Central Nervous System Stimulant Use Research Articles

New research sounds alarm about increased stimulant use among U.S. adults

The number of adults using central nervous system (CNS) stimulants grew by approximately 80% over a 5-year period, according to new findings published in BMJ Open in August 2021. The total number of amphetamine and methylphenidate prescriptions dispensed grew even faster, with an increase of roughly 96%, according to the study results. “My message is this: It's time to start paying attention,” said lead author Thomas J. Moore from the Center for Drug Safety and Effectiveness at Johns Hopkins University Bloomberg School of Public Health. “The opioid epidemic continued for years before the medical and public health community realized action was needed. We need more research to understand this major trend and why it is happening.” Trends in CNS stimulant use that Moore and the research team found included a younger population of adults, as well as adults with higher education degrees who were more likely to be unmarried. “We need to know what is driving this increase, and why so much use is in combination with antidepressants and antianxiety drugs,” said Moore. The study results found that stimulant users frequently reported taking medications for a variety of mental, neurological, and developmental conditions: 77.8% indicated they took medication for ADHD, 26.8% reported taking anxiety medication, 25.1% said they had taken drugs for depression, and 15.3% indicated drug therapy for other mental or neurological conditions. Andrew Peterson, PharmD, PhD, FCPP, executive director of the Substance Use Disorder Institute at the University of the Sciences in Philadelphia, was not surprised by the results of the BMJ Open study. The trend for youths being diagnosed and treated for conditions such as ADHD with stimulant medications has been increasing since the early 2000s, according to CDC. “Therefore, as the youths became adults, the carry-over for using stimulants to treat these conditions may be a strong factor contributing to the increase seen,” said Peterson. “A particularly vulnerable group are college students who may be misusing these agents to improve cognitive ability and academic achievement.” In the BMJ Open study, Moore and the researchers wrote that the growing use of these stimulants should renew interest in updating, characterizing, and managing the risks of this drug class. For example, the larger numbers of younger age groups using CNS stimulants raises the question of whether or when these prescribed stimulants for ADHD in childhood or adolescence should be discontinued as the child grows older. Peterson encourages pharmacists to help counsel patients—youths and parents, as well as adults—about the risks associated with stimulant misuse. He said research should focus on how pharmacists can use evidence-based strategies such as Screening, Brief Intervention and Referral to Treatment (SBIRT) in the community setting to identify individuals at risk for misusing stimulants. But before this, pharmacists and other health care providers need to feel confident addressing substance use disorders with their patients, which includes understanding the prevalence, incidence, and consequences of stimulant use and misuse. “This appears to be a great opportunity for researching the pharmacist's role in providing this education,” Peterson said. While CNS stimulant use was more frequent in the youngest age cohort, according to the study findings, the largest percentage increases occurred in adults aged 25 years and older. Examined by sex, the largest rise occurred among females, with a 72% jump in CNS stimulant use over the 5-year period. “We saw big differences by age, race, and sex,” said Moore. “The growth was largest in younger, white, and female patients, smallest in minorities and older patients. Increase was much larger in amphetamines versus methylphenidate.” Amphetamine product use increased by roughly 119% over the 5-year period. Growth in methylphenidate products was slower with an estimated 39% increase during that time frame. The findings come from the annual U.S. Medical Expenditure Panel Survey, the largest annual health care survey sponsored by the federal government. Researchers analyzed annual surveys from 2013 through 2018 and looked at a random sample of approximately 30,000 individuals and 325,000 prescriptions each year.

1.2 A RANDOMIZED CONTROLLED TRIAL OF INTERVENTIONS FOR GROWTH SUPPRESSION IN CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER TREATED WITH CENTRAL NERVOUS SYSTEM

To examine the impact of central nervous system (CNS) stimulants on the growth of children with ADHD, and to assess the efficacy and feasibility of weight recovery interventions on growth. A total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication. Before WRT assignment, medication was associated with significant reductions in standardized weight and height (p values < 0.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p values < 0.05). Across all WRT participants (n = 71), weight velocity increased significantly after WRT randomization (β2 = 0.271, SE = 0.027, p < 0.001). When analyzed by what parents did (versus what they were assigned to), CS (p < 0.01) and DH (p < 0.05) increased weight velocity more than MON. No increase in height velocity was seen after randomization to any WRT. Over the entire study, WRT participants declined in standardized weight (–0.44 z-units) and height (–0.20 z-units). Drug holidays, caloric supplementation, and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity.

Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study

ObjectiveTo assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their...

