Nonmedical use of prescription stimulants among students

The Adverse Effects and Nonmedical Use of Methylphenidate Before and After the Outbreak of COVID-19: Machine Learning Analysis

BACKGROUND

Methylphenidate is an effective first-line treatment for attention-deficit/hyperactivity disorder (ADHD). However, many adverse effects of methylphenidate have been recorded from randomized clinical trials and patient-reported outcomes, but it is difficult to determine abuse from them. In the context of COVID-19, it is important to determine how drug use evaluation, as well as misuse of drugs, have been affected by the pandemic. As people share their reasons for using medication, patient sentiments, and the effects of medicine on social networking services (SNSs), the application of machine learning and SNS data can be a method to overcome the limitations. Proper machine learning models could be evaluated to validate the effects of the COVID-19 pandemic on drug use.

OBJECTIVE

To analyze the effect of the COVID-19 pandemic on the use of methylphenidate, this study analyzed the adverse effects and nonmedical use of methylphenidate and evaluated the change in frequency of nonmedical use based on SNS data before and after the outbreak of COVID-19. Moreover, the performance of 4 machine learning models for classifying methylphenidate use based on SNS data was compared.

METHODS

In this cross-sectional study, SNS data on methylphenidate from Twitter, Facebook, and Instagram from January 2019 to December 2020 were collected. The frequency of adverse effects, nonmedical use, and drug use before and after the COVID-19 pandemic were compared and analyzed. Interrupted time series analysis about the frequency and trends of nonmedical use of methylphenidate was conducted for 24 months from January 2019 to December 2020. Using the labeled training data set and features, the following 4 machine learning models were built using the data, and their performance was evaluated using F-1 scores: naïve Bayes classifier, random forest, support vector machine, and long short-term memory.

RESULTS

This study collected 146,352 data points and detected that 4.3% (6340/146,352) were firsthand experience data. Psychiatric problems (521/1683, 31%) had the highest frequency among the adverse effects. The highest frequency of nonmedical use was for studies or work (741/2016, 36.8%). While the frequency of nonmedical use before and after the outbreak of COVID-19 has been similar (odds ratio [OR] 1.02 95% CI 0.91-1.15), its trend has changed significantly due to the pandemic (95% CI 2.36-22.20). Among the machine learning models, RF had the highest performance of 0.75.

CONCLUSIONS

The trend of nonmedical use of methylphenidate has changed significantly due to the COVID-19 pandemic. Among the machine learning models using SNS data to analyze the adverse effects and nonmedical use of methylphenidate, the random forest model had the highest performance.

Age differences to methylphenidate-NAc neuronal and behavioral recordings from freely behaving animals

Methylphenidate (MPD) is a psychostimulant that is widely prescribed to treat attention deficit-hyperactivity disorder, but it is abused recreationally as well. The nucleus accumbens (NAc) is part of the motivation circuit implicated in drug-seeking behaviors. The NAc neuronal activity was recorded alongside the behavioral activity from young and adult rats to determine if there are significant differences in the response to MPD. The same dose of MPD elicits behavioral sensitization in some animals and behavioral tolerance in others. In adult animals, higher doses of MPD resulted in a greater ratio of tolerance/sensitization. Animals who responded to chronic MPD with behavioral sensitization usually exhibited further increases in their NAc neuronal firing rates as well. Different upregulations of transcription factors (ΔFOSB/CREB), variable proportions of D1/D2 dopamine receptors, and modulation from other brain areas may predispose certain animals to express behavioral and neuronal sensitization versus tolerance to MPD.

Adolescent rats respond differently to methylphenidate as compared to adult rats- concomitant VTA neuronal and behavioral Recordings

Methylphenidate (MPD) is the most widely prescribed psychostimulant used in adolescents and adults to treat attention-deficit/hyperactivity disorder (ADHD). The recreational use of MPD is becoming more prevalent because of its ability to improve cognitive enhancement. The ventral tegmental area (VTA) of the brain is highly associated with reward, cognition and addiction to drugs including psychostimulants like MPD. The VTA neuronal activity was recorded alongside the horizontal behavioral activity from freely behaving non-anesthetized rats. Four adolescent and four adult groups were treated with either saline, 0.6, 2.5 or 10.0 mg/kg MPD. In both adolescent and adult animals, the animals responded to MPD in a dose-dependent manner, such that as the dose of MPD increased, more animals and more VTA unit responded to the drug. The same doses of MPD elicited in some animals behavioral and neuronal sensitization and in other animals behavioral and neuronal tolerance. In the 0.6 and 10.0 mg/kg MPD dose groups there were significant differences between the age groups for how many animals expressed behavioral sensitization and behavioral tolerance to chronic MPD exposure. Additionally, the animal's behavioral response to MPD by excitation or attenuation of activity did not always correlate to the VTA neuronal response, and the age group with significantly higher behavioral responses did not always correlate to the age group with significantly higher VTA neuronal responses for a given MPD dose. These findings differ from similar studies recorded from the prefrontal cortex (PFC), which exhibited behavioral responses continuously directly correlated to PFC responses for increasing MPD doses. This demonstrates that unlike other areas of the brain, there is not a direct relationship between VTA firing and behavioral activity, suggesting that there is input or modulation of this area from elsewhere in the brain. Further investigation is needed to clearly understand the relationship between VTA firing rates and behavioral responses to different MPD doses, especially given the significant differences in response between young and adult animals and the increasing use of the drug in adolescent populations.

