Prescription Stimulants Research Articles

Misuse of Prescription Pain Relievers, Stimulants, Tranquilizers, and Sedatives Among U.S. Older Adults Aged ≥50 Years

Misuse of prescription medications has led to higher mortality and morbidity in the U.S. This study investigates medical and nonmedical use of prescription medications (prescription pain relievers, stimulants, prescription tranquilizers, and sedatives) among adults aged ≥50 years. Data were from the 2015-2017 National Survey of Drug Use and Health. For each prescription medication, medical and nonmedical use were mutually exclusive (prescription pain relievers, stimulants, tranquilizers, and sedatives). Nonmedical use (misuse) was defined as the use of any prescription medications in greater amounts, frequency, or duration than prescribed or the use of medications without a prescription of the individual's own. Descriptive analysis was performed to assess prescription medication use and misuse among adults aged ≥50 years (pooled N=26,322). Correlates of misuse were assessed within multivariable logistic regression analyses at p<0.05. All analyses were conducted in 2019. In the past 12 months, 46.7% (51.7 million) of adults reported using any prescription medication, of which 7.7% (4.0 million) reported misuse. The proportion of past 12-month users reporting misuse was 5.4% for sedatives, 6.4% for prescription pain relievers, 6.5% for prescription tranquilizers, and 8.1% for stimulants. Overall, 16.2% (17.9 million) reported using 2 or more prescription medications within the past 12 months. Multiple prescription medication use was associated with female sex; White race; younger age; and use of nonprescription substances, including alcohol, tobacco, marijuana, and heroin. It is important to monitor medication misuse behaviors among older adults who may be living with several chronic conditions requiring pain management. The strong associations with serious psychological distress underscore the need for increased access to mental health services among this key population.

Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine

RationalAt all times humans have made attempts to improve their cognitive abilities by different means, among others, with the use of stimulants. Widely available stimulants such as caffeine, but also prescription substances such as methylphenidate and modafinil, are being used by healthy individuals to enhance cognitive performance.ObjectivesThere is a lack of knowledge on the effects of prescription stimulants when taken by healthy individuals (as compared with patients) and especially on the effects of different substances across different cognitive domains.MethodsWe conducted a pilot study with three arms in which male participants received placebo and one of three stimulants (caffeine, methylphenidate, modafinil) and assessed cognitive performance with a test battery that captures various cognitive domains.ResultsOur study showed some moderate effects of the three stimulants tested. Methylphenidate had positive effects on self-reported fatigue as well as on declarative memory 24 hours after learning; caffeine had a positive effect on sustained attention; there was no significant effect of modafinil in any of the instruments of our test battery. All stimulants were well tolerated, and no trade-off negative effects on other cognitive domains were found.ConclusionsThe few observed significant positive effects of the tested stimulants were domain-specific and of rather low magnitude. The results can inform the use of stimulants for cognitive enhancement purposes as well as direct further research to investigate the effects of stimulants on specific cognitive domains that seem most promising, possibly by using tasks that are more demanding.

Higher and Higher? Drug and Alcohol Use and Misuse among HIV-Vulnerable Men, Trans Men, and Trans Women Who Have Sex with Men in the United States

