Prescribed Stimulant Medication Research Articles

Abstract P168: A Novel Protocol Using Ambulatory Blood Pressure Monitoring To Assess The Impact Of Prescription Stimulants On Blood Pressure In Adults

Background: Prescription stimulant medications are an important cause of secondary hypertension (HTN) and use is increasing in US adults. Although stimulants are known to increase blood pressure (BP), a systematic approach to assess impact in individual patients is lacking. Further, treating HTN secondary to stimulant use may differ from treatment of essential HTN. Objective: To develop a protocol using ambulatory blood pressure monitoring (ABPM) to differentiate HTN secondary to stimulant use from essential HTN. Methods: We used ABPM to evaluate pre- and post-stimulant systolic blood pressure (SBP) and diastolic blood pressure (DBP) for patients referred to the BIDMC Hypertension Center. Patient charts were reviewed by a clinical pharmacist to ensure the safety of holding the stimulant medication and to determine the duration of action. Average daytime BP on day 1 (off stimulant) was compared to day 2 (on stimulant) to assess the impact of stimulant on BP. We defined normotension as BP <135/<85 on both days, sustained HTN as BP ≥135/≥85 on both days and stimulant-induced HTN as BP <135/<85 on Day 1 and ≥135/≥85 on Day 2. We also defined an increase of SBP≥10 and/or DBP≥ 5 while taking the stimulant as a clinically significant effect on BP. Results: Eleven patients were assessed (see Table). Four had sustained normotension, six had sustained HTN, and one had stimulant-induced HTN. In addition, four of the patients had a clinically significant increase in their BP while on a stimulant. Overall, average increase in SBP was 6.7 mmHg and average increase in DBP was 3.2 mmHg. Conclusion: This novel ABPM protocol was useful for differentiating secondary HTN from stimulant use from essential HTN.

Assessment of prescription stimulant misuse among college students using the MMPI-2-RF

Prescription stimulant misuse (PSM) is a growing concern on college campuses and more research is needed to validate clinical measures commonly used for the assessment of risk for PSM among college students. The present study examined correlations between scores on the Minnesota Multiphasic Personality Inventory–Second Edition–Restructured Form (MMPI-2-RF) and self- and peer-reported misuse of prescription stimulants and other drugs in a sample of 96 pairs (included within a total N = 212) of undergraduate students. Nearly half of the participants (48%) reported that they had been offered prescription stimulants and one quarter (26%) reported trying someone else's prescription stimulant medications, often to perform better academically. Scores on the MMPI-2-RF scales designed to measure general substance misuse (Substance Abuse [SUB]) and related behavioral or externalizing constructs (e.g., Antisocial Behavior [RC4], Behavioral/Externalizing Dysfunction [BXD], and Disconstraint-Revised [DISC-r]), were correlated positively with both self- and peer-reported prescription stimulant misuse (rs = 0.45–0.66), as well as with problematic use of other drugs (rs = 0.44–0.63). MMPI-2-RF scales designed to measure constructs in the domains of Emotional/Internalizing, Somatic/Cognitive, and Thought Dysfunction, as well as Interpersonal Functioning, had weaker correlations with misuse of prescription stimulants (rs < 0.24) and other drugs (rs < 0.29). These results provide support for the convergent validity of the MMPI-2-RF with regard to the assessment of prescription stimulant misuse and general drug misuse among college students.

A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: Preliminary findings from an open label study

AimsWe piloted the effectiveness and acceptability of a novel text messaging-based (SMS) digital health intervention aimed at addressing the previously documented poor rate of patient engagement in stimulant treatment in the primary care setting. Methods117 adults ages 18–55 from primary care and psychiatric practices who were prescribed a stimulant medication for ADHD treatment received the SMS intervention. Comparators were age-, race-, and sex-matched patients from the same health care organization's electronic medical record who had been prescribed stimulant medications over a similar time period. Using documented prescription records, we determined whether patients had timely prescription refills. ResultsNinety-six percent (N = 112) of participants completed our a priori metric of patient engagement consisting of 37 days of the SMS program. Eighty-one percent of participants refilled their index prescriptions in a timely manner compared to only 36% of patients receiving treatment as usual (OR=7.54, 95% CI: 4.46, 12.77; p<0.001). We found no significant interaction between prescribing source (non-psychiatry vs. psychiatry) and intervention group (SMS vs. treatment as usual). ConclusionsThese data suggest that an ADHD-centric, digital health intervention using text messaging significantly improves patient engagement in stimulant treatment in adults with ADHD.