The Abuse of Central Nervous System Stimulants and its Impact on the Youth of Eastern Nigeria

The class of drugs designated as central nervous system (CNS) stimulants includes the four social drugs that find use among some youth of Eastern Nigeria; caffeine, nicotine, cocaine and marijuana. CNS stimulants increase or enhance the activity of monoamines (such as dopamine and nor epinephrine) in the brain, which leads to increased heart rate, blood pressure, and respiration. They also have a high potential for addiction. Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because these drugs change the brain structure and function. The aim of this review is to answer the following questions: What are the common types of CNS stimulants abused in Eastern Nigeria? What prompts people to start taking these drugs? Why do people become addicted to these drugs? How does CNS stimulant abuse gain foothold in Eastern Nigeria? What are the implications of this drug taking for the users and the development of youth? How does the abuse of these stimulants affect the Eastern Nigerian society? How can the use of CNS stimulants among youth of eastern Nigeria be prevented or discouraged? Is there any treatment available for the youth addicted to CNS stimulants in Eastern Nigeria?

Determination of combination therapy prescribing patterns for the treatment of acute agitation in psychiatric patients: A regression model of patient diagnoses and demographics.

IntroductionGuidelines for the treatment of acute agitation typically recommend monotherapy with an antipsychotic or a benzodiazepine, but combination therapy is frequently used in practice. We created a regression model to identify which factors lead to the prescribing of combination therapy for acute agitation on a psychiatry unit.MethodsWe collected retrospective data from hospitalized patients in the psychiatry unit. An a priori alpha of 0.05 was used for binary logistic regression models to determine if and how the number of prescribed medications for acute agitation was influenced by: age, sex, race, cardiovascular comorbidities, and psychiatric diagnoses.ResultsWe identified 1998 encounters from 1200 patients. Patients are significantly more likely to be prescribed combination therapy if they are young, male, and of non-white race or have a diagnosis of central nervous system stimulant use, hallucinogen use, depression, bipolar, cluster B personality, or psychosis. Patients are significantly more likely to be prescribed monotherapy if they have cardiovascular comorbidity or have neurocognitive disorder.DiscussionSeveral demographic or diagnostic factors predict combination therapy prescribing. Acute agitation guidelines should be reviewed to include more clear instructions on combination therapy use.

A Randomized Controlled Trial of Interventions for Growth Suppression in Children With Attention-Deficit/Hyperactivity Disorder Treated With Central Nervous System Stimulants

To examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD), and to assess the efficacy and feasibility of weight recovery interventions on growth. A total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication. Before WRT assignment, medication was associated with significant reductions in standardized weight and height (p values<.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p values<.05). Across all WRT participants (n= 71), weight velocity increased significantly after WRT randomization (β2 = 0.271, SE= 0.027, p< .001).When analyzed by what parents did (versus what they were assigned to), CS (p< .01) and DH (p< .05) increased weight velocity more than MON. No increase in height velocity was seen after randomization to any WRT. Over the entire study, WRT participants declined in standardized weight (-0.44 z-units) and height (-0.20 z-units). Drug holidays, caloric supplementation, and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity. Novel Approach to Stimulant Induced Weight Suppression and Its Impact on Growth; https://clinicaltrials.gov/; NCT01109849.

Effectiveness of Prescription-Based CNS Stimulants on Hospitalization in Patients With Schizophrenia: A Nation-Wide Register Study.

Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia. By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model. CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P = .009), with a more pronounced reduction for women (mean difference: -1.37, 95% CI = -2.34 to -0.40, P = .006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P < .001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P = .001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88). CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted.

Repeat DUI Offenders Who Have Had a Drug Diagnosis: Are They More Prone to Traffic Crashes and Violations?

Objective: Study objectives are to test for differences (1) in rates of negative traffic outcomes between DUI offenders who have lifetime drug use disorders (DUD) and those with no lifetime DUD; and (2) by drug class for those with a DUD. Methods: The study sample of 379 male and 74 female repeat DUI offenders was interviewed using the Composite International Diagnostic Interview. Results: Compared to those with an alcohol use disorder (AUD) only, the relative risk of being involved in a vehicular crash was greater for those with a central nervous system (CNS) depressant use disorder. The risk of being convicted of a traffic offense was higher for those with any DUD and for those with a CNS stimulant use disorder. Differences by class of drug used, after adjusting for demographics, were a 47 percent (confidence interval: 6–103%) greater risk of being in a crash with a CNS depressant use disorder and 28 percent (confidence interval: 11–48%) greater risk of a traffic conviction with a stimulant use disorder. Conclusions: Results underscore the increased risk of negative traffic outcomes among repeat DUI offenders diagnosed with DUD, particularly CNS depressant disorders, supporting the call to establish policies that include comprehensive evaluation and treatment for this population.

