How Can Stimulant Abuse by College Students Be Deterred?

Michael G. O'Neil, PharmD

Disclosures

February 15, 2013

Question

What measures may reduce the risk for methylphenidate misuse and abuse by college students?

Response from Michael G. O'Neil, PharmD
Professor, Department of Pharmacy Practice; Consultant, Drug Diversion and Substance Abuse, South College School of Pharmacy, Knoxville, Tennessee

When today's teenagers are asking for "Skippy" or "pineapples," they are not necessarily asking for peanut butter or fruit. These are 2 commonly used street names for the central nervous system (CNS) stimulant methylphenidate (Table 1). This is part of a progressive trend in abuse and misuse by adolescents, teenagers, and adults of prescription medications historically used in the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy.

Table 1. Common Street Slang Terms for Methylphenidate

Vitamin R
Skippy
Pineapple
R-Ball
Smarties
Kiddie cocaine

 

CNS stimulant abuse and misuse may be increasing for a variety of reasons, including increased access to medications of family members diagnosed with ADHD (Table 2). According to Castle and colleagues,[1] 66.3% of children diagnosed with ADHD were taking medication for the disorder. In total, 4.8% of all children aged 4-17 years (2.7 million) were taking medications for ADHD.[1]

Table 2. Factors Associated With Increased Use of CNS Stimulants

Academic competition
Increased access in the home
Increased focus in the academic or work environment
Enhanced physical performance in sports
Weight loss
Abuse to achieve euphoria
Unnecessary prescribing for unapproved indications
Poor guideline adherence when diagnosing ADHD and narcolepsy

CNS = central nervous system; ADHD = attention-deficit/hyperactivity disorder

Multiple sources have reported that the primary source of prescription medications used for abuse or misuse is "friends and family."[2] The demand for CNS stimulants has been increasing for a number of reasons, including, but not limited to, the increasing competition in high schools and colleges for school admissions, scholarships, and awards. CNS stimulants increase the ability to focus, stay awake, and study/work longer. All are desirable characteristics in any classroom or work environment. Unfortunately, these medications require continued use for individuals to maintain their higher level of performance.

An even faster-growing group of abusers of these medications is individuals trying to achieve the euphoric or "rush-like" effects of these medications that are reportedly similar to cocaine or methamphetamine. When CNS stimulants are taken in higher doses than prescribed, crushed and snorted, or administered intravenously, a rapid onset of euphoria may be achieved. When abusers come down from their euphoric states, they commonly experience exaggerated feelings of depression, which promotes further abuse of these medications. This type of abuse may rapidly lead to the disease of addiction. Alternatively, there are few, if any, clinical data that support the conclusion that addiction occurs in patients who take their medications exactly as prescribed. CNS stimulant abuse may also be accompanied by dangerous physiologic consequences like tachycardia, high blood pressure, seizures, and psychosis during the euphoric episodes.

Factors complicating the prevention of CNS stimulant abuse and misuse include the perceptions by the general public as well as prescribers that these medications are generally "safe" as long as they are prescribed by a healthcare practitioner. Overprescribing of these agents for unapproved uses at an individual's request for purposes such as studying for exams or driving on long trips should be discouraged. In addition, safe prescription storage in the home is commonly lacking.

Factors that may help minimize abuse and misuse of CNS stimulants include education in the classroom at all levels, education of prescribers about guidelines, and monitoring patients' uses of these medications. Recognizing that most CNS stimulants have the potential to be abused is important (Table 3).

Table 3. Common Prescription CNS Stimulants That May be Abused*

Methylphenidate (eg, Ritalin®, Concerta®, Methylin®, Metadate®)
Dextroamphetamine/amphetamine (Adderall®)
Dexmethylphenidate (Focalin®)
Armodafinil (Nuvigil®)
Modafinil (Provigil®)
Lisdexamfetamine (Vyvanse®)

*List not inclusive for all trade products and dosage forms available

Once these medications are prescribed, parents have an obligation to minimize the risks for abuse and misuse in their homes. Safe storage and monitoring of prescription medications in the home are necessary as first-line steps in preventing unauthorized access to these medications.

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