Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies

Abstract

Objective: To review all literature on the nonmedical use (NMU) and diversion of prescription stimulants to better understand the characteristics, risk factors, and outcomes of NMU and to review risk-reduction strategies. Method: We systematically searched PubMed, PsycINFO, and SCOPUS from inception to May 2018 for studies containing empirical data about NMU and diversion of prescription stimulants. Additional references identified by the authors were also assessed for inclusion. Results: A total of 111 studies met inclusion criteria. NMU and diversion of stimulants are highly prevalent; self-reported rates among population samples range from 2.1% to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to describe NMU, and most studies have examined college students. Although most NMU is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or minor, medical effects; however, adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes. Although academic and occupational performance enhancement are the most commonly cited motivations, there is little evidence that academic performance is improved by NMU in individuals without attention-deficit/hyperactivity disorder. Conclusion: NMU of stimulants is a significant public health problem, especially in college students, but variations in the terms used to describe NMU and inconsistencies in the available data limit a better understanding of this problem. Further research is needed to develop methods to detect NMU, identify individuals at greatest risk, study routes of administration, and devise educational and other interventions to help reduce occurrence of NMU. Colleges should consider including NMU in academic integrity policies.

Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement

“…The increase in ADHD medication prescription in the UK over the last two decades has been a cause of national concern, provoking responses from health and educational representatives (36,37). Concerns have also been expressed around the potential diversion and misuse of ADHD medication as a "study drug" (38). This leads to short-sighted calls to curtail prescriptions, but risks unfairly penalizing those who genuinely need ADHD medication.…”

Why Parents Misuse Prescription Drugs to Enhance the Cognitive Performance of Healthy Children: The Influence of Peers and Social Media

“…While students’ motive to use prescription stimulants nonmedically for better performance while studying has been frequently reported in student samples of different ages (Faraone et al, 2020; Garnier-Dykstra et al, 2012; Rabiner et al, 2009; Schepis et al, 2020; Teter et al, 2020), parents’ willingness to initiate such behavior and the etiology behind their decision-making have rarely been studied. To the best of our knowledge, this is the first set of theory-driven research experiments investigating parents’ willingness to give CE to healthy children and the question of the drivers that lead parents to do so.…”

Neuroenhancement as Instrumental Drug Use: Putting the Debate in a Different Frame

“…A very recent systematic review of nonmedical prescription stimulant use found already 111 studies meeting the inclusion criteria (23). But just like Smith and Farah before, Faraone and colleagues found much variance between the publications in terms of definitions used to investigate nonmedical use, methodologies, and samples, which made a formalized meta-analysis impossible.…”

“…Summarizing all the data, males, 18-25 year-olds, whites, fraternity/sorority members, students with worse grades, people who had been binge drinking in the last month, had used marijuana or nonprescription stimulants (e.g. MDMA or methamphetamine) in the past year, had had adverse childhood experiences, and have not grown up with both biological parents were most likely to use prescription stimulants (23). The authors conclude that this use is a significant public health problem, but that it has not reached epidemic proportions like nonmedical opioid use in the United States.…”