1
|
Baweja R, Faraone SV, Childress AC, Weiss MD, Loo SK, Wilens TE, Waxmonsky JG. From Consensus Statement to Pills to Pixels: New Innovations in Attention-Deficit/Hyperactivity Disorder Care. J Child Adolesc Psychopharmacol 2024; 34:167-182. [PMID: 38686563 PMCID: PMC11302246 DOI: 10.1089/cap.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations.
Collapse
Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - Stephen V. Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Ann C. Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada, USA
| | - Margaret D. Weiss
- Los Angeles Semel Institute, University of California, Los Angeles, California, USA
| | - Sandra K. Loo
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | | | | |
Collapse
|
2
|
Dasgupta J, Lockwood Estrin G, Summers J, Singh I. Cognitive Enhancement and Social Mobility: Skepticism from India. AJOB Neurosci 2023; 14:341-351. [PMID: 35311617 DOI: 10.1080/21507740.2022.2048723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective.Seven Indian experts were purposively sampled for their expertise in bioethics, child development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis.Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs.
Collapse
Affiliation(s)
| | | | | | - Ilina Singh
- Wellcome Trust Centre for Ethics and the Humanities, University of Oxford
| |
Collapse
|
3
|
Magnotti S, Beatty A, Bickford E, Channell I, Weyandt L. Prescription Stimulant Misuse Among Nursing Students: A Systematic Review. J Addict Nurs 2023; 34:216-223. [PMID: 37669341 PMCID: PMC10510837 DOI: 10.1097/jan.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
ABSTRACT Nonmedical prescription stimulants are used to reduce symptoms of inattention, impulsivity, and hyperactivity in children and adults with attention-deficit hyperactivity/disorder. They are Schedule II controlled substances because of their high potential for dependence, and individuals who misuse them without a valid prescription are subject to criminal charges. Stimulant medications are also associated with common side effects (e.g., insomnia) as well as more serious but less common side effects (e.g., arrhythmias). Despite the potential health and legal consequences, misuse of prescription stimulants has become a public health crisis on college campuses in the United States. Neurocognitive enhancement is the primary reason that college students report misusing prescription stimulants, despite no enhancement of cognitive functioning when taken by healthy adults. Nursing students may be at risk for misuse because of their high levels of academic and clinical demands and because many start misusing in nursing school. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases PubMed, Science Direct, EBSCOhost, and Academic OneFile were systematically searched to investigate the (a) percentage of prescription stimulant misuse studies that have included nursing students, (b) prevalence of prescription stimulant misuse among nursing students, (c) motivations for prescription stimulant misuse among nursing students, and (d) demographic factors associated with increased use among nursing students. Results revealed that of the 197 studies conducted within the past decade (2010-2021), only 1.02% (two) included nursing students. Future studies must investigate the prevalence and nature of prescription stimulant misuse among nursing students.
Collapse
|
4
|
Schepis TS, Werner KS, Figueroa O, McCabe VV, Schulenberg JE, Veliz PT, Wilens TE, McCabe SE. Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine 2023; 58:101902. [PMID: 36969344 PMCID: PMC10036501 DOI: 10.1016/j.eclinm.2023.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stimulant and non-stimulant pharmacotherapy improve adolescent ADHD, but their associations with prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear. Using 2005-2020 US Monitoring the Future data, we investigated relationships between ADHD pharmacotherapy history and PSM, cocaine, or methamphetamine use. Methods Secondary students (13-19 years) provided data on pharmacotherapy history (N = 199,560; 86.3% of total sample) between January 1, 2005 and May 31, 2020 in a cross-sectional multi-cohort study; weights assured a nationally representative sample. Participants were grouped by ADHD pharmacotherapy history: none (88.7%; principally non-ADHD controls); stimulant-only (5.8%); non-stimulant-only (3.3%); both stimulant and non-stimulant (2.1%). Outcomes were past-year PSM, cocaine, and methamphetamine use. Logistic regressions examined relationships between pharmacotherapy history and outcomes, controlling for sociodemographics, recent substance use, and stimulant treatment cessation. Findings Past-year outcome rates were lowest in adolescents with no pharmacotherapy history: 4.7% for PSM [8310/174,561], 1.6% for cocaine [2858/174,688], and 0.7% for methamphetamine [1036/148,378]. A history of both stimulant and non-stimulant treatment was associated with the highest rates: 22.3% for PSM [940/4098], 10.4% for cocaine [450/4110], and 7.8% for methamphetamine [275/3427]. Adolescents who received monotherapy (stimulant- or non-stimulant-only) had intermediate rates, with no differences between monotherapy groups. Interpretation While elevated PSM and illicit stimulant use rates are likely influenced by ADHD, our findings suggested adolescents with a history of both stimulant and non-stimulant pharmacotherapy are at highest risk for these stimulant outcomes. Adolescents receiving ADHD pharmacotherapy should be monitored for PSM and illicit stimulant use. Funding National Institute on Drug Abuse/National Institutes of Health (USA) and Food and Drug Administration (USA).