Behavioral Willingness, Descriptive Normative Perceptions, and Prescription Stimulant Misuse among Young Adults 18-20

Objective: It is critical to gain further understanding of etiologic factors, such as descriptive normative perceptions and behavioral willingness, that are associated with prescription stimulant misuse (PSM) among young adults. Our primary hypotheses were that descriptive normative perceptions for PSM (i.e., perceptions of how much and how often others engage in PSM) and perceived peer willingness (i.e., perceptions of how open others are to PSM under certain circumstances) would be positively associated with higher willingness to engage in PSM, which in turn would account for significant shared variance with self-reported PSM. Method: Data were collected from a U.S. sample of 18-20-year-olds (N = 1,065; 54.5% females; 70.5% White) recruited for a larger study on alcohol-related risky sexual behavior. Results: Findings indicated higher descriptive normative perceptions and higher perceived peer willingness were associated with higher participants' willingness to engage in PSM. Participants' own willingness was positively associated with PSM. Finally, participants' own willingness to use, descriptive normative perceptions, and perceived peer willingness were associated with higher willingness to engage in PSM, which accounted for significant shared variance with self-reported PSM. Conclusions: Findings suggest the potential utility of personalized feedback interventions for PSM that focus on constructs such as descriptive normative perceptions and behavioral willingness.

Non-medical use of methylphenidate by medical students: prevalence and motivations. Integrative review

Objective: This study performed a literature review evaluating aspects of prevalence and motivations on the non-medical use of methylphenidate by medical students. Methods: We searched the Scopus, PubMed, SciELO, and Web of Science databases and the Google Scholar search tool using the keywords "Methylphenidate" and "Medical Student" and their correlates in Portuguese. A total of 472 articles were recovered, of which 24 were included for full reading and discussion after the application of the pre-established inclusion and exclusion criteria. Results: It was observed that the prevalence of non-prescribed use of methylphenidate ranged from 0.51% in Lithuania to 35% in Colombia. The main motivations reported for using the drug were academic outcomes improvement and increase in concentration during studies, although research shows no significant improvement in academic performance with the use of medication by healthy individuals. Conclusion: The non-prescribed use of methylphenidate presents a high and worrying frequency. Also, scientific studies questioning the use of psychostimulant medications for cognitive improvement by healthy students make the practice illegal and unfounded.

An update on the clinical pharmacology of methylphenidate: therapeutic efficacy, abuse potential and future considerations

INTRODUCTION

Methylphenidate remains a first-line medication for treating ADHD in children and adults. However, its behavioral pharmacological similarities to methamphetamine and cocaine have historically created concern for its potential as a drug of abuse. In September 2019, the FDA published a docket requesting comments for the development of abuse deterrent formulations for CNS stimulants, emphasizing the abuse of methylphenidate as a public health concern.

AREAS COVERED

We conducted a narrative review of research on the clinical pharmacology, therapeutic efficacy, and abuse potential of methylphenidate.

EXPERT OPINION

Several studies indicate that methylphenidate has at least some abuse potential. Methylphenidate, amphetamine, methamphetamine, and cocaine overlap in their subjective, reinforcing, and discriminative stimulus effects. Regardless, methylphenidate remains an efficacious treatment for ADHD in children and adults when properly adhered to, especially when paired with non-pharmacological treatments. The development of abuse deterrent formulations of methylphenidate is warranted.

Drug instrumentalization

Psychoactive drugs with addiction potential are widely used by people of virtually all cultures in a non-addictive way. In order to understand this behaviour, its population penetrance, and its persistence, drug instrumentalization was suggested as a driving force for this consumption. Drug instrumentalization theory holds that psychoactive drugs are consumed in a very systematic way in order to make other, non-drug-related behaviours more efficient. Here, we review the evolutionary origin of this behaviour and its psychological mechanisms and explore the neurobiological and neuropharmacological mechanisms underlying them. Instrumentalization goals are discussed, for which an environmentally selective and mental state-dependent consumption of psychoactive drugs can be learned and maintained in a non-addictive way. A small percentage of people who regularly instrumentalize psychoactive drugs make a transition to addiction, which often starts with qualitative and quantitative changes in the instrumentalization goals. As such, addiction is proposed to develop from previously established long-term drug instrumentalization. Thus, preventing and treating drug addiction in an individualized medicine approach may essentially require understanding and supporting personal instrumentalization goals.

Disordered eating is associated with non-medical use of prescription stimulants among college students

BACKGROUND

Disordered eating behaviors are associated with non-medical use of prescription stimulants for weight and appetite-related purposes. Yet, estimates of the prevalence and types of disordered eating associated with non-medical use vary. Additionally, little is known about the association between medical use of prescription stimulants and disordered eating.

METHOD

Data were collected from 87,296 college students at 127 institutions that participated in the Healthy Minds Study. We assessed the relationship between disordered eating, medical and nonmedical prescription stimulant use using multivariable logistic regression models adjusted for demographic characteristics, lifestyle and behavioral factors, and psychiatric comorbidity.