Background: Substance use (SU) and misuse are disproportionately more common among sexual and gender minority (SGM) individuals compared to their heterosexual peers. Yet, little is known about regional and demographic differences in use and misuse among SGM. In this study, we investigated regional and demographic differences in SU and misuse in a U.S. national, internet-based cohort (n = 6,280) of men and trans persons who have sex with men. Methods: Data collected included the WHO ASSIST (substance) and AUDIT (alcohol) SU scales to estimate recent (≤ 3 months) non-problematic use (≤ 3 ASSIST, ≤ 10 AUDIT) and misuse (≥4 ASSIST, ≥11 AUDIT). We used bivariate and multivariable logistic models to examine demographic and regional factors associated with SU and misuse. Results: Participants reported using alcohol (85.6%), cannabis (53.9%), and inhalants (39.1%) in the past three months. More than one-third self-reported misuse of cannabis, Gamma-Hydroxybutyrate (GHB), inhalants, methamphetamines, and prescription sedatives. We observed regional differences in substance use for cannabis (Southeast aOR = 0.76, 95% CI: 0.63–0.93; West aOR = 1.27, 95% CI: 1.02–1.59, ref. Northeast) and prescription Stimulants (Midwest aOR = 1.39, 95% CI: 1.00–1.93), as well as for cannabis misuse (Southeast aOR = 0.83, 95% CI: 0.69–0.99). We also observed significant associations between socioeconomic factors with use and misuse. Conclusions: Findings suggest geographic differences in misuse of certain substances among men and trans persons who have sex with men in the US, and that socio-economic factors, also play a key role in indicating risk.

Preoperative Sedative Use and Other Risk Factors for Continued Narcotic Use After Total Knee Arthroplasty: A Comprehensive Analysis of a Mandatory Database.

Opioids are used for pain control after total knee arthroplasty (TKA) and carry risk for abuse. Mandatory statewide databases have been created to monitor their use. The goal of this study was to identify patient risk factors for prolonged opioid use after TKA. The authors retrospectively reviewed a consecutive series of 676 primary TKA procedures performed between January 2017 and July 2017. Information on fulfillment of narcotic, sedative, benzodiazepine, and stimulant prescriptions was obtained from the Pennsylvania State Controlled Substance Monitoring website 6 months before and 1 year after the procedure. Bivariate and multivariate analyses were used to identify risk factors for the need for a second prescription and opioid use for longer than 6 months. Of this cohort, 30.3% used preoperative opioids, 60.5% filled a second opioid prescription, and 11.8% continued opioid use for longer than 6 months. Patients who had opioid use before the index procedure had more than 3-fold (odds ratio [OR], 3.29; P<.001) increased odds of filling a second opioid prescription and 8-fold (OR, 8.05; P<.001) increased odds of postoperative opioid use for longer than 6 months. Multivariate analysis was used to identify independent risk factors for requiring a second prescription, including discharge to a rehabilitation facility (OR, 2.77), bilateral procedures (OR, 1.88), preoperative narcotic use (OR, 1.70), and younger age (OR, 0.95). Independent risk factors for narcotic use for longer than 6 months included preoperative sedative (OR, 3.30) or narcotic use (OR, 1.49). This study identified several risk factors associated with prolonged narcotic use after TKA, including preoperative sedative use, and determined their relative weight. [Orthopedics. 2021;44(1):e50-e54.].

Differences in Prescription Stimulant Misuse Motives Across Adolescents and Young Adults in the United States.

While prescription stimulant misuse (PSM) is common in adolescents and young adults (AYAs), PSM motives are poorly understood. This study examined a number of PSM motives across the AYA age spectrum using the 2015-2018 National Survey on Drug Use and Health. In all, 86,918 AYAs (aged 14-25 years) were included. Individual PSM motives (eg, to study) and motive categories (ie, cognitive enhancement only, recreational only, weight loss only, and combined motives) were examined by age. Logistic regression models examined links between individual motives or motive categories and educational status, substance use, DSM-IV substance use disorders (SUD), and mental health correlates. Significant differences were found across AYAs in cognitive enhancement only (14 years = 40.4%; 24 and 25 years = 71.2%; P < .0001) and recreational only (14 years = 25.8%; 24 and 25 years = 9.8%; P < .0001) or combined PSM motives, (14 years = 32.3%; 24 and 25 years = 18.0%; P = .008); college students and graduates had particularly high rates of cognitive enhancement only (college = 78.2%; graduates = 74.7%; non-college = 63.5%). Recreational-only and combined motives were significantly elevated in AYAs with any past-year SUD, especially to get high (78%-136% higher in those with SUD; P ≤ .001). While any PSM was associated with higher odds of SUD and mental health outcomes, including suicidal ideation, odds were highest for recreational or combined motives. Cognitive enhancement with PSM occurs more often in young adults compared to adolescents, college students endorse more cognitive enhancement than those not in school, and the presence of any PSM in AYAs is linked to more substance use, suicidal ideation, and other psychopathology. PSM prevention in adolescents as well as screening and intervention among AYA is highly recommended.

