Prescription Stimulant Abuse in Youth Rising…Again

Pauline Anderson

May 28, 2019

SAN FRANCISCO — After a lull in the rates of prescription stimulant abuse in youth, it looks as though the phenomenon is on the rise again, results of a new survey show.

Investigators conducting the Study of Non-Oral Administration of Prescription Stimulants (SNAPS) found that almost 14% of young respondents who used a prescription stimulant had snorted, smoked, or injected the drug.

After an apparent lull in non-medical use of stimulants prescribed to treat attention deficit hyperactivity disorder (ADHD), it looks like such use is now picking up.

Dr Linda Cottler

Physicians may not be aware of all the consequences of stimulant misuse and diversion among young people, study investigators Linda Cottler, PhD, Dean's Professor of Epidemiology, and Associate Dean for Research, University of Florida, Gainesville, told Medscape Medical News

"If youth start misusing stimulants, there's a chance they're going to misuse other things as well. They may get into marijuana and other drugs, and may start vaping and smoking cigarettes," she said.

The findings were presented here at the American Psychiatric Association (APA) 2019 annual meeting.

"Dangerous Route"

Chemically related to cocaine and methamphetamine, prescription stimulants, which are commonly used to treat attention deficit hyperactivity disorder (ADHD), can produce mood-altering, euphoric effects over the short term.

It is estimated that about 11% of youth report having used prescription stimulants, and of these, one third have engaged in non-medical use of these agents, which is defined as not having a prescription or taking more than prescribed.

As with other drugs, taking stimulants by snorting or injecting them means they reach the brain more quickly than oral administration.

For the study, investigators interviewed youth in urban areas of three populous states: California (Los Angeles), Texas (Houston and Dallas), and Florida (Tampa, Orlando, and Miami).

"We went to places where we think youth are going to hang out at places such as malls, parks, and theatres, and we interviewed them there," said Cottler.

The written survey takes about 20 minutes to complete, but participants and their parents were very receptive to the project, said Cottler.

"They understand the intense need to find out more about what's going on in youth today in terms of stimulant use," she said.

Researchers analyzed surveys from 1777 respondents ages 10 to 17 years. The results showed that among users, 68.9% indicated oral use, 9.7% indicated snorted/sniffed misuse, and 4.1% indicated smoking misuse.

About 0.5% said they were injecting stimulants, which Cottler called "a very dangerous route."

About 12.7% of those surveyed were involved in some kind of diversion — for example, selling, giving away, or stealing the drugs.

"These youths may not be using these drugs themselves, but they know kids want these stimulants. They know that a friend or their brother or sister has them and they can take them out of the medicine cabinet and start to divert them," said Cottler.

Children misuse stimulants for different reasons. Some might take the drug to "get a buzz," others to stay up at night to study, and still others might just be curious about what their friends are talking about, she added.  

Stimulant misuse received a lot of attention about a decade ago. "Everyone was on high alert and we were telling parents and teachers to please be aware of what's going on," said Cottler.

Attention on this problem then faded. "But I think we're seeing this increase again," said Cottler.

She likened it to the waxing and waning of opioid use. The opioid epidemic "took attention away from cocaine, but now we're seeing a bit of a dip in opioid use and an increase in cocaine."

Cottler and her colleagues plan to further analyze the data to determine whether patterns of misuse and diversion differ between rural and urban centers and between boys vs girls and older vs younger users.

Increase in ADHD Diagnoses

Commenting on the findings for Medscape Medical News, John Leikauf, MD, clinical assistant professor of psychiatry and behavioral sciences at Stanford University in California, said it makes sense that there's more stimulant misuse as there are more of these drugs in circulation.

Data from the Centers for Disease Control and Prevention (CDC) show rates of ADHD have recently doubled in some parts of the country, said Leikauf.

"So there would be an increase in the number of stimulant prescriptions and more people would be getting hold of them," he said.

There's no consensus as to why ADHD rates are going up. Experts have pointed to environmental factors such as smoking and lead exposure, and to increased screen time among youth, as possible factors, "but nothing seems to clearly match up," said Leikauf.

Of Leikauf's patients with ADHD, the majority are 13 years and younger, although he does treat some older teens and young adults.

As with opioid manufacturers, producers of stimulants are making these medications more difficult to divert.

"Some of the newer long-acting versions, which we tend to use a lot more these days, are a lot harder to crush," he said.

One of the newer drugs, lisdexamfetamine (Vyvanse, Shire), "doesn't become active until it's actually metabolized in your blood" which can reduce the risk of misuse, said Leikauf.

The study was funded by Arbor Pharmaceuticals LLC. Cottler and Leikauf have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2019: Abstract 21 (Session 6). Presented May 20, 2019.

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