RESULTS

Non-medical use of prescription stimulants (NMUPS) was reported by 2.8 % n = 2435 of the sample. One-third of students using prescription stimulants non-medically reported two or more disordered eating attitudes and behaviors. Disordered eating was a significant predictor of non-medical, but not medical use of prescription stimulants. A dose-response relationship was identified between disordered eating and non-medical use, where risk for non-medical use increased with the number of disordered eating attitudes and behaviors reported.

CONCLUSIONS

The risk for NMUPS increases with disordered eating symptomatology. There is a need to assess for NMUPS among college students presenting with disordered eating.

Non-pharmacological factors that determine drug use and addiction

Based on their pharmacological properties, psychoactive drugs are supposed to take control of the natural reward system to finally drive compulsory drug seeking and consumption. However, psychoactive drugs are not used in an arbitrary way as pure pharmacological reinforcement would suggest, but rather in a highly specific manner depending on non-pharmacological factors. While pharmacological effects of psychoactive drugs are well studied, neurobiological mechanisms of non-pharmacological factors are less well understood. Here we review the emerging neurobiological mechanisms beyond pharmacological reinforcement which determine drug effects and use frequency. Important progress was made on the understanding of how the character of an environment and social stress determine drug self-administration. This is expanded by new evidence on how behavioral alternatives and opportunities for drug instrumentalization generate different patterns of drug choice. Emerging evidence suggests that the neurobiology of non-pharmacological factors strongly determines pharmacological and behavioral drug action and may, thus, give rise for an expanded system's approach of psychoactive drug use and addiction.

The prefrontal cortex and the caudate nucleus respond conjointly to methylphenidate (Ritalin). Concomitant behavioral and neuronal recording study

Methylphenidate (MPD) is commonly used to treat attention-deficit hyperactivity disorder (ADHD). Recently, it is being abused for cognitive enhancement and recreation leading to concerns regarding its addictive potential. The prefrontal cortex (PFC) and caudate nucleus (CN) are two of the brain structures involved in the motive/reward circuit most affected by MPD and are also thought to be responsible for ADHD phenomena. This study is unique in that it investigated acute and chronic, dose-response MPD exposure on animals' behavior activity concomitantly with PFC and CN neuronal circuitry in freely behaving adult animals without the interference of anesthesia. Further, it compared acute and chronic MPD action on over 1,000 subcortical and cortical neurons simultaneously, allowing for a more accurate interpretation of drug action on corticostriatal neuronal circuitry. For this experiment, four groups of animals were used: saline (control), 0.6, 2.5, and 10.0 mg/kg MPD following acute and repetitive exposure. The data shows that the same MPD dose elicits behavioral sensitization in some animals and tolerance in others and that the PFC and CN neuronal activity correlates with the animals' behavioral responses to MPD. The expression of sensitization and tolerance are experimental biomarkers indicating that a drug has addictive potential. In general, a greater percentage of CN units responded to both acute and chronic MPD exposure as compared to PFC units. Dose response differences between the PFC and the CN units were observed. The dichotomy that some PFC and CN units responded to the same MPD dose by excitation and other units by attenuation in neuronal firing rate is discussed. In conclusion, to understand the mechanism of action of the drug, it is essential to study, simultaneously, on more than one brain site, the electrophysiological and behavioral effects of acute and chronic drug exposure, as sensitization and tolerance are experimental biomarkers indicating that a drug has addictive potential. The behavioral and neuronal data obtained from this study indicates that chronic MPD exposure results in behavioral and biochemical changes consistent with a substance abuse disorder.

Cognitive enhancement with licit and illicit stimulants in the Netherlands and Finland: what is the evidence?

Purpose

European studies have shown lower prevalence rates of prescription stimulant use for cognitive enhancement, especially among student populations, compared to North America. This difference requires more cross-country research of the various factors involved. To find out whether other parts of the globe are witnessing similar increases in extra-medical stimulant use, and how this might relate to cognitive enhancement, requires empirical study of local contexts. This paper aims to argue that the academic and public discussion on cognitive enhancement should consider the specific country context of drug policy and research and rethink which drugs are included under the term cognitive enhancement drugs.

Design/methodology/approach

This paper offers a general review and a sociological country comparison between the Netherlands and Finland, focusing not only on prescription stimulants used to treat attention deficit hyperactivity disorder but also illicit amphetamines among young adults and methylphenidate use among Dutch and Finnish participants of the Global Drug Survey. This paper emphasises sociocultural perspectives and the importance of context in cognitive enhancement in general as the line between therapeutic and enhancement use can often be blurred. Data is drawn from global, European and national sources, including the International Narcotics Control Board, European Monitoring Centre for Drugs and Drug Addiction and Global Drug Survey.

Findings

There are hardly any national empirical studies done on cognitive enhancement drug use in Finland. On the other hand, there have been studies in the Netherlands showcasing that the use of prescription stimulants and other drugs for enhancement purposes is something that is happening among young people, albeit yet in a relatively small scale. Illicit and licit stimulant use and drug policy action in relation to cognitive enhancement drugs in the two countries varies, emphasising the importance of country context.