The problem of prescribing for pain.

Friends recently sent us, as lockdown entertainment, the boxed set of a BBC series called A Very Peculiar Practice ,1 which may be familiar to many. A satire set in a supremely dysfunctional university practice that ran for two series in 1986 and 1988, it covered many of the challenges and personalities seen in primary care. The second episode has a truly terrifying depiction of a consultation where the patient, aptly named Professor Furie, wants a prescription for an amphetamine-like stimulant and the doctor is reluctant to prescribe it. Despite using textbook consultation techniques and attempting to explore the underlying concerns and issues relating to the request, the doctor is bullied into prescribing against their better judgement and left anxious and scarred by the …

Medicate to Graduate: Academic Strain and Nonmedical Prescription Stimulant Use Among Graduate and Undergraduate Students

The nonmedical use of prescription stimulants has been prevalent on college campuses in recent years. Previously, nonmedical prescription stimulant use (NMPSU) has been associated with increased use of other illicit substances, drug abuse, school dropout, and arrest. It is, therefore, imperative to understand the etiology of NMPSU for prevention, intervention, and harm reduction purposes. This study builds upon previous research on the role of academic strain in NMPSU by (a) considering a measure of strain that is more consistent with strain theory and (b) extending the examination to include graduate students. By utilizing an original data set of 1,121 undergraduate and graduate students at a Southern urban university, our overall results are consistent with general strain theory but mixed with respect to the role of academic strain in particular. The implications of our study for academic strain are discussed.

Prenatal and early childhood exposure to tetrachloroethylene (PCE) and non-medical use of prescription drugs: A retrospective cohort study in Cape Cod, MA

BackgroundBetween 1968 and 1983, public drinking water supplies of Cape Cod, Massachusetts were contaminated with the chlorinated solvent tetrachloroethylene (PCE). We previously found an affinity for risk-taking behaviors, including the use of illicit drugs, following prenatal and early childhood exposure to PCE. Using newly collected data, we investigated the risk of non-medical use of prescription drugs (NMUPD) following prenatal and early childhood PCE exposure. MethodsParticipants were identified from a retrospective cohort study ("Cape Cod Health Study”) via cross-matching birth certificates and water system data. The original self-administered questionnaire gathered data on demographics, work and medical history, and alcohol and illicit drug use from 618 individuals (363 exposed and 255 unexposed). The follow-up survey added questions on non-medical use of prescription pain relievers, tranquilizers, stimulants and sedatives. A validated leaching and transport model was used to estimate exposure to PCE exposure in drinking water. ResultsThere was a wide distribution of cumulative prenatal and early childhood PCE exposure levels (range: 0.04 g–3722.2 g). PCE exposed subjects had a 1.92-fold increase in risk of any non-medical use of prescription drugs [Adjusted RR: 1.92, (95% CI: 1.31, 2.83)]. Furthermore, the association followed a dose-response relationship where the risk of NMUPD was higher for those exposed to PCE levels greater than or equal the median level versus those exposed to levels less than the median [Adjusted RR: 2.05 (95% CI: 1.34, 3.15) vs. 1.83 (95% CI: 1.20, 2.79) (p-value for trend < 0.01)]. Additionally, we found moderate increases in risk by level of non-medical use (any non-medical use, non-medical use of 1 or more categories of prescription drugs, or 2+ categories) as well as by category of drug for pain relivers, stimulants and tranquilizers. ConclusionWe found that prenatal and early childhood exposure to PCE was associated with a moderate increase in the risk of NMUPD. Exposed subjects had dose-related increased risks of NMUPD of pain relievers, tranquilizers, and stimulants. This study has a number of limitations and is the first to report this association. Additional longitudinal studies of populations exposed to PCE during early life should be conducted to examine its long-term neurotoxic effects.

