Prescription Stimulant Misuse Research Articles

Neurocognitive enhancement or impairment? A systematic meta-analysis of prescription stimulant effects on processing speed, decision-making, planning, and cognitive perseveration.

Increasing numbers of adults, particularly college students, are misusing prescription stimulants primarily for cognitive/academic enhancement, so it is critical to explore whether empirical findings support neurocognitive benefits of prescription stimulants. Previous meta-analytic studies have supported small benefits from prescription stimulants for the cognitive domains of inhibitory control and memory; however, no meta-analytic studies have examined the effects on processing speed or the potential impairment on other domains of cognition, including planning, decision-making, and cognitive perseveration. Therefore, the present study conducted a meta-analysis of the available literature examining the effects of prescription stimulants on specific measures of processing speed, planning, decision-making, and cognitive perseveration among healthy adult populations. The meta-analysis results indicated a positive influence of prescription stimulant medication on processing speed accuracy, with an overall mean effect size of g = 0.282 (95% CI [0.077, 0.488]; n = 345). Neither improvements nor impairments were revealed for planning time, planning accuracy, advantageous decision-making, or cognitive perseveration; however, findings are limited by the small number of studies examining these outcomes. Findings support that prescription stimulant medication may indeed act as a neurocognitive enhancer for accuracy measures of processing speed without impeding other areas of cognition. Considering that adults are already engaging in illegal use of prescription stimulants for academic enhancement, as well as the potential for stimulant misuse to have serious side effects, the establishment of public policies informed by interdisciplinary research surrounding this issue, whether restrictive or liberal, is of critical importance. (PsycINFO Database Record

Memorable Messages about the Misuse of Prescription Stimulants

ABSTRACTThe misuse of prescription stimulants among college undergraduates is a prevalent and dangerous problem on college campuses across the United States. Guided by a memorable messages framework, this research sought to examine the messages that college students recall about the misuse of prescription stimulants and examine how those messages are associated with students’ intention to use stimulants. We analyzed the recalled memorable messages of 129 undergraduates. Three predominant themes emerged from the analysis: academic implications, health implications, and ethical implications. Theme, source, and valence of the memorable messages were not associated with behavioral intention to engage in the misuse of prescription stimulants. These findings contribute to the scholarly and practical understanding of undergraduates’ experiences with illicit behaviors, and demonstrate a need to further investigate students’ sense-making in relation to risky decisions made during their college experience.

ADHD medication overdose and misuse: the NSW Poisons Information Centre experience, 2004-2014.

To describe Australian trends in overdoses with medications used to treat attention deficit hyperactivity disorder (ADHD). This was a retrospective observational study of intentional exposures to methylphenidate, dexamphetamine, modafinil and atomoxetine reported to the New South Wales Poisons Information Centre (NSWPIC) from 1 January 2004 to 31 December 2014. The NSWPIC takes calls from New South Wales, Tasmania and the Australian Capital Territory between 6 am and midnight each day, and, as part of a national after-hours roster, from all Australian states between midnight and 6 am on seven nights each fortnight. The target population included Australian residents aged 10-75 years. Demographic characteristics of the patients, changes in numbers of exposures with time, co-ingestants, route of exposure, and disposition of patients. During the 11-year study period, 1735 intentional exposures to the four medications were reported to NSWPIC. There was a 210% increase in intentional exposures to methylphenidate over this period, whereas the number of dexamphetamine exposures declined by 25%. Illicit use (defined as co-ingestion with alcohol or a street drug) increased by 429% across the study period. At least 93% of overdose patients required hospitalisation. Trends in exposures paralleled trends in the dispensing of these medications, as recorded in Pharmaceutical Benefits Scheme data. NSWPIC data show a dramatic increase in intentional exposures to ADHD medications between 2004 and 2014, mainly to methylphenidate. Further, the data suggest that illicit use of these substances is increasing. The potential harm related to misuse of prescription stimulants and the close correlation between these exposures and the prescribing of these drugs causes concerns about their diversion, and highlights the importance of the quality use of medicines (ie, ensuring that they are used safely, appropriately and in an evidence-based manner, including considering non-medical or non-stimulant alternatives) and of risk assessment for misuse when prescribing ADHD drugs.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension: A Scientific Statement from the American Heart Association and the American College of Cardiology.

