Dr. Mark Gold's Research You Can Use
Management of prescription stimulants can be complex due to the risk for misuse. Recently published in The American Journal of Psychiatry, a paper addressed the prevalence and correlates of prescription stimulant use, abuse, use disorders and the motivations for misuse among adults in the U.S. through a nationally representative household population study.
Stimulant misuse is common as half a million youths and 4.8 million adults, including the 2.5 million young adolescents, reported stimulant abuse in 2015.
Prescription stimulants and their misuse
Prescription stimulants are primarily used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, the involuntary episodes of deep sleep. Parents and teachers usually initiate an evaluation for learning problems, attention problems, or school problems. Meeting the DSM criteria for ADHD at a Pediatrician, Psychiatrist or other prescribers office might result in a prescription for psychostimulants. These medications help with increase alertness, attention, and energy. These stimulants typically come in the form of a tablet, capsule or liquid, directed to be taken via the mouth.
Misuse of prescription stimulants, however, means consuming this medication in ways or doses other than prescribed, using someone else’s medicine and consuming the medicine to get high. Individuals intending to misuse this medication either take inappropriate doses in its normal form or they can crush the tablets into powder, dissolve it into water and inject the liquid into a vein. Some also resort to smoking or snorting this powder.
Prescription stimulants, like drugs of abuse, increase the release of dopamine. These changes in the activity of the brain chemicals, like dopamine, involved in pleasure and rewarding behaviors, and norepinephrine, which influences blood pressure, nervousness and breathing. Misuse also leads to several adverse effects including loss of appetite, anxiety, paranoia, hallucinations, insomnia, accelerated heart rate, addiction, seizures, heart failure, and even death.
Misuse of stimulants among adults
While the misuse of stimulants by youths and young adults has dominated much of the attention, it is concerning that 55 percent of the total prescriptions written in 2015 were issued to adults aged 20 and older. Furthermore, the increases for adults have overtaken those for the youths over the past ten years.
Adults with stimulant use disorders are at a much higher risk for clinically significant complexities as compared to the misusers.
This has deemed the examination of the source of misuse critical, especially for the purposes of prevention and clinical practices.
The identification of patterns, correlation of prescription stimulant misuse, and use disorders will enable the clinicians to intervene in more timely and effective manners. Ultimately, the study aimed to facilitate effective interventions for adults who are prone to a greater risk for misuse and accordingly design effective clinician training programs, public health policies and programs for prevention and reduction of the associated adverse effects.
The study
The study, based on the data from 2015 and 2016 National Surveys on Drug Use and Health (NSDUH), focused on four key components:
1. First, the 12-month prevalence of any prescription use, misuse, and use disorders
2. Second, how the prescription stimulant use trends were influenced by the sociodemographic characteristics, health conditions and mental health status
3. Third, the main motivation for misuse
4. Fourth, the source of prescription stimulants obtained for misuse
Researchers examined data from adult participants in the 2015-2016 NSDUH, aged 18 and older, which comprised of one-on-one surveys conducted by the Substance Abuse and Mental Health Services Administration. The measures utilized included prescription stimulant use, use without misuse, misuse without disorders and misuse with use disorders, alongside the sociodemographic characteristics, health conditions and mental health factors.
Amongst respondents who reported prescription stimulant use over the last year, NSDUH enquired about the primary motivation for misusing stimulations: to lose weight, to concentrate more, to help be alert or stay awake, to study, for sake of experimentation, to acquire a high or feel good, to manage effects of other drugs, feeling “hooked” or any other reason. Data was also collected regarding how the stimulants were obtained: merely given by a friend or family, prescribed by a physician, stolen from someone close, bought from friend or family, purchased from a stranger or drug dealer or stolen from a clinic.
Results revealed that 6.6 percent of the American adults used prescription stimulants.
Overall, 4.5 percent used stimulants without any misuse. 1.9 percent misused without use disorders, and 0.2 percent suffered from use disorders.
Adults with past-year prescription stimulant use disorders did not vary much from those who misused the stimulants without a use disorder in any of the assessed sociodemographic categories and many of the examined substance use problems.
Almost 78 percent of the participants reported help to be alert or concentrate better or as a study aid as their primary motivation for misuse making these the most common motivations. Contrarily, only 15.5 percent illicit use motivations in terms of experimentation, intoxication and or to manage effects from other drugs. About 4 percent of misusers, mostly women, reported misusing stimulants for losing weight.
The most probable source of misused prescription stimulants emerged as getting the medicine for free from a friend or relative, as 56.9 percent reported so.
More frequent stimulant misuse and use disorder were found to be connected with a higher probability of acquiring medications from physicians or drug dealers and lower likelihood of acquiring them from a friend or relative.
Looking ahead
Data has revealed that 16 million American adults used prescription stimulants in the last year, 5 million misused prescription stimulants and 4 million suffered from prescription stimulant use disorders. Hence, preventative measures and actions need to be taken to provide a more comprehensive, safer and more evidence-based treatment for ADHD and to inhibit prescribing that may leave unnecessary amounts of stimulants available for potential misuse.
The fact that most common source of misused stimulants stems from friends and families strongly suggests that physicians prescribing any addictive substances need to be highly mindful for the population impacts of their medical practices. Prevention interventions directed at patients with risky patterns of stimulant misuse need to take into consideration the social network of patients as well. Patients with a substance use disorder appear to be at higher risk of abuse. Clinicians need to vigilantly screen and identify adults with an alcohol or drug use disorder, depression, or other causes of a greater risk for prescription stimulant misuse.
While medication-assisted therapies are widely used in opioid use disorders, neither cocaine, methamphetamine, or prescription stimulant use disorders have such proven safe and effective treatments.
References:
1. https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants
2. https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2018.17091048?journalCode=ajp
3. https://www.drugabuse.gov/news-events/news-releases/2018/04/five-million-american-adults-misusing-prescription-stimulants
About the Author:
Mark S. Gold, M.D. served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD
About the Transcript Editor:
A journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.
Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.
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Published on December 17, 2018
Reviewed by Jacquelyn Ekern, MS, LPC on December 17, 2018
Published on AddictionHope.com