Early life exposure to tetrachloroethylene (PCE) and misuse of prescription drugs: a retrospective cohort study in Cape Cod, MA

Background/Aims: Between 1968 and 1983, public drinking water supplies of Cape Cod, Massachusetts were contaminated with tetrachloroethylene (PCE), an established neurotoxicant. We previously found an affinity for risk-taking behaviors, including the use of illicit drugs, following early-life exposure to PCE. Using newly collected data, we investigated the risk of misusing prescription drugs following early life PCE exposure. Methods: Participants were identified from a retrospective cohort study ("Cape Cod Health Study”) via cross-matching birth certificates and water system data. The original self-administered questionnaire gathered data on demographics, work and medical history, and alcohol and illicit drug use from 615 individuals (361 with early-life exposure and 254 unexposed). The follow-up survey added questions on misuse of prescription pain relievers, tranquillizers, stimulants and sedatives. A validated leaching and transport model was used to estimate exposure to PCE exposure in drinking water. Results: One hundred and thirty-four (19.3%) participants misused at least one type of prescription drug. Pain relievers were the most commonly misused prescription drug (14.3%). Compared to unexposed subjects, individuals with early-life exposure to PCE were 93% more likely to misuse prescription drugs (Adjusted relative risk (RR)1.93, 95% CI: 1.31, 2.83), after adjusting for maternal education, father occupation and participant age. Similar increases in risk were seen for pain relievers, tranquillizers and stimulants (Adjusted RRs:1.82-2.17) and for misusing only 1 or 2 or more prescription drugs [Adjusted RRs 1.97 and 2.12, respectively]. Participants exposed to PCE levels &gt;= median had a slightly higher risk of misusing prescription drugs than those exposed to levels &lt; median [Adjusted RRs: 2.06 (95% CI: 1.34, 3.17) and 1.83 (95% CI: 1.20, 2.79), respectively]. Conclusions: Results suggest early life exposure to PCE increases the risk of misusing several types of prescription drugs.

Age of First Use of Prescription Opioids and Prescription Opioid Non-Medical Use among Older Adolescents

Background Non-medical use (NMU) of prescription opioids is of concern due to the opioid epidemic in the United States. Objective: We examined sex differences in the effect of age of first use of prescription opioids on prescription opioid NMU among 17- and 18-year olds. Methods: The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10–18 years from 10 United States cities between 2008 and 2011 (n = 11,048). The cross-sectional survey included questions on past 30 day prescription opioid use (10,965 provided responses; 278 age 17 to 18 years who used opioids in past 30 days), with NMU defined as non-oral use and/or use of someone else’s opioids. Nonparametric survival analysis with lifetable estimates was used to examine age at first use. Binomial logistic regression was conducted predicting any NMU, adjusted for covariates. Results: Among 278 youth 17 to 18 years, a significant difference in age of first use between those with MU only and any NMU (p < .0001) was observed. Each one year increase in age resulted in a 33% decrease in the odds of any prescription opioid NMU compared to MU only, after controlling for covariates (Odds Ratio = 0.67, 95% Confidence Interval: 0.47,0.96). Sex differences in age at first use were not observed. Conclusions: Risk of past 30 day prescription opioid NMU decreased by a third for each one year increase in age of first use, after adjustment for other covariates. Use of prescription opioids in young adolescents may need to be limited where possible and researched further.

Educational and Personal Opportunity Costs of Medical Student Preparation for the United States Medical Licensing Examination Step 1 Exam: A Single-Center Study.