Collapse
Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kennedy S. Werner
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Olivia Figueroa
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Vita V. McCabe
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - John E. Schulenberg
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Phil T. Veliz
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Timothy E. Wilens
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Prescription Stimulants in College and Medical Students: A Narrative Review of Misuse, Cognitive Impact, and Adverse Effects. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stimulants are effective in treating attention-deficit/hyperactivity disorder (ADHD). Psychiatrist Charles Bradley first made this discovery in 1937 when he found that children treated with amphetamines showed improvements in school performance and behavior. Between 1995 and 2008, stimulants to treat ADHD increased six-fold among American adults and adolescents at an annual rate of 6.5%. Stimulants without a prescription, known as nonmedical use or misuse, have also increased. The highest rates of nonmedical prescription drug misuse in the United States are seen most notably in young adults between 18 and 25 years, based on data from the Substance Abuse and Mental Health Services Administration in 2021. Aside from undergraduate students, nonmedical prescription stimulant use is prevalent among medical students worldwide. A recent literature review reported the utilization of stimulants without a prescription in 970 out of 11,029 medical students. The percentages of medical students across the country misusing stimulants varied from 5.2% to 47.4%. Academic enhancement, reported in 50% to 89% of college students with stimulant misuse, is the most common reason for nonmedical stimulant use. With the increasing use of stimulants among adolescents and adults, it is unclear what long-term outcomes will be since little data are available that describe differences in how side effects are experienced for prescribed and non-prescribed users. The present narrative review focuses on these adverse effects in this population and the reasonings behind misuse and nonmedical use.
Collapse
|
6
|
Francis AR, Weyandt LL, Anastopoulos AD, DuPaul GJ, Shepard E. Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD. J Atten Disord 2022; 26:779-793. [PMID: 34189993 DOI: 10.1177/10870547211027650] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.
Collapse
|
7
|
Schepis TS, Ford JA, Wilens TE, Teter CJ, Esteban S. Differences in Prescription Stimulant Misuse Motives Across Adolescents and Young Adults in the United States. J Clin Psychiatry 2020; 81:20m13302. [PMID: 33147656 PMCID: PMC7883338 DOI: 10.4088/jcp.20m13302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Jason A. Ford
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Timothy E. Wilens
- Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Cambridge, Massachusetts, USA
| | | | - Sean Esteban
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Cole VT, Hussong AM. Psychosocial functioning among college students who misuse stimulants versus other drugs. Addict Behav 2020; 105:106290. [PMID: 32007830 DOI: 10.1016/j.addbeh.2020.106290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/09/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
The misuse of prescription stimulants (e.g., Ritalin, Adderall) is a large and growing problem on college campuses. Emerging research examines not only the demographic predictors of stimulant misuse but also the potentially role that stimulant misuse plays in a college student's overall functioning and mental health. To better understand the experiences specifically linked with stimulant misuse rather than substance use more broadly, we tested whether psychosocial functioning differed across four groups of college students: those who do not misuse stimulants or other hard drugs; those who misuse both stimulants and other hard drugs; those who misuse stimulants but not other hard drugs; and those who misuse other hard drugs but not stimulants (N = 1534; 40.3% male; 33.9% ethnic minority). Those who misused stimulants reported higher levels of impulsivity, as well as substance use consequences, than those who did not use any hard drugs. However, these differences were exacerbated among those who misused stimulants and other hard drugs. Taken together, these findings suggest that stimulant misuse typically occurs in a broader pattern of substance use, and that stimulant misusers generally fall along a continuum of substance use severity in terms of psychosocial functioning.
Collapse
|
9
|
Wilens TE, Martelon M, Yule A, Kaminski TA, Burke C, Schepis TS, McCabe SE. Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students. Am J Addict 2020; 29:476-484. [PMID: 32436300 DOI: 10.1111/ajad.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co-occurring substance use disorders (SUD) compared with those without co-occurring SUDs. METHODS Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ2 test, and the Wilcoxon rank-sum test. RESULTS College students who endorsed NMUPS with co-occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use. DISCUSSION AND CONCLUSIONS Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants. SCIENTIFIC SIGNIFICANCE The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476-484).
Collapse
Affiliation(s)
- Timothy E Wilens
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - MaryKate Martelon
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Yule
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tamar A Kaminski
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Colin Burke
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
| | - Sean E McCabe
- School of Nursing and Institute for Research on Women and Gender, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
10
|
Wilens TE, Kaminski TA. Editorial: Stimulants: Friend or Foe? J Am Acad Child Adolesc Psychiatry 2020; 59:36-37. [PMID: 31759095 DOI: 10.1016/j.jaac.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022]
Abstract
Stimulants remain the treatment of choice for attention-deficit/hyperactivity disorder (ADHD), in part owing to their large effect size within the pharmacotherapeutic repertoire for ADHD-in other words, they are highly effective. When used appropriately, they are also quite safe and actually mitigate the misuse of drugs or alcohol. So, why all the fuss?
Collapse
Affiliation(s)
- Timothy E Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.
| | | |
Collapse
|
11
|
Vosburg SK, Robbins RS, Antshel KM, Faraone SV, Green JL. Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit. Front Psychiatry 2020; 11:631792. [PMID: 33597899 PMCID: PMC7883730 DOI: 10.3389/fpsyt.2020.631792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults. Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews. Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways. Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.
Collapse
Affiliation(s)
| | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Stephen V Faraone
- Department of Psychiatry, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Jody L Green
- Inflexxion, An IBH Company, Costa Mesa, CA, United States
| |
Collapse
|