Personality and substance use correlates of e-cigarette use in college students

Many studies have examined psychological and substance use correlates of e-cigarette use. However, several potentially important personality and substance use variables have yet to be considered. In an effort to remedy this omission, we studied the associations among e-cigarette use, personality, and substance use in a sample of 380 college students. All associations were examined for both weekday and weekend e-cigarette use. The mean age of the sample was 19.1 with a standard deviation of 1.7. Regarding current e-cigarette use, 11.8% of participants reported using e-cigarettes on weekdays and 13.9% reported weekend use. The variables most strongly associated with being an e-cigarette user versus non-user were amount of tobacco cigarette smoking, being male, taking a prescribed stimulant medication for a diagnosed medical condition, and low levels of forgiveness toward others. Two of the variables (taking a prescribed stimulant medication and low forgiveness) are novel predictors that appear to have not been previously examined. Implications of the results for understanding e-cigarette use are discussed and directions for future research are considered.

How to say “no” most effectively: Evaluating resistance strategies for prescription stimulant diversion to inform preventive interventions

Objective We evaluated the perceived effectiveness of resistance strategies students could employ if approached to give away, trade, or sell their prescription stimulant medication, a growing concern on college campuses. Participants: We sampled undergraduates (N = 1,521) at three demographically dissimilar institutions between Fall 2017 and Spring 2018. Methods: We administered an anonymous, online survey and used linear mixed models to examine the effects of strategy type, face support (ie, adding politeness), and substance use history on perceived strategy effectiveness. Results: Internal (eg, “I am not comfortable sharing my medication”) and external (eg, “My doctor won’t prescribe me if I share”) explanations were perceived to be most effective. Excuses, direct refusals, and suggesting an alternative (eg, energy drink) were less preferred. Adding face support improved perceived effectiveness for direct refusals and internal explanations. Conclusion: Preventive interventions for stimulant diversion could encourage the use of internal or external explanations or direct refusals with face support.

A Novel Text Message Intervention to Improve Adherence to Stimulants in Adults With Attention Deficit/Hyperactivity Disorder.

Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurobiological disorder associated with a wide range of adverse outcomes. Although large data sets document that stimulants decrease the risks for many ADHD-associated adverse outcomes, compliance with stimulants remains very poor. The main aim of this study was to assess the effectiveness of a novel text messaging-based intervention aimed at improving the poor rate of adherence to stimulant medications in adults with ADHD. Subjects were adults with ages 18 to 55, prescribed a stimulant medication for ADHD treatment. For comparators, we identified at a 5-to-1 ratio (age and sex matched) adult patients from the Partners HealthCare electronic medical record who had been prescribed stimulant medications over a 1-year period. We determined whether patients had timely prescription refills, defined as refilled within 37 days, using prescriptions documented in their electronic medical record. Our results showed that 68% of the SMS intervention group refilled their prescriptions in a timely manner. In contrast, only 34% of patients receiving treatment as usual refilled their prescriptions in a timely fashion (odds ratio, 4.04; 95% confidence interval, 2.49-6.56; P < 0.001). These data indicate that an innovative ADHD-centric text messaging intervention significantly improved patient engagement to treatment with stimulants in adults with ADHD. Findings provide strong support for the use of a readily accessible, inexpensive, and widely available technology to improve the poor rate of adherence to stimulant treatment in adults with ADHD. To the best of our knowledge, this study is the first digital health intervention aimed at improving adherence to stimulant medication for adults with ADHD.

Death after probable misuse of several stimulants: Ethylphenidate (ETH), methylphenidate (MTH) and modafinil (MODA)

