co‐occurring SUDs. Methods Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ2 test, and the Wilcoxon rank‐sum test. Results College students who endorsed NMUPS with co‐occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use. Discussion and Conclusions Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants. Scientific Significance The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476–484)

Characterizing prescription stimulant nonmedical use (NMU) among adults recruited from Reddit

“…Concurrent substance use with prescription stimulant NMU has been reported previously ( Compton et al, 2018 , Faraone et al, 2019 , Schepis et al, 2020 , Arria et al, 2013 , Wilens et al, 2020 , McCabe et al, 2015 ). In particular, alcohol and prescription stimulant use among college students was associated with negative outcomes ( Schepis et al, 2019 ).…”

Intranasal Use of Prescription Stimulants Among Adults Aged 18 to 30: Results From A Crowdsourcing Platform

“…Prescription stimulant NMU has been associated with a number of risks that have been epidemiologically reported including behavioral risks such as possible off-label use (Burcu et al, 2016), diversion (Compton et al, 2018; Han et al, 2017), or dating violence (Whiteside et al, 2015), health risks such as aortic dissection (Westover & Nakonezny, 2010), acute myocardial infarction (Westover et al, 2008), or psychiatric disorders (Wilens et al, 2020) among others (Faraone et al, 2019, 2020). While the existence of non-oral NMU is well-documented, details surrounding use with specific routes of administration (ROAs) are less well understood.…”

“…Reports of NMU persist in the scientific literature and in the popular press (Arria et al, 2011; Faraone et al, 2020; Friedman, 2010; Garnier-Dykstra et al, 2012; Italiano, 2011; McCabe & West, 2013; McCabe et al, 2004, 2005, 2006b, 2009; Peltz, 2012; Pratt-Kielley, 2020; Schepis, Ford et al, 2020; Schepis, Klare et al, 2020; Swanson & Volkow, 2008; Wilens et al, 2020). Prescription stimulant NMU has been associated with a number of risks that have been epidemiologically reported including behavioral risks such as possible off-label use (Burcu et al, 2016), diversion (Compton et al, 2018; Han et al, 2017), or dating violence (Whiteside et al, 2015), health risks such as aortic dissection (Westover & Nakonezny, 2010), acute myocardial infarction (Westover et al, 2008), or psychiatric disorders (Wilens et al, 2020) among others (Faraone et al, 2019, 2020). While the existence of non-oral NMU is well-documented, details surrounding use with specific routes of administration (ROAs) are less well understood.…”

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

“…Participants were recruited because they had used prescription stimulants non-orally, a risk factor for substance use severity (57,66). For example, the speed of transition from first use to daily heroin was faster if the initial use was non-oral (injection) (58).…”

“…Prescription stimulant NMU route of administration transitions may include moving between oral and non-oral routes of administration (26,60). Prescription stimulant substance transitions would involve moving on to other substances after prescription stimulant NMU, a trajectory that is possible among individuals with polysubstance use; a characteristic reported in individuals endorsing prescription stimulant NMU (61)(62)(63)(64)(65)(66).…”