An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athletics. The 2013 update from the American Heart Association using the National Health and Nutrition Examination (NHANES) data from 2007 to 2010 estimates that 9.1% of men aged 20 to 34 years and 6.7% of women of that age are hypertensive, based on having an elevated BP measurement or answering “yes” to the question, “Are you taking antihypertensive medication or were you told that you had hypertension?”1 The prevalence in children and adolescents is estimated to be ≈3.5%, with higher percentages in older and obese children.2 The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week.3 However, BP measurements in the competitive athlete are typically obtained by different healthcare providers, which makes it particularly necessary that the testing conditions be standardized before the diagnosis of hypertension is made. People >18 years of age with a BP >140 mm Hg systolic and/or >90 mm Hg diastolic are considered to have hypertension.3 In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves …

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes.

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

Misuse of prescription stimulant medication in a sample of college students: Examining differences between varsity athletes and non-athletes

BackgroundThe misuse of prescription stimulants (MPS) has been identified as an adverse health behavior among college students. Because stimulant medication is often taken to increase focus and decrease reaction time, these substances have the potential to enhance athletic performance. However, the role that athlete status (varsity athlete vs. non-athlete) has on MPS has rarely been examined in the college student population. ObjectivesTo examine whether there are differences in past-year MPS and MPS-related motivations between college varsity athletes and non-athletes. MethodsA sample of 682 (482 non-athletes; 200 athletes) college students between the ages of 18 and 25 completed a paper-based questionnaire to assess MPS, MPS-related motivations, and other potential MPS correlates (e.g., gender, energy drink consumption, tobacco use, heavy episodic drinking). Then, we conducted bivariate and multivariate analyses to examine potential correlates of MPS, including athlete status. Finally, we examined differences in MPS-related motivations between varsity athletes and non-athletes. ResultsOverall, 98 (13.9%; 16.6% non-athletes v. 7.5% varsity athletes) respondents reported past-year MPS and varsity athletes were significantly less likely (p<0.05) to do so. Past-year MPS was also significantly associated with energy drink consumption, tobacco use, and heavy episodic drinking in our sample. Concerning MPS-related motivations, athletes more often cited a need to enhance athletic performance as the impetus for their misuse. ConclusionsMPS was prevalent among the sample. Varsity athletes were significantly less likely to engage in past-year MPS and were motivated to do so for different reasons.

The Use of Prescription Drugs and Drugs of Abuse for Neuroenhancement in Europe

Abstract. Pharmacological neuroenhancement, defined as the misuse of prescription drugs, illicit drugs, or alcohol for the purpose of enhancing cognition, mood, or prosocial behavior, is not widespread in Europe – nevertheless, it does occur. Thus far, no drug has been proven as safe and effective for cognitive enhancement in otherwise healthy individuals. European studies have investigated the misuse of prescription and illicit stimulants to increase cognitive performance as well as the use of tranquilizers, alcohol, and cannabis to cope with stress related to work or education. Young people in educational settings report pharmacological neuroenhancement more frequently than those in other settings. Although the regular use of drugs for neuroenhancement is not common in Europe, the irregular and low-dose usage of neuroenhancers might cause adverse reactions. Previous studies have revealed that obtaining adequate amounts of sleep and using successful learning techniques effectively improve mental performance, whereas pharmacological neuroenhancement is associated with ambiguous effects. Therefore, non-substance-related alternatives should be promoted to cope with stressful situations. This paper reviews the recent research on pharmacological neuroenhancement in Europe, develops a clear definition of the substances used, and formulates recommendations for practitioners regarding how to react to requests for neuroenhancement drug prescriptions. We conclude that monitoring the future development of pharmacological neuroenhancement in Europe is important to provide effective preventive measures when required. Furthermore, substance use to cope with stress related to work or education should be studied in depth because it is likely more prevalent and dangerous than direct neuroenhancement.

The Illicit Use of Prescription Stimulants on College Campuses: A Theory-Guided Systematic Review.