PurposeTo assess the degree to which medical students choose to disengage from their regular preclinical curriculum and extracurricular activities in order to focus on United States Medical Licensing Examination (USMLE) Step 1 exam preparation, as well as learner-perceived effects of Step 1 preparation on their physical, social, and mental health.MethodOnline survey of medical students who have taken the USMLE Step 1 exam at a single large Midwestern academic medical center.ResultsThe response rate was 54%. Students often reported absenteeism from a variety of preclinical curricular activities, including lectures (44%) and didactics focusing on medical ethics (37%), clinical skills (28%), and encounters with actual and standardized patients (9%) in order to study for USMLE Step 1. Many students also forewent extracurricular opportunities including research (53%), elective patient care opportunities (45%), community service (39%), and healthcare advocacy experiences (38%) in order to study for USMLE Step 1. Majorities of students identified Step 1 preparation as a cause of burnout (79%) or significant anxiety or depression (61%), for which nearly a third sought mental healthcare; students also reported Step 1 preparation as a cause of engaging in dangerous behaviors such as illicit prescription stimulant use as well as driving or providing patient care while impaired by fatigue. In narrative comments, students frequently described Step 1 to be a barrier to their development into effective clinicians, the traditional medical school curriculum to be a barrier to performance on Step 1, or both.ConclusionsMedical students often prioritize Step 1 exam preparation over engaging with the standard preclinical curriculum, extracurricular opportunities, and activities to promote wellbeing. These findings have implications for the emphasis residency program directors place on single high-stakes standardized exams in the resident recruitment process.

Association of elevated neonatal thyroid-stimulating hormone levels with school performance and stimulant prescription for attention deficit hyperactivity disorder in childhood.

Untreated severe newborn thyroid deficiency causes neurocognitive impairment; however, the impact of mild thyroid deficiency is not known. This study aimed to examine whether mildly elevated neonatal thyroid-stimulating hormone (TSH) levels are associated with poor school performance or stimulant prescription for attention deficit hyperactivity disorder (ADHD). This record-linkage study included 232,790 term-born infants in Australia with a TSH level below newborn screening threshold (< 15mIU/L). Among our cohort, as TSH levels increased, the proportion of infants born low birthweight via caesarean section and with disadvantaged socioeconomic status increased. Multivariable logistic regression analysis showed that, compared with infants with 'normal' neonatal TSH level (< 5mIU/L), those with neonatal TSH 10-15mIU/L had an increased risk of being exempt from school testing (aOR 1.63 (95% CI 1.06-2.69)) or prescribed a stimulant for ADHD (aOR 1.57 (95% CI 1.10-2.24)), adjusted for perinatal and sociodemographic factors. Among a nested analysis of 460 sibling pairs, siblings with 'mildly elevated' TSH levels were more likely to be exempt from school tests compared with siblings with normal TSH levels (aOR 2.53, 95% CI 1.01-6.33).Conclusion: In this population cohort and sibling analysis, mildly elevated neonatal TSH levels were associated with being exempt from school testing due to significant or complex disability. What is Known: • Newborn screening for severe thyroid hormone deficiency has virtually eliminated congenital hypothyroidism-associated intellectual disability in developed countries. • The impact of mild thyroid hormone deficiency in infants is unclear. What is New: • Children with a mildly elevated neonatal TSH level below current newborn screening cut-offs have an increased likelihood of being exempt from school testing due to significant or complex disability compared with siblings and peers. This study includes a population-based and nested sibling analysis.

Neuro-enhancement among German junior physicians: Prevalence, reasons and associations to mental health outcomes and quality of life.