Originality/value

Given that cross-country research is scarce, this general review provides one of the first glimpses into cognitive enhancement drug use by comparing the country context and research in Finland, where the phenomenon has not been studied, with the Netherlands, where the topic has received more research and public attention. Further research areas are suggested.

Beyond Treatment Versus Enhancement: A Qualitative Study of Pharmacological Neuro-Enhancement Among Dutch and Lithuanian University Students

This article examines the ambiguous relationship between treating illness and enhancing normalcy through the use of “cognitive enhancement” drugs. Although the literature on pharmacological neuro-enhancement generally differentiates between the “licit/therapeutic” and “illicit/enhancement” use of substances, in-depth interviews with 35 university students in the Netherlands and Lithuania—both with and without formal medical diagnoses of (mainly) Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder—reveal the fluidity of these categories. Our study of the perceptions and experiences of people who use such drugs further suggests a much broader range of substances, motives, and sought-after effects than are commonly acknowledged in the “cognitive enhancement” literature. We need a more inclusive and context-sensitive approach to study pharmacological neuro-enhancement, for instance, by approaching both licit and illicit drugs as tools or instruments.

Protective potential of Vitamin E against methylphenidate-induced male gonadal changes in albino rats

OBJECTIVE

Attention deficit hyperactivity disorder ranks among the top neuropsychiatric disorder of childhood and adolescents. Methylphenidate (MPH) is the most frequently used pharmacologic agent to treat this condition. Its long-term use has been associated with many unwanted and adverse effects on many organs including male gonads, but so far no study has been done to find out a protective agent. This study investigated the protective potential of Vitamin E (Vit E) against the microscopic and morphometric alterations in male gonads induced by MPH, using albino rats.

METHODS

Adult male albino rats were assigned into three equal groups including one control and two experimental groups. Experimental groups administered with MPH (10 mg/kg) and MPH (10 mg/kg) + Vit E orally (50 mg/kg), daily for 40 days. Testes of the sacrificed animals were removed, processed, and stained with hematoxylin and eosin for examining the microscopic and morphometric alterations and protective potential of Vit E. Data were analyzed using ANOVA.

RESULTS

Experimental animals treated with MPH showed a significant decrease in the diameter of seminiferous tubules (296.86 ± 14.70 µm) and height of germinal epithelium (51.73 ± 3.15 µm) with a corresponding gain in the thickness of the interstitium (47.05 ± 4.94 µm). Animals treated with MPH + Vit E did not reveal any significant testicular microscopic changes and seminiferous tubular alterations induced by MPH.

CONCLUSION

Vit E demonstrated a protective potential against the adverse changes induced by MPH in the male gonads in albino rats.

Efeitos do metilfenidato sobre as glândulas salivares maternas de camundongos

Resumo Introdução O metilfenidato (MFD) é um derivado anfetamínico estimulante do sistema nervoso central, que vem sendo cada vez mais consumido pela população mundial, incluindo as mulheres em idade fértil. Ainda não foram estabelecidos os efeitos deste medicamento nas glândulas salivares, durante a gestação. Objetivo Identificar alterações histomorfológicas em glândulas salivares maternas expostas ao metilfenidato. Material e método Para análise histológica, foram utilizadas 32 fêmeas de camundongos Swiss prenhes, distribuídas em um grupo controle e um grupo tratado. A administração foi realizada do quinto ao 17º dia de gestação, via injeção subcutânea; o grupo tratado recebeu 5 mg/kg de metilfenidato, enquanto o grupo controle recebeu o mesmo volume de solução salina estéril. As fêmeas foram eutanasiadas e tiveram suas glândulas salivares removidas e incluídas em parafina para análise em microscopia óptica. Para avaliar a associação entre as variáveis dos grupos, o teste de Kolmogorov-Smirnov e o teste T foram utilizados. Resultado As glândulas parótidas do grupo tratado apresentaram alterações no raio dos ductos e na quantidade de ácinos, quando comparadas às glândulas parótidas do grupo controle. A glândula submandibular do grupo tratado foi a mais afetada: mostrou diferença estatisticamente significativa na espessura da parede dos ductos secretores, no raio dos ductos e no raio dos ácinos, quando comparada à glândula submandibular do grupo controle. A glândula sublingual não apresentou alterações significativas. Conclusão Neste delineamento experimental, o metilfenidato apresentou-se como agente indutor de alterações morfológicas das glândulas salivares, promovendo alterações significativas nos raios de ductos e ácinos das mesmas, sendo a glândula submandibular a mais susceptível a este fármaco.

Stimulant Use Disorders

Compared with other illicit substances, stimulants are not commonly used by adolescents; however, they represent a serious concern regarding substance use among youths. This article uses methamphetamine as a model for stimulant use in adolescents; cocaine and prescription stimulants are also mentioned. Methamphetamine use among adolescents and young adults is a serious health concern with potentially long-term physical, cognitive, and psychiatric consequences. Brain development and the effects of misusing stimulants align such that usage in adolescents can more dangerous than during adulthood. It seems helpful to keep in mind the differences between adolescents and young adults when implementing interventions.

Drugs as instruments: a new framework for non-addictive psychoactive drug use

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a "necessary" prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of "drug instrumentalization." Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific "instrumentalization goals" and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future.

