Up to 1 in 4 students misuse ADHD drugs, study finds

More students from middle school to high school are misusing ADHD prescription drugs, amid an increasing number of children being diagnosed with the condition in the United States, a study published Tuesday finds.

At some schools, as many as 1 in 4 students reported misusing drugs for attention-deficit/hyperactivity disorder in the previous year — meaning they used the medications without a doctor’s prescription or for nonmedical reasons, according to the study in JAMA Network Open.

“The findings should be a major wake-up call,” said the study’s lead author, Sean McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan’s School of Nursing.

Prescription stimulants are safe and effective when used appropriately.

The medications “help millions of people” with ADHD, McCabe said, “but it is important to balance the need for access to the medications while reducing the risk for misuse.”

The study’s findings were based on survey results from more than 231,000 students in eighth, 10th and 12th grades across more than 3,200 public and private schools in the U.S. The researchers looked at survey data from 2005 to 2020.

Rates of misuse were the highest in schools that had the highest rates of students being treated for ADHD. Schools surveyed in more recent years — from 2015 to 2020 — had higher rates of misuse than those surveyed in earlier years.

The drugs included in the survey were amphetamine, methylphenidate, Ritalin, Adderall, Concerta, Metadate, Dexedrine, Focalin and Vyvanse.

The researchers found that students in schools with the highest rates of ADHD prescriptions had a 36% higher risk of misusing the stimulants.

Middle school students were more likely to report misuse of the medications compared to high school students. Schools with high or moderate rates of binge drinking also had higher rates of misuse.

In addition, the researchers found that schools with more white students or whose students’ parents had a higher level of education also had higher levels of misuse than those with fewer white students and whose parents had lower levels of education.

What are the risks?

Dr. Robert Bassett, the associate medical director of the Poison Control Center at the Children’s Hospital of Philadelphia, said that there is a misperception that prescription stimulants can “help garner an advantage and help improve academic performance or memory or stamina.”

“In environments or households that place a high value on academic performance, there may be unintended stressors or pressures that could result in seeking an advantage by using stimulants,” said Bassett, who was not involved in the new research.

But stimulants are not always benign medications.

“Long term, they have a variety of effects in the body, not the least of which is cardiovascular problems like increased heart rate or blood pressure and increase the risk of neuropsychiatric complications too,” he said.

Dr. Sam Wang, an emergency medicine physician and pediatrician at Children’s Hospital Colorado, who was not involved in the study, noted that misusing these types of medications has been found to be associated with a risk of substance abuse disorder and lower graduation rates.

Others say that the problem could get worse in the coming years.

Misuse of stimulants could become more common as children face rising rates of depression, anxiety and eating disorders, said Dr. Nusheen Ameenuddin, a pediatrician at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.

“I think the tendency to self-medicate has likely increased,” she said.

McCabe, the study’s author, said that because the students were self-surveyed, there is a chance some either misclassified or underreported their substance use. The study also didn’t include students who were home-schooled, dropped out or were absent on the day the surveys were taken.

McCabe said parents of children with ADHD should talk to them about how to properly manage their medication, including talking with them about what to do if someone else asks to use their prescription.

“It’s important to intervene while kids are still looking at these as medications rather than drugs of misuse,” he said.

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