The illicit use of prescription stimulants (IUPS) is a substance use behavior that remains prevalent on college campuses. As theory can guide research and practice, we provide a systematic review of the college-based IUPS epidemiological literature guided by one ecological framework, the theory of triadic influence (TTI). We aim to assess prevalence, elucidate the behavior's multietiological nature, and discuss prevention implications. Peer-reviewed studies were located through key phrase searches (prescription stimulant misuse and college, "prescription stimulant misuse" and "college," illicit use of prescription stimulants in college, and nonmedical prescription stimulant use in college students) in electronic databases (PubMed, PubMed Central, and EBSCO Host) for the period 2000 to 2013. Studies meeting inclusion criteria had their references reviewed for additional eligible literature. Statistically significant correlates of IUPS in the 62 retrieved studies were organized using the three streams of influence and four levels of causation specified in the TTI. Results show that the prevalence of IUPS varies across campuses. Additionally, findings suggest the behavior is multifaceted, as correlates were observed within each stream of influence and level of causation specified by the TTI. We conclude that IUPS is prevalent in, but varies across, colleges and is influenced by intrapersonal and broader social and societal factors. We discuss implications for prevention and directions for future research.

Middle-Class Motives for Non-Medical Prescription Stimulant Use among College Students

Among policymakers and media in the United States, there is growing concern over increasing rates of illicit prescription drug use among college students. Using semi-structured interviews with 22 college students who misused prescription stimulants, we find that they draw on conventional middle-class beliefs (e.g., success and moderation) to make sense of their drug use. They do this by creating identities as people who are focused on success and use stimulants only as a tool to perform their best. They use excuses and justifications rooted in middle-class values to create symbolic boundaries between themselves (as legitimate users) and others (as hedonistic users). This allows them to persist with their illegal behaviors while maintaining an identity as conventional citizens.

Prescription stimulant misuse in a military population.

Increased prescription drug misuse has been reported in veterans, yet there has not been a focused look at stimulant misuse in the military community or correlation with deployment injuries and illnesses. Our objective was to identify rates of stimulant misuse and any correlation with deployment in the military population. A prospective, anonymous institutional review board-approved survey in the emergency department waiting room of a military tertiary care hospital using a 12-item questionnaire created with fixed response and multiple-choice questions. Stimulant misuse was defined as taking more than prescribed, obtaining stimulants from others, and taking it for a nonprescribed reason. Proportions were assessed by Chi-square test and Fisher's exact test. 26/498 (5%) of respondents reported misusing stimulants in the last 5 years. Misusers were more likely to have a mental health diagnosis, and they suffered either a deployment-related injury or another injury, as compared to those who used stimulants properly (p<0.05). The stimulant misuse did not correlate with age, gender, active duty status, education, location of deployment, number of times deployed, traumatic brain injury diagnosis, or enlistment status. Stimulant drug misuse in the military community is associated with mental health conditions, deployment-related injuries, or new physical injuries.

Treatments for Adolescents With Comorbid ADHD and Substance Use Disorder: A Systematic Review

Objective: Comorbid ADHD and substance use disorder (SUD) presents frequently in adolescence, a developmental period that may promote the emergence of substance misuse among individuals with ADHD. Comorbid ADHD and SUD in adolescence results in significant and unique treatment challenges, necessitating examination into effective interventions. Method: This systematic review examined existing research into the treatment of comorbid adolescent ADHD and SUD. Results: Findings from a small number of pharmacological intervention studies suggest potential efficacy of extended-release stimulant and nonstimulant medications. Efficacy of psychotherapeutic interventions has not been systematically examined. Conclusion: Current research on treatments for comorbid ADHD and SUD in adolescence is limited. Future placebo-controlled clinical trials using large samples are needed to examine the efficacy of psychotherapeutic interventions, the heightened risk of prescription stimulant misuse, and the long-term maintenance of treatment gains in this population. Clinical guidelines for the treatment of comorbid ADHD and SUD are discussed.