Patterns of concurrent substance use among adolescent nonmedical ADHD stimulant users

OBJECTIVES

There are growing concerns about nonmedical use of ADHD stimulants among adolescents; yet, little is known whether there exist heterogeneous subgroups among adolescents with nonmedical ADHD stimulant use according to their concurrent substance use.

METHODS

We used latent class analysis (LCA) to examine patterns of past-year problematic substance use (meeting any criteria for abuse or dependence) in a sample of 2203 adolescent participants from the National Surveys on Drug Use and Health 2006-2011 who reported past-year nonmedical use of ADHD stimulants. Multivariable latent regression was used to assess the association of socio-demographic characteristics, mental health and behavioral problems with the latent classes.

RESULTS

The model fit indices favored a four-class model, including a large class with frequent concurrent use of alcohol and marijuana (Alcohol/marijuana class; 41.2%), a second large class with infrequent use of other substances (Low substance class, 36.3%), a third class characterized by more frequent misuse of prescription drugs as well as other substances (Prescription drug+class; 14.8%), and finally a class characterized by problematic use of multiple substances (Multiple substance class; 7.7%). Compared with individuals in Low substance class, those in the other three classes were all more likely to report mental health problems, deviant behaviors and substance abuse service use.

CONCLUSIONS

Adolescent nonmedical ADHD stimulants users are a heterogeneous group with distinct classes with regard to concurrent substance use, mental health and behavioral problems. The findings have implications for planning of tailored prevention and treatment programs to curb stimulant use for this age group.

Psychostimulants: Basic and Clinical Pharmacology

Substance use disorder, and particularly psychostimulant use disorder, has considerable socioeconomic burden globally. The psychostimulants include several chemical classes, being derivatives of benzoylecgonine, phenethylamine, phenylpropanolamine, or aminoaryloxazoline. Psychostimulant drugs activate the brain reward pathways of the mesoaccumbal system, and continued use leads to persistent neuroplastic and dysfunctional changes of a variety of structures involved in learning and memory, habit-forming learning, salience attribution, and inhibitory control. There are a variety of neurochemical and neurobehavioral changes in psychostimulant addiction, for example, dopaminergic, glutamatergic, serotonergic (5-HT-ergic), and γ-amino butyric acid (GABA) changes have all noted. In this chapter, we will review pharmacological changes associated with psychostimulant use and abuse in humans and animals, and on the basis of the best characterized and most widely abused psychostimulants (amphetamines, cocaine) discuss why use transitions into abuse and review basic science and clinical strategies that might assist in treating psychostimulant abuse.

Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: a comprehensive narrative overview of English-language studies

There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed.

Sources of nonmedically used prescription stimulants: differences in onset, recency and severity of misuse in a population-based study

AIM

Epidemiological data indicate that nonmedical use of prescription stimulants has increased over the past decade. However, little is known regarding the source of the misused stimulants and whether different sources correspond to differences in risk profiles and associated social and health problems.

METHOD

Data from the 2006 to 2011 National Survey on Drug Use and Health were used. A total of 4945 participants who used prescription stimulants nonmedically and also reported their source of misused stimulants were categorized by the source: friend/relative, physician and illegal. Logistic regression models compared the socio-demographic, mental health and behavioral problems, and stimulant use-related problems (onset, recency, frequency, severity) according to the source of the misused stimulants.

RESULTS

The most common sources of stimulants were friends/relatives, followed by physicians and illegal sources. Compared to participants reporting friends/relatives as the source, participants reporting an illegal source were more likely to be male, unemployed, have less than a high school education, a history of criminal behavior and an earlier age of use onset. Participants reporting a physician source were more likely to have mental health problems and mental health service use. Higher odds of past-month stimulant use, frequent use (≥ 10 days per year), drug dependence and substance service use were found in individuals reporting physician and illegal sources.

CONCLUSIONS

Identifying the source of misused stimulants may be useful in detecting distinct subgroups of nonmedical prescription stimulant users, which may inform development of tailored prevention and treatment programs and contribute to individual treatment planning.

Generating genius: how an Alzheimer's drug became considered a 'cognitive enhancer' for healthy individuals

Background

Donepezil, an acetylcholinesterase inhibitor used in the treatment of Alzheimer’s disease, has been widely cited in media and bioethics literature on cognitive enhancement (CE) as having the potential to improve the cognitive ability of healthy individuals. In both literatures, this claim has been repeatedly supported by the results of a small study published by Yesavage et al. in 2002 on non-demented pilots (30–70 years old). The factors contributing to this specific interpretation of this study’s results are unclear.

Methods

We examined print media and interdisciplinary bioethics coverage of this small study, aiming to provide insight into how evidence from research may be shaped within different discourses, potentially influencing important policy, ethics, and clinical decisions. Systematic qualitative content analysis was used to examine how this study was reported in 27 media and 22 bioethics articles. Articles were analyzed for content related to: (1) headlines and titles; (2) colloquialisms; and, (3) accuracy of reporting of the characteristics and results of the study.

