David Giwerc, MCAC, MCC
Stimulant diversion, which can range from giving a friend a single pill to selling one’s prescribed pills to others, is on the rise; and young adults, particularly college students, are the primary source of this increasing and troubling form of prescription medication misuse.
Nonmedical use of psychoactive stimulant medication for ADHD is a growing trend within the overarching concern about prescription drug misuse among young adults, most notably college students.1 Diversion rates for prescribed stimulants was 61.7% in one study.
Prevalence rates of nonmedical use on college campuses are on the rise. Stimulant-related emergency department visits have increased threefold in recent years2.
However, despite this steep rise in drug diversion, prescribing physicians who treat ADHD have relatively few clinical strategies for management of this pervasive problem in fact, the non-medical use of prescription drugs in general, with attention on the stimulants are the focus of research by NIDA.
Brooke Molina, PhD., of the University of Pittsburgh, presented preliminary findings during a research symposium on college students with ADHD at the 2017 APSARD Conference. She cited research indicating a significant upsurge in the diversion of prescription stimulant medications, specifically among young adults in college and in treatment for ADHD. In addition to the public health concerns related to this trend, she noted that college students with ADHD may not be prepared for the social pressures placed on them to share their medications as well as the potential consequences for doing so, including legal penalties and their standing in school. It is important to note that drug diversion is considered drug trafficking and applies to the illegal distribution of prescription drugs, including stimulant medications. Under federal and state laws drug trafficking is a felony.
Dr. Molina noted a relative lack of strategies for addressing the growing problem of stimulant diversion among college students. Her research project team is developing and testing practical strategies targeted to effectively communicate the dangers/consequences of drug diversion to primary care providers and college patients who may not be aware of the consequences of giving away or selling their prescription stimulant medication to a fellow student.
In addition to the study and dissemination of the sorts of educational programs, there are initial steps that can be taken by prescribing physicians as well as psychosocial clinicians who treat college students with ADHD. Drawing from the sorts of strategies in Dr. Molina’s program, the first step is preparing students with ADHD that they will likely be approached at some point about sharing or selling their stimulant medications.
Information can be shared about the risks in terms of potential legal culpability and the fact that expulsion from college is a possible consequence if they would be caught diverting medications. In fact, encouraging college patients to not publicize the fact that they take prescribed medications in the first place, or at least making sure that they keep their medications in some sort of locked container is a step that decreases the likelihood of facing peer pressure or the chance that their pills are at risk for theft. Lastly, anticipating and rehearsing some scenarios in which a student imagines they might feel pressured to share medications is a way to practice what to say in advance rather than figuring out what to say on the spot.
Despite these problems with diversion, the pharmacologic treatment of ADHD among college students continues to be important. Effective treatment allows these students, many of whom in previous decades would not have been identified with ADHD and therefore unable to get into college, to be able to manage their symptoms, demonstrate their skills, and pursue their goals. By taking a few extra moments to counsel students who are taking prescribed medications for ADHD about the risks of diversion, perhaps this disturbing trend can start to be reversed.
References
1Wilens TE, Adler LA, Adams J, et al. Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. J Am Acad Child Adolesc Psychiatry 2008;47:21–31.
2 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 24, 2013). The DAWN Report: Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant Medications. Rockville, MD.