Developing a University-Wide Primary Prevention Intervention for Prescription Stimulant Misuse and Diversion in College Students

Developing a University-Wide Primary Prevention Intervention for Prescription Stimulant Misuse and Diversion in College Students

Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse

ObjectiveThis study examined relations between adolescents' family structures, social ties, and drug-related attitudes, and their misuse of prescription opioids and stimulants. Different relationships were anticipated for the substances based on prior research highlighting varying motivations for their use. MethodBased on an earlier model of adolescent substance misuse, two path analytic models were tested using data from 12 to 17year olds in the 2012 U.S. National Survey on Drug Use and Health (NSDUH: N=17,399). ResultsFemale respondents reported higher levels of parental warmth, as did youth from wealthier families. Greater parental monitoring was reported by adolescents from wealthier and intact families. Parental monitoring and warmth predicted adolescents' social ties and individual differences associated with drug use, and both variables predicted prescription opioid and stimulant misuse. Contrary to previous research, for adolescents aged 12 to 14, high levels of parental monitoring, while positively associated with attitudes and social ties, also predicted higher rates of prescription stimulant misuse when combined with low levels of parental warmth. Results were cross-validated with data from the 2011 NSDUH. ConclusionsAnalyses highlighted the importance of understanding and differentiating the underlying factors associated with adolescent prescription stimulant and opioid misuse, and the role of parental behaviors in prevention.

Prevalence and correlates of prescription stimulant misuse among youth in the emergency department

Prevalence and correlates of prescription stimulant misuse among youth in the emergency department

Collegiate Misuse of Prescription Stimulants: Examining Differences in Self-Worth

Background: Prescription stimulant medication is commonly used to treat attention-deficit hyperactivity disorder (ADHD). However, stimulant medication misuse is a prevalent problem among the college population. There is limited research on psychological factors associated with collegiate nonmedical stimulant misuse. Objectives: To examine the association between college students’ self-worth and stimulant medication misuse. Methods: A quantitative study implemented during the 2013–2014 academic year in which we utilized a convenience sample of undergraduate students at a public university. College students (N = 3,038) completed an electronic survey packet including a stimulant use index and the Contingencies of Self-Worth Scale. We conducted descriptive discriminant analysis (DDA) to measure the associations between four groups: Nonusers, Appropriate Users, Nonprescribed Misusuers, and Prescribed Users. Results: Significant differences in contingencies of self-worth existed between the four groups of students. Specifically, external contingencies of self-worth, such as appearance and approval, were associated with stimulant medication misuse, whereas, internal contingencies of self-worth, such as God's love and virtue, were associated with nonuse and appropriate prescribed use. Conclusions/Importance: The findings of the current study suggested contingencies of self-worth partially explain prescription stimulant misuse among the collegiate population. Addressing self-worth may be helpful in the treatment of stimulant misuse with college students.

Pharmacological interventions for adolescents and adults with ADHD: stimulant and nonstimulant medications and misuse of prescription stimulants.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity that cause functional impairment. Recent research indicates that symptoms persist into adulthood in the majority of cases, with prevalence estimates of approximately 5% in the school age population and 2.5%–4% in the adult population. Although students with ADHD are at greater risk for academic underachievement and psychosocial problems, increasing numbers of students with ADHD are graduating from high school and pursuing higher education. Stimulant medications are considered the first line of pharmacotherapy for individuals with ADHD, including college students. Although preliminary evidence indicates that prescription stimulants are safe and effective for college students with ADHD when used as prescribed, very few controlled studies have been conducted concerning the efficacy of prescription stimulants with college students. In addition, misuse of prescription stimulants has become a serious problem on college campuses across the US and has been recently documented in other countries as well. The purpose of the present systematic review was to investigate the efficacy of prescription stimulants for adolescents and young adults with ADHD and the nonmedical use and misuse of prescription stimulants. Results revealed that both prostimulant and stimulant medications, including lisdexamfetamine dimesylate, methylphenidate, amphetamines, and mixed-amphetamine salts, are effective at reducing ADHD symptoms in adolescents and adults with ADHD. Findings also suggest that individuals with ADHD may have higher rates of stimulant misuse than individuals without the disorder, and characteristics such as sex, race, use of illicit drugs, and academic performance are associated with misuse of stimulant medications. Results also indicate that individuals both with and without ADHD are more likely to misuse short-acting agents than long-acting agents. These findings have implications for intervention, prevention, and future research.