Prescription stimulant medications may be misused with consumption of illegal drugs of the same pharmacologic class. We describe the case of a man presenting at the time of his death blood impregnation of several stimulants: ethylphenidate, methylphenidate and modafinil. A 37-year-old man, who presented bipolar disorders with psychiatric follow-up, was found dead at home. His usual treatment included MTH, MODA, clorazepate, amisulpride, sertraline and lamotrigine. The autopsy findings were nonspecific with only an acute asphyxia syndrome with a possible toxicological contribution, and no macroscopic heart abnormalities. Large screenings of drugs and toxics were performed on autopsy peripheral blood samples. Blood alcohol content was 0.37 g/L. Three stimulants, pharmacologically related to amphetamines were detected: ETH (7.2 ng/mL), MTH (< 1 ng/mL) and MODA (10.1 mg/L). Other psychotropic drugs were found (ng/mL): nordiazepam (518), oxazepam (26.9), amisulpride (11.4), sertraline (22.5) and lamotrigine (2790). ETH is an emergent illicit psychoactive substance that is an analogue of the prescription drug MTH (Ritalin ® ), both registered on the list of narcotics. Interestingly, ETH is produced as a metabolite from the co-ingestion of MTH and ethanol [1] . The hypothesis of a specific intake of ETH was retained because of its very high concentration compared to MTH. The therapeutic concentrations are between 5 and 80 ng/mL for MTH with a toxic level greater than 500 ng/mL, which can be extrapolated to ETH. Therefore we can exclude a toxic impregnation at the time of death. MODA, not classified as narcotic but with restricted prescription, is used in the treatment of excessive daytime sleepiness, and had also been used for working late and/or improved concentration [2] . The blood concentration is compatible with the expected concentration 2 hours after the administration at a dosage of 400 mg. A toxic concentration of MODA may be excluded at the time of death. The pharmacological activity of MODA can be described as comparable to that of MTH and ETH. These molecules potentiate their actions in case of combined consumptions, but the concentrations present are not in favour of cumulative impregnation intoxication. The cumulative concentrations of nordiazepam and oxazepam compatible with consumption of clorazepate are in the therapeutic level at the time of death. The measured blood concentration of amisulpride is much lower than the concentrations usually expected in therapy (100–320 ng/mL) and the activity of amisulpride at the time of sampling may be considered negligible. The concentration of sertraline is in the therapeutic range (10–150 ng/mL) and the measured blood concentration of lamotrigine is at least nontoxic. The combination of these treatments is not contraindicated. The patient presented at the time of his death a blood impregnation of several stimulants: MODA in high therapeutic zone, traces of MTH, and ETH (narcotic without authorized therapeutic use) in nontoxic zone. The concentrations present are not in favour of a cumulative impregnation intoxication. MODA and MTH may be misused for their stimulant effects and can occur aggressive states or psychotic pathologies, which requires a reinforced monitoring. Uncontrolled consumption of these compounds can also induce cardiac pathologies as arrhythmias with lethal evolution that may constitute a toxicological hypothesis of death for this patient in absence of other cause of death.

Studies examine nonmedical use and outcomes of ADHD medications in adults

Recent trends indicate a rise in nonmedical use of prescription stimulant medications in adult patients with attention deficit hyperactivity disorder (ADHD). The nonmedical use of these medications, whether oral or non‐oral, carries risk for serious adverse medical outcomes, according to new data addressing both of these issues, released this month.

Nonmedical Use of Stimulants Is Associated With Riskier Sexual Practices and Other Forms of Impulsivity.

Background:This study sought to examine the occurrence of the nonmedical use of prescription stimulants (amphetamines and methylphenidate) in a university sample and their associated physical and mental health correlates, including potential relationships with risky sexual practices.Methods:A 156-item anonymous online survey was distributed via e-mail to a sample of 9449 university students. Current use of alcohol and drugs, psychological and physical status, and academic performance were assessed, along with questionnaire-based measures of impulsivity and compulsivity.Results:A total of 3421 participants (59.7% female) were included in the analysis. 6.7% of the sample reported current/recent nonmedical use of prescription stimulants, while an additional 5.8% reported misuse in the past. Nonmedical use of prescription stimulants was associated with lower grade point averages, and with taking a broad range of other drugs (including alcohol, nicotine, illicit substances, and consumption of caffeinated soft drinks). Nonmedical use of stimulants was also significantly associated with impulsivity (Barratt scale), prior treatment for substance use problems, and elevated occurrence of disordered gambling, post-traumatic stress disorder, and anxiety; but not depression symptoms or binge-eating disorder (though it was associated with using drugs to lose weight). The relationship with probable attention-deficit/hyperactivity disorder (ADHD) on screening was not significant but was numerically elevated. Finally, those using nonmedical prescribed stimulants were significantly more sexually active (including at a younger age), and were less likely to use barrier contraception.Conclusions:Nonmedical use of prescription stimulants is common in young adults and has profound public health associations including with a profundity of other drug use (licit and illicit), certain mental health diagnoses (especially gambling, anxiety, and post-traumatic stress disorder ), worse scholastic performance, and riskier sexual practices. The majority of people with nonmedical use of prescription stimulants do not have ADHD, and its link with current ADHD symptoms was less marked than for certain other disorders. Clinicians should screen for the misuse of prescription stimulants as they may be associated with a range of problematic behaviors. Risk of diversion (which may be higher for those living in shared accommodation and those with substance use disorder history) merits careful assessment before prescribing stimulant medication.

