Psychostimulants and college students: 7 steps to prevent misuse

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In a survey of 115 college students taking medication for attention-deficit/hyperactivity disorder (ADHD), 31% reported having taken their drugs more frequently or at a higher dose than prescribed, or used someone else’s medication since beginning college.¹ Fifty-six percent reported being asked to give or sell their medication in the past 6 months; 26% of those solicited gave or sold their medication to a peer.¹ The 3 most frequently reported reasons for misusing ADHD medications centered on studying: to improve concentration, to lengthen study time, and to feel less restless while studying.¹

Although treating ADHD with first-line stimulants may reduce the incidence of substance use disorders,^2,3 monitor patients closely to ensure therapeutic drugs are not being misused or abused.

1. Use screening tools such as the CRAFFT test⁴ for adolescents and the 5-question RAFFT test for adults.⁵ Also, consider toxicology screenings.
2. Consider extended-release formulations, which can reduce recreational stimulant use because subjective likeability is more strongly influenced by the drug delivery rate than by plasma concentration.
3. Consider other medications/formulas such as a transdermal patch delivery of methylphenidate or prodrug formulations such as lisdexamfetamine, which is gut enzyme-dependent to hydrolyze into lysine and d-amphetamine. Also, consider nonstimulants such as atomoxetine, bupropion, or tricyclic antidepressants.
4. Rule out mood disorders, especially depression, which may be driving the urge to get “high.”
5. Involve family members or other forms of supervision, who may be able to better monitor medications.
6. Improve physician/patient communication because active physician involvement and better patient communication about treatment-related issues is better for all involved.
7. Provide triplicate prescriptions in person to avoid “prescriptions lost in the mail,” and keep a log of all prescriptions you dispense.

Disclosure

Dr. Jain reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Discuss this article at www.facebook.com/CurrentPsychiatry

In a survey of 115 college students taking medication for attention-deficit/hyperactivity disorder (ADHD), 31% reported having taken their drugs more frequently or at a higher dose than prescribed, or used someone else’s medication since beginning college.¹ Fifty-six percent reported being asked to give or sell their medication in the past 6 months; 26% of those solicited gave or sold their medication to a peer.¹ The 3 most frequently reported reasons for misusing ADHD medications centered on studying: to improve concentration, to lengthen study time, and to feel less restless while studying.¹

Although treating ADHD with first-line stimulants may reduce the incidence of substance use disorders,^2,3 monitor patients closely to ensure therapeutic drugs are not being misused or abused.

1. Use screening tools such as the CRAFFT test⁴ for adolescents and the 5-question RAFFT test for adults.⁵ Also, consider toxicology screenings.
2. Consider extended-release formulations, which can reduce recreational stimulant use because subjective likeability is more strongly influenced by the drug delivery rate than by plasma concentration.
3. Consider other medications/formulas such as a transdermal patch delivery of methylphenidate or prodrug formulations such as lisdexamfetamine, which is gut enzyme-dependent to hydrolyze into lysine and d-amphetamine. Also, consider nonstimulants such as atomoxetine, bupropion, or tricyclic antidepressants.
4. Rule out mood disorders, especially depression, which may be driving the urge to get “high.”
5. Involve family members or other forms of supervision, who may be able to better monitor medications.
6. Improve physician/patient communication because active physician involvement and better patient communication about treatment-related issues is better for all involved.
7. Provide triplicate prescriptions in person to avoid “prescriptions lost in the mail,” and keep a log of all prescriptions you dispense.

Disclosure

Dr. Jain reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Discuss this article at www.facebook.com/CurrentPsychiatry

In a survey of 115 college students taking medication for attention-deficit/hyperactivity disorder (ADHD), 31% reported having taken their drugs more frequently or at a higher dose than prescribed, or used someone else’s medication since beginning college.¹ Fifty-six percent reported being asked to give or sell their medication in the past 6 months; 26% of those solicited gave or sold their medication to a peer.¹ The 3 most frequently reported reasons for misusing ADHD medications centered on studying: to improve concentration, to lengthen study time, and to feel less restless while studying.¹

Although treating ADHD with first-line stimulants may reduce the incidence of substance use disorders,^2,3 monitor patients closely to ensure therapeutic drugs are not being misused or abused.

1. Use screening tools such as the CRAFFT test⁴ for adolescents and the 5-question RAFFT test for adults.⁵ Also, consider toxicology screenings.
2. Consider extended-release formulations, which can reduce recreational stimulant use because subjective likeability is more strongly influenced by the drug delivery rate than by plasma concentration.
3. Consider other medications/formulas such as a transdermal patch delivery of methylphenidate or prodrug formulations such as lisdexamfetamine, which is gut enzyme-dependent to hydrolyze into lysine and d-amphetamine. Also, consider nonstimulants such as atomoxetine, bupropion, or tricyclic antidepressants.
4. Rule out mood disorders, especially depression, which may be driving the urge to get “high.”
5. Involve family members or other forms of supervision, who may be able to better monitor medications.
6. Improve physician/patient communication because active physician involvement and better patient communication about treatment-related issues is better for all involved.
7. Provide triplicate prescriptions in person to avoid “prescriptions lost in the mail,” and keep a log of all prescriptions you dispense.

Disclosure

Dr. Jain reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.