ATLANTA — Patients with attention-deficit hyperactivity disorder who engage in drug diversion or misuse are easy to identify, Timothy Wilens, M.D., said at the annual meeting of the American Psychiatric Association.
To gauge the extent and nature of stimulant misuse and diversion, Dr. Wilens and his colleagues at Massachusetts General Hospital in Boston administered a self-report questionnaire on medication use to young adult patients (average age 20.8 years) receiving stimulant drugs for their condition.
Of the 98 patients, 55 had concomitant conduct disorder and/or substance abuse problems. Approximately 11% of the patients surveyed reported selling their medication, and 22% acknowledged deliberate misuse—either by taking more than their prescribed dose or by adding a later dose—primarily to enhance performance or to “get high,” Dr. Wilens said.
All of the patients who sold their drugs had either a conduct or substance abuse disorder, as did all but 5% of those who misused their medication.
Among those who diverted medications, 83% had a substance abuse history, and 30% had comorbid conduct disorder. Among those who misused their medications, 75% had a substance abuse history, and 59% had comorbid conduct disorder.
Those patients taking intermediate-acting formulations of stimulants were more likely to engage in drug diversion or misuse.
No diversion or misuse occurred with extended-release formulations.
“There are a few take-home messages from these findings,” Dr. Wilens noted.
“First is that the majority of ADHD drugs are used appropriately. Diversion and misuse does occur, but not that often,” he said.
In addition, the young people most likely to misuse or divert their medication are easily identifiable in practice because of the concomitant problems.
Particular attention should be paid—looking out for warning signs such as early or too frequent refills—to this subset of patients to make sure medication is being used as directed, Dr. Wilens said.
One option for reducing the risk of misuse or diversion of medications is to start patients with a history of substance abuse or conduct disorder on nonstimulant medications.
If the nonstimulants don't work, “consider extended-release formulations of stimulant drugs, because diversion and misuse occur primarily with shorter-acting formulations,” Dr. Wilens said. “The extended-release drugs are less popular because they don't produce the same high.”
Clinicians should also be talking to all ADHD patients about misuse and diversion, the importance of keeping the medication in a safe place, and being careful who knows about it. “In particular, patients who live in a college dormitory or who share living arrangements should be advised to keep their medication in a secure place, such as a locked cabinet, to prevent it from being taken and diverted,” he said.