Previous research studies have demonstrated that neuro-enhancement, the use of legal or illegal drugs by healthy individuals to improve their job performance, is practiced among employees. Researchers discussed possible reasons for employees to consider the use of substances for neuro-enhancement. The aim of this study was to identify the prevalence of usage and motives for practicing neuro-enhancement among a sample of German junior physicians. The secondary objective was to determine associations between neuro-enhancement, mental health outcomes and quality of life. This cross-sectional study included an online survey to analyze junior physicians' neuro-enhancement stimulant use and their motives for usage (n = 873). Second, mental health outcomes and quality of life were assessed. Descriptive and analytic (Kruskal Wallis test, logistic regression) statistics were obtained. Of the 873 junior physicians, 18% reported having used stimulants for neuro- enhancement. 8% of the physicians have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to enhance concentration, to relax and to increase alertness. Neuro-enhancement was associated with emotional exhaustion (p < 0.01), lower quality of life (p < 0.05) and work-related stress (p < 0.01). Our study results give an overview on the actual situation regarding frequency and motives for taking performance-enhancing substances. The prevalence rate was low in comparison to current public debates. Decreasing the prevalence of neuro-enhancement among physicians requires the implementation of strategies targeting stress reduction and workload management.

U.S. Military Veteran Versus Nonveteran Use of Licit and Illicit Substances

To provide up-to-date substance use surveillance data among U.S. military veterans versus nonveterans, this study assesses current use of tobacco products, alcohol, marijuana, prescription pain relievers, tranquilizers, sedatives, stimulants, cocaine, heroin, methamphetamines, inhalants, and hallucinogens. Pooled data were from the 2015-2017 National Survey on Drug Use and Health, a nationally representative, self-reported survey of the U.S. adult non-institutionalized population. Military veterans were those who had "ever been in the United States Armed Forces" and were "now separated/retired from reserves/active duty" (n=7,301). Nonveterans were those who had never been in the U.S. Armed forces (n=121,366). Age- and gender-stratified weighted prevalence estimates were calculated and compared with chi-square tests. All analyses were conducted in 2019. Illicit substance use, including marijuana and cocaine, was generally lower among veterans than nonveterans, whereas use of licit substances such as tobacco and alcohol was higher among veterans than nonveterans. The most commonly used substances among veterans were tobacco and alcohol. Among male participants aged 18-25 years, 59.8% of veterans reported past-12-month cigarette/cigar smoking (vs 46.6% of nonveterans), whereas 17.6% reported heavy drinking (vs 12.2% of nonveterans). For both cigarette/cigar smoking and binge drinking, there was a marked narrowing of the male-female gap in prevalence with increasing age among veterans. Female veterans aged 18-25 years reported significantly higher opioid use than their nonveteran counterparts (54.7% vs 35.0%); they also had the highest prevalence of opioid misuse (15.3%) than any other group. Intensified efforts are needed to reduce substance use among veterans and provide cessation and mental health services.

5.6 CHARACTERISTICS, NONORAL USE, AND PATHWAYS TO PRESCRIPTION STIMULANT (RXSTIM) NONMEDICAL USE IN COLLEGE STUDENTS

ADHD medications are widely available on college campuses and often used for nonmedical use (NMU). This study aimed to characterize prescription stimulant (RxSTIM) NMU via nonoral routes and explore drug pathways among college students.

Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender

Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations. Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only. Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use. Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.

Trends in stimulant dispensing by age, sex, state of residence, and prescriber specialty — United States, 2014–2019

