ADHD Medication Misuse Rampant in College Students

Liam Davenport

March 16, 2015

More than one sixth of college students misuse stimulant medications meant to treat attention-deficit/hyperactivity disorder (ADHD), primarily in the mistaken belief that the drugs will improve academic performance, new research shows.

A meta-analysis of 30 studies revealed that the prevalence of stimulant medication misuse was 17%, with students who were members of a college fraternity/sorority and users of other substances more likely to misuse the drugs.

"Misuse of stimulant medication among college students is a significant concern as more students with ADHD are attending college and prescriptions for stimulant medications are on the rise," say the investigators, led Kate Flory, PhD, associate professor, University of South Carolina's (USC's) Parenting and Family Research Center, in Columbia.

The study was published in the March issue of the Clinical Child and Family Psychology Review.

Supply Source

Noting that students with a prescription for stimulant medications are a common source of misused drugs, the researchers note that it is "important for physicians who provide college students with prescriptions for stimulant medications to discuss the possible consequences of misusing or diverting medication, including potential negative health outcomes and legal consequences."

The study was prompted by the reaction of fellow students after coinvestigator Kate Benson, a student in the Department of Psychology, started working with Dr Flory on social impairment in children with ADHD.

"People would ask me if I could get them Adderall or Ritalin," Benson said in a release. "I realized that this was a pretty prevalent issue on campus, and I wanted to see what I could do about it."

After an initial literature review, the researchers conducted a comprehensive search of a number of major literature databases. Initially identifying 727 articles of potential interest, they selected 30 articles for inclusion in a meta-analysis.

The prevalence of stimulant medication misuse recorded in the 23 studies that reported rates ranged from 8% to 43%. Random-effects meta-analysis estimated the rate of misuse at 17% (P < .001), with significant heterogeneity observed across studies (P < .001).

Further analysis by the researchers revealed that the most common source of stimulant medication was college peers, with the majority of students believing that they were easy to obtain.

Reasons for Misuse

Factors associated with stimulant medication misuse were being male, being a member of a college fraternity/sorority, and using other substances. There was also evidence to suggest that white students and college upperclassmen are more likely to misuse stimulant medications than other students.

Primarily, students misused the medications to improve academic performance, although the researchers found that nonusers appeared to perform better academically than users.

Other reasons for misusing stimulant medications included losing weight and getting high. Factors that differentiated users and nonusers included ADHD symptoms, alcohol use problems, and marijuana use. A protective factor against misuse was the perceived risk of misusing medications.

Although stimulant medications typically have few adverse effects, they can cause cardiac problems and death in those with preexisting conditions.

Overdose can occur, especially when snorting the medications; overdose is accompanied by symptoms similar to those seen with acute amphetamine intoxication, such as delirium, euphoria, confusion, and toxic psychosis.

It has also been reported that students misuse stimulant drugs to allow greater ingestion of alcohol over a longer period.

"It makes it possible to drink beyond the normal limit," said Benson. "So instead of passing out drunk, you might end up in the hospital having to get your stomach pumped."

Next Steps

The investigators want to extend the research by using the results of the meta-analysis and a survey of more than 1000 University of Carolina students to examine characteristics associated with drug misuse to identify students for intervention programs.

"That's something we're hoping to do here," said Dr Flory. "We have a substance abuse prevention and education office, and they have a group that's focused on prescription medications."

"We've pulled together an interdisciplinary group of researchers here at USC to apply for a grant from the National Institute of Drug Abuse, which would enable us to actually do an intervention on campus," she concluded.

The work was supported by a University of South Carolina Honors College Exploration Scholar Award and a University of South Carolina Magellan Fellowship, both awarded to Kari Benson. The authors report no relevant financial relationships.

Clin Child Fam Psychol Rev. 2015;18:50-76. Abstract

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