4.70 Personalized Normative Feedback Intervention for Prescription Stimulant Medication: Preliminary Evidence in College Students

4.70 Personalized Normative Feedback Intervention for Prescription Stimulant Medication: Preliminary Evidence in College Students

Physician Training and Qualification to Educate Patients on Attention-Deficit/Hyperactivity Disorder Stimulant Diversion and Misuse.

The increased number of adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in recent years has raised concerns regarding diversion and misuse of prescription stimulant medications. As prescribers of these medications, physicians must be prepared to educate patients on these issues. This is the first study to evaluate physician training and qualification to educate adolescent patients on stimulant diversion and misuse. A questionnaire was developed and mailed to a national sample of child and adolescent psychiatrists (CAPs), child neurologists (CNs), and developmental-behavioral pediatricians (DBPs) in the United States. In addition to descriptive statistics, multivariable regressions (log-binomial and ordinal logistic) were performed to identify differences between subspecialists. The final sample consisted of 826 physicians who currently prescribe stimulants. Only 48% of physicians reported receiving formal training on prescription drug diversion (PDD) in medical school, residency, and/or fellowship. Twenty five percent and 48% of physicians felt inadequately qualified to educate patients on the health and legal consequences, respectively, of stimulant misuse and diversion. CAPs were more likely to have received formal training and felt better qualified to educate patients than CNs and DBPs. Physicians who received formal training were 2.4 times more likely to feel adequately qualified to educate patients on these issues. Only 58% of physicians correctly answered a legal question relating to stimulant diversion. Most physicians have not received formal training on PDD and many feel inadequately qualified to educate patients on the health and legal consequences of stimulant misuse and diversion. Increased training is needed so physicians can effectively educate patients with ADHD.

Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students.

Prescription stimulant medications are considered a safe and long-term effective treatment for Attention Deficit Hyperactivity Disorder (ADHD). Studies support that stimulants enhance attention, memory, self-regulation and executive function in individuals with ADHD. Recent research, however, has found that many college students without ADHD report misusing prescription stimulants, primarily to enhance their cognitive abilities. This practice raises the question whether stimulants actually enhance cognitive functioning in college students without ADHD. We investigated the effects of mixed-salts amphetamine (i.e., Adderall, 30 mg) on cognitive, autonomic and emotional functioning in a pilot sample of healthy college students without ADHD (n = 13), using a double-blind, placebo-controlled, within-subjects design. The present study was the first to explore cognitive effects in conjunction with mood, autonomic effects, and self-perceptions of cognitive enhancement. Results revealed that Adderall had minimal, but mixed, effects on cognitive processes relevant to neurocognitive enhancement (small effects), and substantial effects on autonomic responses, subjective drug experiences, and positive states of activated emotion (large effects). Overall, the present findings indicate dissociation between the effects of Adderall on activation and neurocognition, and more importantly, contrary to common belief, Adderall had little impact on neurocognitive performance in healthy college students. Given the pilot design of the study and small sample size these findings should be interpreted cautiously. The results have implications for future studies and the education of healthy college students and adults who commonly use Adderall to enhance neurocognition.

Patterns and profiles of methylphenidate use both in children and adults.

The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3-year period. Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18-24, 25-49 and ≥50years of age for adults and <6, 6-11 and 12-17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow-up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs. We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long-term use of MPH with few comedications. The group of 25-49-year-old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50year-old group was more often coprescribed antidepressants and antiparkinsonian drugs. Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25-49-year-old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.

