Stimulant Use Exceptionally High Among Medical Students

Caroline Cassels

February 06, 2013

Medical students are significantly more likely to use prescription stimulant medications to boost academic performance compared with other college students, new research suggests.

A survey conducted in third-year medical students at a single school in the United States showed a lifetime use prevalence of about 20%, a figure that is "distinctly higher" than the average of 6.9% among college students. In addition, the researchers found that the prevalence of stimulant use among medical students while in school was 15%.

"Medical training is a demanding endeavor; students often are pushed to the limits to succeed, and must find ways of copying and adapting. Three-fourths of medical students reported that they believed stimulants could enhance cognitive performance, and 1 in 5 had used them, typically for performance enhancement ," the authors, led by Jadon R. Webb, MD, PhD, Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, write.

The study is published in the February issue of the Annals of Clinical Psychiatry.

Illicit Use

Stimulant use among high school and college students to improve academic performance is widespread, with users reporting that they take the drugs to help keep them awake and to improve their academic focus and performance on exams.

According to the study authors, experimental research shows there may be some truth to these beliefs. Regardless, they note that the illicit use of these drugs is more prevalent in competitive academic environments and during times of increased academic stress.

A few studies have shown that stimulant use is relatively common among dentistry and pharmacy students, but little is known about its use by medical students, for whom it may be particularly relevant.

"Medical students eventually will become the prescribing doctors who dispense these medications, and their personal experience with stimulant use may affect future prescribing trends for children diagnosed with attention-deficit/hyperactivity disorder (ADHD) and students experiencing academic difficulties for other reasons," the investigators write.

Exploring Student Perceptions

To better understand stimulant use in this population, including prevalence and demographic characteristics and how these medications were obtained, the researchers surveyed a cohort of 148 third-year medical students.

The survey, which consisted of 16 multiple choice and free-form questions, was administered to students prior to orientation lectures at a single US medical school.

Stimulants were defined as those typically prescribed for ADHD, including methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine, benzphetamine, lisdexamfetamine, and other medications used to treat ADHD or sleep disorders, including atomoxetine and modafinil.

For the purposes of the survey, caffeine was excluded as a stimulant.

Students were asked about lifetime stimulant use, stimulant use during medical school, and, if they used the drugs, how and why they obtained them.

The survey also explored student perceptions of stimulant use, including whether they believed that stimulants had the ability to improve academic performance and what percentage of their classmates used the drugs to boost academic results.

Use and Academic Achievement

Of 148 medical students, 145 (98%) responded to the survey. The results revealed that 20% of students reported lifetime use of stimulants, with 15% reporting stimulant use during medical school.

Compared with Asian students, white students had a 9-fold increase in odds for stimulant use (P = .001). The investigators note that the sample size was not large enough to reliably compare prevalence of stimulant use in black and Hispanic medical students.

The researchers report that 13 students (9%) reported a diagnosis of ADHD and had an odds ratio of 37 for stimulant use in medical school compared with those without an ADHD diagnosis (P < .001).

The study also revealed that, of those who had taken stimulants, 83% used them specifically to boost cognitive performance, including improving focus while studying and staying awake longer while on clinical duty.

There were no differences in stimulant use by age, marital status, or academic achievement.

"Indeed, those with high standardized test scores had an almost identical use prevalence compared with those with lower test scores," the investigators report.

The majority (83%) of students who reported using stimulants used them specifically to improve cognitive performance. Of those with lifetime stimulant use, more than one half (52%) obtained at least some stimulants without a prescription.

In addition, 25% of the sample reported that they had been offered stimulant medications without a prescription while in medical school.

The most commonly used stimulants were methylphenidate (52%) and amphetamine salts (52%).

Balancing Act

According to investigators, the study's findings have implications for medical schools, which must balance the need to teach high volumes of material while safeguarding students' health and well-being.

"It also has implications for patient care, because medical students who use stimulant medications or who work with colleagues who use them may be influenced by these experiences when treating patients reporting ADHD symptoms," they write.

The authors have disclosed no relevant financial relationships.

Ann Clin Psychiatry. 2012;25:27-31.