An examination of the misuse of prescription stimulants among college students using the theory of planned behavior

The misuse of prescription stimulants (MPS) is an emergent adverse health behavior among undergraduate college students. However, current research on MPS is largely atheoretical. The purpose of this study was to validate a survey to assess MPS-related theory of planned behavior (TPB) constructs (i.e. attitudes, subjective norms, and perceived behavioral control) and determine the relationship between these constructs, MPS-related risk factors (e.g. gender and class status), and current MPS (i.e. past 30 days use) among college students. Participants (N = 978, 67.8% female and 82.9% Caucasian) at a large public university in the southeastern USA completed a survey assessing MPS and MPS-related TPB constructs during fall 2010. To examine the relationship between MPS-related TPB constructs and current MPS, we conducted (1) confirmatory factor analyses to validate that our survey items assessed MPS-related TPB constructs and (2) a series of regression analyses to examine associations between MPS-related TPB constructs, potential MPS-related risk factors, and MPS in this sample. Our factor analyses indicated that the survey items assessed MPS-related TPB constructs and our multivariate logistic regression analysis indicated that perceived behavioral control was significantly associated with current MPS. In addition, analyses found that having a prescription stimulant was a protective factor against MPS when the model included MPS-related TPB variables.

Using structural equation modeling to understand prescription stimulant misuse: A test of the Theory of Triadic Influence

ObjectiveTo test a theory-driven model of health behavior to predict the illicit use of prescription stimulants (IUPS) among college students. ParticipantsA probability sample of 554 students from one university located in California (response rate=90.52%). MethodsStudents completed a paper-based survey developed with guidance from the Theory of Triadic Influence. We first assessed normality of measures and checked for multicollinearity. A single structural equation model of frequency of IUPS in college was then tested using constructs from the theory's three streams of influence (i.e., intrapersonal, social situation/context, and sociocultural environment) and four levels of causation (i.e., ultimate causes, distal influences, proximal predictors, and immediate precursors). ResultsApproximately 18% of students reported engaging in IUPS during college, with frequency of use ranging from never to 40 or more times per academic term. The model tested had strong fit and the majority of paths specified within and across streams were significant at the p<0.01 level. Additionally, 46% of the variance in IUPS frequency was explained by the tested model. ConclusionsResults suggest the utility of the TTI as an integrative model of health behavior, specifically in predicting IUPS, and provide insight on the need for multifaceted prevention and intervention efforts.

Popping smart pills: prescription stimulant misuse by university and college students in Flanders

Background In the USA, between 7 and 16% of the students use stimulants in a non-medical way. In European countries, data on this phenomenon are scarce. Yet, apart from the question of unfair competition during the exams, the misuse of prescription stimulants can also have detrimental health effects. Methods In Flanders, a large-scale repeated quantitative survey among university and college students was performed. This survey started in 2005 in the Antwerp students. In 2009, a …

Assessing prescription stimulant use, misuse, and diversion among youth 10–18 years of age

Assessing the medical and nonmedical use (NMU) of stimulants and diversion is a challenge, especially among youth, with different methods for recruitment and definitions of NMU. The field needs inexpensive, yet effective and reliable, methods of data collection to understand the prescription drug use problem. Most studies of youth are school or web-based, and conducted with teens. The National Monitoring of Adolescent Prescription Stimulants Study recruited 11,048 youth 10-18 years of age from urban, rural, and suburban areas in 10 US cities using an entertainment venue intercept study. This review discusses the effectiveness of the method and results from four cross-sections as well as the representativeness of the sample. Lifetime prevalence of any stimulant use was 14.8%, with rates highest among rural 16-18 year olds. The rate of last 30-day use was 7.3%, with over half (3.9%) NMU. Nearly 12% of all youth (whether a user or not) reported lifetime incoming/outgoing diversion of prescription stimulants. Because no study has focused on stimulant use among youth as young as 10 and 11, this study is a landmark for future comparisons and offers a unique strategy for sampling and data collection.