Prevalence of nonmedical use and routes of administration for prescription stimulant medications among adults in a substance abuse treatment population

The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV®) as part of the clinical intake process between January 2013 and March 2016. A cross-sectional observational study examined prevalence and prescription-adjusted prevalence of past 30-day NMU of prescription stimulants and compound-specific use by ROA (oral, snort, smoke, inject, other oral, and alternate ROA). Compounds of interest were amphetamine extended-release (ER), amphetamine immediate-release (IR), amphetamine mixed salts, methylphenidate ER, and methylphenidate IR. Of 198,411 respondents, 4,185 reported prescription stimulant NMU, prevalence ranged from 0.33% for methylphenidate IR to 1.61% for amphetamine mixed salts. Prescription-adjusted prevalence of NMU was highest for methylphenidate IR (0.51%) and lowest for amphetamine ER (0.28%). The most common ROA was oral, swallowed whole followed by snorting. There was a greater probability of nonmedical prescription stimulant use among respondents with higher drug severity ratings. Results suggest that one should not overlook the impact of prescription stimulant NMU in adults in treatment for substance use problems. NMU of prescription stimulants was associated with riskier routes of administration than reported for college student samples. A pattern of high-risk alternate ROA and increasing drug problem severity has important implications of substance use evaluation.

Prescribing Stimulants in College Populations: Clinical and Ethical Challenges

Objective: Increased concern exists regarding non-prescription use of stimulants in college populations such as for perceived enhancement of cognition and subsequent improved academic performance or for recreational purposes. Psychiatrists face serious clinical challenges in making a new diagnosis of adult ADHD in college-age patients and distinguishing between students who have legitimate ADHD symptoms versus students seeking secondary gain. Methods: A hypothetical case will illustrate those challenges and an ethics-based framework named dialectical principlism will be applied to the case to demonstrate how the competing considerations can be balanced to inform a resolution for this clinical dilemma. Results: The weighted considerations related to principles of autonomy, beneficence, nonmaleficence, and distributive justice were balanced to favor not prescribing stimulant medication in this hypothetical situation. Others might come to the opposite conclusion using the same dialectical principlism model because their unique narrative and set of values may lead to weighing the importance of these principles differently and thus altering the balance in the other direction. Conclusion: The method of dialectical principlism was applied to this hypothetical to illustrate how practitioners can make clinical decisions guided by what is most ethical after identifying, prioritizing, and balancing the competing considerations. Dialectical principlism is primarily an aspirational model for practitioners, with the goal of empowering them with a systematic approach to determine the best way to resolve complex challenges via an ethics analysis. Keywords: Ethics, ADHD, adolescent mental health, stimulant medication, college students, dialectical principlism.

Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.

Non-medical use of prescribed stimulant medications is a growing concern. This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. Cox proportional hazards regression in a retrospective cohort adjusted by baseline covariates. United States, national administrative database of the Veterans Affairs (VA) health-care system. Adult incident users of stimulant medications (n=78 829) from fiscal years (FY) 2001 to 2012. Primary outcomes were time-to-event: (1) occurrence of AUD diagnosis and (2) death. Baseline covariates included demographic information, Food and Drug Administration (FDA)-approved indications for stimulant use, substance use disorders (SUD) and depression. Stimulant users compared with non-users were younger, more likely to be non-Hispanic white and female. Incident stimulant medication users increased threefold from FY2001-FY2012 and eightfold among adults aged 18-44years. Nearly one in 10 incident users in FY2012 had a comorbid baseline SUD. Off-label use was common-nearly three of every five incident users in FY2012. Comorbid SUDs among incident stimulant medication users were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.83 (Ps<0.05). Increased mortality risk was observed with occurrence of AUD during follow-up [AHR=1.55, 95% confidence interval (CI)=1.13-2.14, P=0.007], while on-label prescribing was protective against death (AHR=0.686, 95% CI=0.63-0.75, P<0.0001). In a US national cohort of adult incident stimulant medication users in the Veterans Affairs health-care system, measured from fiscal years 2001 to 2012, comorbid substance use disorders were common and were risk factors for development of an amphetamine use disorder (AUD). Increased mortality risk among incident users of stimulant medications was observed among both those who developed an AUD later and those whose use was defined as off-label.

