From the University of South Carolina, Columbia, SC.
Abstract
Objective: To provide a summary of the existing research on the characteristics of college students who report misusing prescription stimulant medications, to offer a set of clinical recommendations for practitioners, and to offer several possible prevention strategies.
Methods: Literature review and research-based recommendations for clinical practice and prevention.
Results: Misuse of prescription stimulant medication among college students is a prevalent and growing problem. Significant risk factors for misuse of stimulant medication include being male, being a member of a college sorority or fraternity, struggling academically, having elevated symptoms of ADHD and/or depression, being a high sensation-seeker, and using/misusing alcohol, cigarettes, and/or other illicit drugs. Health care providers, particularly those that see adolescent or college-aged individuals, need to be informed about stimulant medication indications, risks, benefits, and side effects and aware and attuned to problems associated with stimulant medication diversion and misuse. Suggestions for preventing misuse and diversion of prescription stimulant medications, including strategies for the individual and potential policy changes on college campuses, are offered.
Conclusions: Misuse and diversion of prescription stimulant medications is a growing concern among adolescents and young adults and should be addressed by health care practitioners. Additional research on effective intervention and prevention strategies is needed.
Prescription stimulant medications (eg, methylphenidate, amphetamines) are typically used for the treatment of attention-deficit/hyperactivity disorder (ADHD) to increase attentiveness, decrease distractibility, and improve daily functioning. Prescriptions for stimulant medications are on the rise; between 2002 and 2010, the number of prescriptions for ADHD medications for youth under 18 increased 46% [1].
A recent review of ADHD diagnosis among college students estimated a prevalence rate of 2% to 8% [2]. More individuals with ADHD are matriculating to college than in the past [3,4], as more supports have been put in place for college students diagnosed with ADHD, including improved educational/organizational treatments and accommodations [2]. Many college students with ADHD also use prescription stimulant medications as part of their treatment plan; McCabe, Teter, and Boyd reported that 2.2% of college students had prescriptions for stimulant medications annually [5].
As the number of individuals of all ages with stimulant medication prescriptions increase, more individuals without prescriptions are gaining access to stimulant medications. In a survey of college students with medication prescriptions, stimulants were the most commonly diverted medication, with 61.7% of students with these prescriptions reporting having shared or sold their medication at least once [6]. Studies report that as many as 43% of college students have misused stimulant medication in their lifetime [7], though prevalence rates vary by study. Throughout this review, “misuse of stimulant medication” refers to using prescription stimulant medications without a prescription or using more stimulant medication than prescribed (ie, a higher or more frequent dosage).
Given the ease with which college students are able to obtain stimulant medications, the alarming prevalence of stimulant medication misuse among this population, and the potentially serious health risks associated with misuse of stimulant medication (especially when combined with other substances, such as alcohol, that are commonly used by college students), there is a need to both better understand and ultimately reduce the misuse of stimulant medication among college students. Thus, the purpose of this paper is threefold. First, we provide a summary of the existing research literature on the characteristics of college students who report misusing stimulant medication. Second, we offer a set of clinical recommendations for practitioners, which includes stimulant medication indications, risks, benefits, and side effects, along with problems associated with stimulant medication diversion and misuse. Finally, we offer several prevention strategies, including strategies for the individual as well as several suggestions for changing policies on college campuses to prevent stimulant diversion and misuse. Importantly, although our literature review addresses prescription stimulant misuse among college students, our clinical recommendations are also appropriate for adolescents and young adults not enrolled in college.