Results

In media and bioethics articles referencing this small study, strong claims were made about donepezil as a CE drug. The majority of headlines, titles, and colloquialisms used enhancement language and the majority of these suggest that donepezil could be used to enhance intellectual ability. Further, both literatures moved between reporting the results of the primary study and magnifying the perceived connection between these results and the CE debate that was alluded to in the primary study. Specific descriptions of the results overwhelmingly reported an improvement in performance on a flight simulator, while more general statements claimed donepezil enhanced cognitive performance. Further, a high level of reporting accuracy was found regarding study characteristics of the original study, but variable levels of accuracy surrounded the presentation of complex characteristics (i.e., methods) or contentious properties of the CE debate (i.e., initial health status of the study subjects).

Conclusions

Hyped claims of CE effects cannot be completely accounted for by sheer inaccuracy in reporting. A complex interaction between the primary and secondary literature, and expectations and social pressures related to CE appears to drive enthusiastic reports.

Illicit use of prescription stimulants in a college student sample: a theory-guided analysis

BACKGROUND

The illicit use of prescription stimulants (IUPS) has emerged as a high-risk behavior of the 21st century college student. As the study of IUPS is relatively new, we aimed to understand (1) characteristics of IUPS (i.e., initiation, administration routes, drug sources, motives, experiences), and (2) theory-guided intrapersonal, interpersonal, and environmental correlates associated with use.

METHODS

Using one-stage cluster sampling, 520 students (96.3% response rate) at one Pacific Northwest University completed a paper-based, in-classroom survey on IUPS behaviors and expected correlates. Aim 1 was addressed using descriptive statistics and aim 2 was addressed via three nested logistic regression analyses guided by the Theory of Triadic Influence.

RESULTS

The prevalence of ever engaging in IUPS during college was 25.6%. The majority (>50.0%) of users reported initiation during college, oral use, friends as the drug source, academic motives, and experiencing desired outcomes. Intrapersonal correlates associated with use included identifying as White, lower grade point average, diagnoses of attention deficit disorder, and lower avoidance self-efficacy. Interpersonal correlates of use included off-campus residence, varsity sports participation, IUPS perceptions by socializing agents, and greater behavioral norms. Exposure to prescription drug print media, greater prescription stimulant knowledge, and positive attitudes towards prescription stimulants were environmental correlates associated with use. In all models, IUPS intentions were strongly associated with use.

CONCLUSIONS

IUPS was prevalent on the campus under investigation and factors from the intrapersonal, interpersonal and environmental domains were associated with the behavior. Implications for prevention and future research are discussed.

Development and psychometric properties of a theory-guided prescription stimulant misuse questionnaire for college students

A theory-guided instrument for examining prescription stimulant misuse in the college population was developed and its psychometric properties were evaluated from 2011 to 2012 at one Pacific Northwest (United States) university. Study methods included instrument development, assessment by five health and measurement professionals, group interviews with six college students, a test-retest pilot study, and a paper-based, in-classroom, campus study using one-stage cluster sampling (N = 520 students, 20 classrooms, eligible student response rate = 96.30%). The instrument demonstrated reliability (i.e., internal consistency and stability) and validity (i.e., face, content, and predictive). Limitations and implications are discussed.

The prescription drug abuse epidemic

In the United States, the nonmedical use of prescription drugs is the second most common illicit drug use, behind only marijuana. This article discusses the abuse issues with three of the most widely abused prescription drugs: opioids, central nervous system (CNS) depressants (eg, benzodiazepines), and stimulants (eg, amphetamine-dextroamphetamine and methylphenideate) in the United States. Efforts to deal with the problem are described as well.

Cognitive test anxiety and cognitive enhancement: the influence of students' worries on their use of performance-enhancing drugs

This online panel study (n(t)(1) = 5,882; n(t)(2) = 3,486 (randomly selected)) used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010. Rare events logistic regression revealed that increased cognitive test anxiety increased the prevalence of medication use over various time windows. Negative binomial regression models showed that the higher the cognitive test anxiety, the higher the use frequencies were during the previous six months. The models controlled for expected side effects, risk attitudes, self-attributed competencies, prior medication use, sex, and age. We also discuss the study's implications.

Acute myocardial infarction induced by concurrent use of adderall and alcohol in an adolescent

Adderall (amphetamine, dextroamphetamine mixed salts), a widely prescribed stimulant for the treatment of attention-deficit/hyperactivity disorder in children and adolescents, is considered safe with due precautions. Nonmedical use of Adderall is prevalent and rising in high school and college students. Use of prescribed Adderall without intention to overdose as a cause of myocardial infarction is extremely rare, and to our knowledge, only 3 cases have been reported in the pediatric literature. We report a case of acute myocardial infarction in an adolescent without cardiovascular risk factors who took the total prescribed daily dose of Adderall one time while consuming alcohol. The sporadic use of Adderall with alcohol creates a potentially dangerous situation with serious cardiovascular adverse effects. We should have a high degree of suspicion for children and adolescents on stimulant therapy who present with chest pain and an abnormal electrocardiogram in the pediatric emergency department, and there is a need to evaluate them for myocardial ischemia and infarction.