The diversion of prescribed stimulant medications of 10th graders in Iceland

ADHD is a neurodevelopmental disorder that usually surfaces before seven years of age. Stimulants are commonly used medications for the treatment of this disorder in Iceland, but they carry with them a significant risk of both abuse and diversion - i.e. when it is used by an individual other than it was prescribed for by a physician. The purpose of this study was to estimate the prevalence of diversion amongst Icelandic adolescents. This study is based on data collected in the Icelandic portion of the European School Survey Project on Alcohol and Other Drugs (ESPAD) focused on the drug and alcohol use of 10th graders in Europe. Of the 2,306 students that participated in the study 91% (2,098) claimed they had never been prescribed stimulant medications while 9% (208) claimed they had. Boys were twice as likely to get a stimulant prescription compared to girls. Almost 18% of the participants that had been prescribed simulants said they had at some point in time diverted their stimulant medication. The diversion of stimulants by 10th graders in Iceland is quite common compared to studies from other countries where the prevalence is closer to 5-10%. These findings demonstrate the importance of carefully overseeing stimulant use of adolescents, for the benefit of both those who divert as well as those diverted to.

Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period

Methylphenidate (MPH) is a prescription-stimulant medication which is authorized in France for two indications: attention-deficit hyperactivity disorder in children (aged≥6years) and narcolepsy in cases where modafinil is ineffective (for children and adults). MPH use has increased worldwide in the past 2 decades in children and adults. Different pharmacoepidemiological Europeans studies have described MPH patterns of use. To our knowledge, few pharmacoepidemiological studies have described MPH patterns of use in France. In this context, we have performed a study on regional reimbursement database (PACA-Corse area, covering approximately 4 millions inhabitants). The first part of the study analyzed the evolution of MPH users characteristic's yearly (grouped by age and gender) over a 7year period (2005-2011). In order to better characterize patterns of MPH use in adults, a specific analyze has been performed in the second part on MPH adult users in 2011 with a gender descriptive approach. During the 7year period, MPH dispensing grew from 0.28 to 0.68 patient per 1000. The proportion of adult patients rose from 14.8 to 25.7% (P<0.0001), with patients mainly aged 35-49years old. Gender differences in MPH users were noted between adults and children: the proportion of girls was less important in children than in adult (in 2011, 20.7% of girls among children vs 44.9% among adults). Moreover, the proportion of girls among children increased between 2005 to 2011 (15.1% of girls in 2005 versus 20.7% in 2011). Among adults, women were prescribed more antidepressants (41.5% versus 28.2%, P=0.003) and less opiate maintenance treatments (22.4% versus 31.9%, P=0.03) than men. Finally, 11% of men and 16.4% of women were over 50years old. MPH prescription greatly increased over7years, especially in adults. Moreover, in this population, patterns of MPH use differed with gender specificities. Such findings may increase clinical attention on monitoring MPH use in adults.

ADHD Medication and Substance-Related Problems.

Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. The authors analyzed 2005-2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not. In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64-0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67-0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78-0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82-0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

Neuropsychological functioning in college students with and without ADHD.

Increasing numbers of students with attention-deficit/hyperactivity disorder (ADHD) are attending college; however, little empirical information is available concerning the functional impairment experienced by these students. Although preliminary studies suggest that college students with ADHD are more likely to experience a variety of psychosocial and academic difficulties compared to their peers without the disorder, findings regarding neuropsychological functioning have been inconsistent with some studies reporting that college students with ADHD perform more poorly on various cognitive and neuropsychological tasks while others report no differences compared to their peers without ADHD. The purposes of the present study, the Trajectories Related to ADHD in College project, a longitudinal study following the 4-year outcomes of college students with and without ADHD, were to (a) examine the performance of 436 first-year college students with and without ADHD (51.6% female) on measures of executive function (EF) and intelligence and (b) investigate the association of self-reported use of stimulant medication and neuropsychological performance in students with ADHD. Participant data from their first year of involvement in the study were analyzed. Participants with ADHD performed more poorly on task-based and self-report EF measures relative to the comparison group. In contrast, no significant group differences were found with respect to intellectual performance. Within the ADHD group, use of prescription stimulant medication was associated with improved performance on some, but not all, neuropsychological tasks. Additional analyses also revealed significant group differences in EF based on clinical diagnostic status. College students with ADHD demonstrated poorer EF than their peers without ADHD and psychostimulant medication was associated with improved EF performance. No group differences were found with respect to intellectual functioning, Lastly, having one or more comorbid psychiatric diagnoses in addition to ADHD was associated with poorer EF outcomes. (PsycINFO Database Record