BackgroundStimulant medications are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder; however, they also have high potential for diversion and misuse. We estimated national stimulant dispensing trends from 2014 to 2019 and differences in dispensing by age, sex, state, prescriber specialty, payor type, patient copay, and stimulant type. MethodsWe calculated rates of stimulant dispensing using IQVIA National Prescription Audit (NPA) New to Brand, NPA Regional, and NPA Extended Insights data, which provide dispensing estimates from approximately 49,900 pharmacies representing 92 % of prescriptions dispensed in the United States. Average annual percent change (AAPC) from 2014 to 2019 was analyzed using Joinpoint regression. ResultsFrom 2014 to 2019, the national annual rate of stimulant dispensing increased significantly from 5.6 to 6.1 prescriptions per 100 persons. Rates differed by prescription stimulant type, with increases occurring among both amphetamine-type stimulants and long-acting stimulants. Rates among females (AAPC = 3.6 %; P = 0.001) and adults aged 20–39 years (AAPC=6.7 %; P = 0.002), 40–59 years (AAPC=9.7 %; P < 0.001), and ≥60 years (AAPC = 6.9 %; P = 0.001) increased significantly during the study period. Stimulant dispensing rates varied substantially across states, ranging from 1.0 per 100 in Hawaii to 13.6 per 100 in Alabama. ConclusionsNational stimulant dispensing rates increased from 2014 to 2019, driven by notable increases among females and adults aged ≥20 years. These trends should be considered when prescribing stimulants given growing concerns over prescription stimulant diversion, misuse, and related health harms.

Factors Associated with Gabapentin Misuse among People Who Inject Drugs in Appalachian Kentucky

Aims Gabapentin is misused to potentiate the euphoric effects of opioids, self-treat physical pain, and moderate opioid withdrawal symptoms. Because examinations of gabapentin misuse among people who inject drugs (PWID) are scant, the aim of this study is to identify factors associated with gabapentin misuse among this population. Methods: Data are drawn from a study examining the uptake of syringe service programs (SSPs) in Appalachian Kentucky. The sample includes 324 PWID who were age 18 and over and reported past month drug injection. Logistic regression models were constructed to examine recent (past 90 days) gabapentin misuse. Results: Participants are female (50.0%); Hispanic (2.2%), Black (1.5%), white (90.7%), and other race/ethnicity (4.6%). Mean age is 37. Participants reporting gabapentin misuse had higher odds of reporting (mis)use of marijuana, cocaine, methamphetamine, prescription opioids, benzodiazepines, prescription stimulants, fentanyl, and buprenorphine (p < .042); severe substance use disorder (p < .000); and recent physical pain (p < .003). In multivariable models, findings related to misuse of prescription opioids and buprenorphine; severe substance use disorder; and recent physical pain or discomfort, remained significant (p < .042). Conclusions: This is one of the first studies to examine gabapentin misuse among PWID. It is possible that individuals reporting recent gabapentin misuse are attempting to self-treat physical pain when healthcare is limited. Gabapentin may also be misused to achieve desired central nervous system effects and to potentiate opioid highs. Syringe service programs can educate PWID about the potential dangers of polydrug use involving gabapentin and to connect PWID with needed healthcare services.

Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants - 24 States and the District of Columbia, January-June 2019.

IntroductionProvisional estimates indicate that drug overdose deaths increased in 2019 after a slight decrease in 2018. In 2018, overdose deaths primarily involved opioids, with continued increases in deaths involving illicitly manufactured fentanyls (IMFs). Deaths involving stimulants such as cocaine and methamphetamine are also increasing, mainly in combination with opioids.MethodsCDC analyzed data on drug overdose deaths during January–June 2019 from 24 states and the District of Columbia (DC) in the State Unintentional Drug Overdose Reporting System to describe characteristics and circumstances of opioid- and stimulant-involved overdose deaths.ResultsAmong 16,236 drug overdose deaths in 24 states and DC, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants. Approximately 80% of overdose deaths involved one or more opioid, and IMFs were involved in three of four opioid-involved overdose deaths. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths. More than three in five (62.7%) overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention.Conclusions and implications for public health practiceIdentifying opportunities to intervene before an overdose death and implementing evidence-based prevention policies, programs, and practices could save lives. Strategies should address characteristics of overdoses involving IMFs, such as rapid overdose progression, as well as opioid and stimulant co-involvement. These efforts should be complemented by efforts to prevent initiation of prescription opioid and stimulant misuse and illicit drug use.

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 &lt;135/&lt;85 on both days, sustained HTN as BP ≥135/≥85 on both days and stimulant-induced HTN as BP &lt;135/&lt;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.