Brain processes in discounting: consequences of adolescent methylphenidate exposure

Traits of inattention, impulsivity, and motor hyperactivity characterize children diagnosed with attention-deficit/hyperactivity disorder (ADHD), whose inhibitory control is reduced. In animal models, crucial developmental phases or experimental transgenic conditions account for peculiarities, such as sensation-seeking and risk-taking behaviors, and reproduce the beneficial effects of psychostimulants. An "impulsive" behavioral profile appears to emerge more extremely in rats when forebrain dopamine (DA) systems undergo remodeling, as in adolescence, or with experimental manipulation tapping onto the dopamine transporter (DAT). Ritalin(®) (methylphenidate, MPH), a DAT-blocking drug, is prescribed for ADHD therapy but is also widely abused by human adolescents. Administration of MPH during rats' adolescence causes a long-term modulation of their self-control, in terms of reduced intolerance to delay and diminished proneness for risk when reward is uncertain. Exactly the opposite profile emerges when exogenous alteration of DAT levels is achieved via lentiviral transfection. Both adolescent MPH exposure and DAT-targeting transfection lead to enduring hyperfunction of dorsal striatum and hypofunction of ventral striatum. Together with upregulation of prefronto-cortical phospho-creatine, striatal upregulation of selected genes (like serotonin 7 receptor gene) suggests that enhanced inhibitory control is generated by adolescent MPH exposure. Operant tasks, which assess the balance between motivational drives and inhibitory self-control, are thus useful for investigating reward-discounting processes and their modulation by DAT-targeting tools. In summary, due to the complexity of human studies, preclinical investigations of rodent models are necessary to understand better both the neurobiology of ADHD-like symptoms' etiology and the long-term therapeutic safety of adolescent MPH exposure.

Epidemiologic Trends of Adolescent Use of Alcohol, Tobacco, and Other Drugs

This article provides an overview of drug and alcohol use and risk factors among American adolescents. Current trends indicate that tobacco, alcohol, and marijuana are the most frequently used substances among this age group. Further, the greatest risk factors for using these substances are being male, being White, being an older adolescent, engaging in sexual risk behaviors, having a family history of substance abuse, associating with peers who abuse substances, and lacking a sense of school commitment and connectedness. These findings underscore the need to involve communities, families, schools, and peer groups to effectively prevent and treat this problem.

Usage trends for memory and vitality-enhancing medicines: A pharmacoepidemiological study involving pharmacists of the Gujarat region

OBJECTIVE

The aim of the study was to explore the trends and rationale of use of memory and vitality-enhancing medicines (MVEM) in the Gujarat region.

MATERIALS AND METHODS

A prospective pharmacoepidemiological study involving pharmacists of Gujarat region was carried out in the year 2005. Pharmacists (n = 351) working in general and Ayurvedic medical stores were selected from 12 districts of Gujarat region. The pharmacists were explained about the objective of the study and were given a pretested, validated questionnaire.

OUTCOME MEASURES

The questionnaire included the questions regarding herbal MVEM used most commonly, percentage sale of herbal MVEM - sold with or without prescriptions - age group of patients and professional groups who used these drugs most commonly.

RESULTS

The number of individuals using MVEM was highest in the age group of 11-20 years (17.54%), followed by the 21-40 years group (17.12%), supporting the results that the professional group of students (17.29%) and the persons of business or service class (15.29%) are the highest users of these medicines. Evaluation of various constituents in the marketed polyherbal MVEM revealed that Brahmi (Bacopa monniera), Shankhpushpi (Evolvulus alsinoides), Ashwangandha (Withania somnifera), Jatamansi (Nardostychos jatamansi), Vacha (Acorus calamus) and Amla (Phyllanthus emblica) were the common ingredients in the polyherbal preparations.

CONCLUSIONS

This study highlights commonly used Ayurvedic medicines that can be explored for safely enhancing memory and vitality performance. Hence, detailed and scientifically designed research on these drugs would help to identify safe and effective drugs for enhancing the same.

Pharmacological approaches to methamphetamine dependence: a focused review

Methamphetamine dependence is a serious worldwide public health problem with major medical, psychiatric, socioeconomic and legal consequences. Various neuronal mechanisms implicated in methamphetamine dependence have suggested several pharmacological approaches. A literature search from a range of electronic databases (PubMed, EMBASE, PsycInfo, the NIDA research monograph index and the reference list of clinicaltrials.gov) was conducted for the period from January 1985 to October 2009. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type. A variety of medications have failed to show efficacy in clinical trials, including a dopamine partial agonist (aripiprazole), GABAergic agents (gabapentin) and serotonergic agents (SSRI, ondansetron, mirtazapine). Three double-blind placebo-controlled trials using modafinil, bupropion and naltrexone have shown positive results in reducing amphetamine or methamphetamine use. Two studies employing agonist replacement medications, one with d-amphetamine and the other with methylphenidate, have also shown promise. Despite the lack of success in most studies to date, increasing efforts are being made to develop medications for the treatment of methamphetamine dependence and several promising agents are targets of further research.