Efficacy of central nervous system stimulant treatment for cocaine dependence: a systematic review and meta‐analysis of randomized controlled clinical trials

To evaluate the efficacy of central nervous system (CNS) stimulants compared with placebo for the treatment of cocaine dependence. A systematic review and meta-analysis was carried out. Bibliographic databases were searched, reference lists of retrieved studies were hand-searched and the first authors of each study were contacted. All randomized controlled clinical trials (RCCT) comparing the efficacy of any CNS stimulant with placebo in cocaine-dependent patients were included. Quantitative data synthesis was performed for each single CNS stimulant and for all CNS stimulants. Nine RCCT met the inclusion criteria. These RCCT included 640 patients and compared five CNS stimulants: mazindol, dextroamphetamine, methylphenidate, modafinil and bupropion with placebo. No CNS stimulant improved study retention [RR = 0.94 (0.81-1.09)] or cocaine use [RR = 0.90 (0.79-1.02)]. An exploratory analysis using indirect estimations of cocaine use showed that the proportion of cocaine-positive urine screens was lower with dexamphetamine than with placebo [RR = 0.73 (0.60-0.90)] and that all CNS stimulants pooled together also suggested a significant decrease of cocaine use [RR = 0.87 (0.77-0.99)]. Data on craving could not be meta-analysed due to heterogeneity, but no RCCT found differences in cocaine craving between active drug and placebo except one, whose outcome favoured dexamphetamine. No serious adverse event (AE) was reported. Average of AE-induced dropouts was low and was greater for CNS stimulants than placebo: 4.4% versus 1.3% (P = 0.03). The main outcomes of this study do not support the use of CNS stimulants for cocaine dependence. Nevertheless, secondary analyses provide some hopeful results that encourage further research with these drugs, mainly with dexamphetamine and modafinil.

Benefits and risks of pharmacotherapy for narcolepsy.

Narcolepsy is a life-long central nervous system (CNS) syndrome characterised by excessive sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed night-time sleep. Unsuccessfully treated narcolepsy confers increased risks on patients and on society due to the patient's increased chance of becoming involved in vehicle crashes and workplace mishaps. The syndrome may be diagnosed by a clinical history positive for cataplexy and excessive daytime sleepiness and negative for other more common sleep disorders such as sleep apnoea and sleep deprivation. Night-time polysomnography and multiple sleep latency testing are helpful in differentiating narcolepsy from other sleep problems. Recent data from canine, murine, and human forms of narcolepsy indicate that genetically or developmentally mediated deficits in the hypocretin neurotransmitter system may cause some, but not all, forms of narcolepsy. Pharmacotherapy for narcolepsy is required to control symptoms and involves the use of CNS stimulants or modafinil to control sleepiness and antidepressant medications or sodium oxybate to control cataplexy. Modafinil and sodium oxybate have been developed and approved specifically for the indication of narcolepsy based on large, double-blind, placebo-controlled, parallel group efficacy and safety studies. The efficacy of drugs in the treatment of narcolepsy is variable from patient to patient and usually associated with adverse effects that can limit patient compliance and, therefore, symptom control. Nevertheless, the benefits of pharmacotherapy are judged to outweigh the risks to the patient. The favourable benefit-risk ratio of pharmacotherapy is greater if one considers the reduced risk to society of vehicle crashes and workplace mishaps that might be precipitated by attentional lapses or sleep attacks in the untreated or under-treated patient with narcolepsy.

Stimulant Use in Paediatric Acquired: Brain Injury: Evaluation of a Protocol

AbstractChildren with acquired brain injury (ABI) experience deficits in attentional skills such as, sustained attention, distractability and impulsivity, which have the potential to influence all aspects of their functioning. The use of central nervous system (CNS) stimulants is gaining increasing popularity in adult ABI literature. CNS stimulants have been successfully utilised in the management of attentional problems in attention deficit-hyperactivity disorder and are believed to have their therapeutic effect by modulating neurotransmitter function in the neocortex, an area of the brain implicated in the neurobehavioural sequelae of ABI. Research into the use of CNS stimulants in paediatric ABI reports contradictory findings. We present the case of LI a 7-year-old boy with a history of ABI who underwent a trial of stimulant medication for management of attentional deficits. The case is discussed with regard to the efficacy of the pharmacological intervention and the design of objective protocols for stimulant trials.