Reinforcing effects of stimulants in humans: sensitivity of progressive-ratio schedules

Drug self-administration methodologies have been developed for use in humans to model naturalistic stimulant drug-taking behaviors. These methodologies use a number of schedules of reinforcement, including progressive-ratio schedules. As the name implies, in a progressive-ratio schedule, the response requirement for each subsequent delivery of drug increases, and the primary outcome variable is often the break point (i.e., the last ratio completed to receive a drug delivery). These schedules have been used in a number of human laboratory studies evaluating the reinforcing effects of stimulants. The results of these studies have demonstrated that progressive-ratio schedules are sensitive to manipulation of a pharmacological variable, dose, and to nonpharmacological variables contributing to stimulant drug effects. In addition, findings with progressive-ratio schedules are largely concordant with clinical findings, suggesting that drug self-administration under these schedules has predictive validity in terms of drug abuse and dependence. Future research is necessary, however, to understand better how pharmacological factors like route of administration, onset of effects, and pretreatment influence the reinforcing effects of stimulants under progressive-ratio schedules.

New treatments for cocaine dependence: a focused review

Cocaine, already a significant drug problem in North and South America, has become a more prominent part of the European drug scene. Cocaine dependence has major somatic, psychological, psychiatric, socio-economic, and legal implications. No specific effective pharmacological treatment exists for cocaine dependence. Recent advances in neurobiology have identified various neuronal mechanisms implicated in cocaine addiction and suggested several promising pharmacological approaches. Data were obtained from Medline, EMBASE, and PsycINFO searches of English-language articles published between 1985 and June 2007 using the key words: cocaine, addiction, cocaine dependence, clinical trials, pharmacotherapy(ies) singly and in combination. Large well-controlled studies with appropriate statistical methods were preferred. Pharmacological agents such as GABA agents (topiramate, tiagabine, baclofen and vigabatrin) and agonist replacement agents (modafinil, disulfiram, methylphenidate) seem to be the most promising in treatment of cocaine dependence. The results from trials of first- and second-generation neuroleptics are largely negative. Aripiprazole, a partial dopaminergic agonist that may modulate the serotonergic system, shows some promise. Preliminary results of human studies with anti-cocaine vaccine, N-acetylcysteine, and ondansetron, are promising, as are several compounds in preclinical development. While no medication has received regulatory approval for the treatment of cocaine dependence, several medications marketed for other indications have shown efficacy in clinical trials. An anti-cocaine vaccine and several compounds in preclinical development have also shown promise. Findings from early clinical trials must be confirmed in larger, less selective patient populations.

Cocaine and amphetamine-like psychostimulants: neurocircuitry and glutamate neuroplasticity

Although the pharmacology of amphetamine-like psychostimulants at dopamine transporters is well understood, addiction to this class of drugs has proven difficult to deal with. The reason for this disconnection is that while the molecular mechanism of amphetamine action is critical to reinforce drug use, it is only the first step in a sequence of widespread neuroplastic events in brain circuitry. This review outlines the affect of psychostimulants on mesocorticolimbic dopamine projections that mediate their reinforcing effect, and how this action ultimately leads to enduring pathological neuroplasticity in glutamatergic projections from the prefrontal cortex to the nucleus accumbens. Molecular neuroadaptations induced by psychostimulant abuse are described in glutamate neurotransmission, and from this information potential pharmacotherapeutic targets are identified, based upon reversing or countermanding psychostimulant-induced neuroplasticity.

Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult

Management of a child, adolescent, college student, or adult with ADD/ADHD (ADHD) is reviewed with emphasis on pharmacologic approaches in the adult. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants (psychostimulants), antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Psychopharmacology approved and/or used in pediatric patients are also used in adults with ADHD, though most are not officially FDA-approved. It is emphasized that ADHD management should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient of any age, and judicious use of medications. Such an approach is recommended to benefit those with ADHD achieve their maximum potential across the human life span.

Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration

OBJECTIVES

To explore the illicit use of specific prescription stimulants among college students and add to our understanding of reasons (motives) and routes of administration associated with illicit use of these drugs.

METHODS

A random sample of 4580 college students self-administered a Web-based survey. The survey contained a variety of items pertaining to the illicit use of prescription stimulants. An extensive list of prescription stimulants was provided, and students were asked to select all the specific prescription stimulants that they had used illicitly. Items were also included to assess the motives and routes of administration associated with illicit use of prescription stimulants.

RESULTS

Lifetime and past-year prevalence rates for illicit use of prescription stimulants were 8.3% (382 students) and 5.9% (269 students), respectively. Approximately three fourths (75.8%) of the 269 past-year illicit users of prescription stimulants reported using an amphetamine-dextroamphetamine combination agent (e.g., Adderall) in the past year, and approximately one fourth (24.5%) reported using methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin). Past-year illicit use of prescription stimulants was more than 3 times more likely among Caucasians (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.5-6.6) and Hispanics (OR 3.8, 95% CI 1.6-9.3) compared with African-Americans, and more than twice as likely among Caucasians (OR 2.1, 95% CI 1.3-3.4) and Hispanics (OR 2.6, 95% CI 1.4-5.1) compared with Asians. The most commonly reported motives for illicit use were to help with concentration (65.2%), help study (59.8%), and increase alertness (47.5%). Other motives included getting high (31.0%) and experimentation (29.9%). Nearly every illicit user (95.3%) reported oral administration, and 38.1% reported snorting prescription stimulants.

CONCLUSION

Illicit use of amphetamine-dextroamphetamine is more prevalent than illicit use of methylphenidate formulations among college students.