Study: Up to One in Four Teens Has Abused Stimulant Medications for ADHD
Non-medical use of prescription stimulants among teens remains more prevalent than misuse of other prescription drugs, including opioids and benzodiazepines, researchers from the University of Michigan found.
April 24, 2023
Up to one in four middle and high school students has reported abusing prescription stimulant medications used to treat ADHD, according to a cross-sectional study recently published in the journal JAMA Network Open. 1 Non-medical use of prescription stimulants among teens remains more prevalent than misuse of other prescription drugs, including opioids and benzodiazepines, the research found.
According to researchers at the University of Michigan, students who used marijuana in the past 30 days were four times more likely to abuse ADHD medications than teens who did not use cannabis. In addition, stimulant drug abuse was 36% more likely to occur in schools with a large population of students with stimulant medication prescriptions to treat ADHD than it was in schools with fewer students using prescription stimulants like Adderall or Ritalin. (Studies have shown that one in every nine high school seniors reported taking prescribed stimulants for ADHD.) (2, 3)
According to the research, other factors associated with increased rates of stimulant drug abuse included:
- Schools located in suburban, non-Northeastern regions of the U.S.
- Schools with a high proportion of parents with a college degree
- Schools with a higher proportion of white students
- Schools with a medium amount of binge drinking among students (10%-19% of the total student body)
Prolonged stimulant abuse, researchers said, can lead to several detrimental health effects, including cardiovascular conditions, depression, anxiety, seizures, overdoses, psychosis, and stimulant use disorder.
“The key takeaway here is not that we need to lessen prescribing stimulants for students who need them, but that we need better ways to store, monitor, and screen for stimulant access and use among youth to prevent misuse,” said study author Sean Esteban McCabe, Ph.D.
For the study, the University of Michigan research team analyzed data collected between 2005 and 2020 by Monitoring the Future, a National Institute of Drug Abuse (NIDA) multi-cohort survey that measures drug and alcohol use among adolescents nationwide. More than 230,000 teens in grades 8, 10, and 12 from 3,284 secondary schools participated in the survey.
Dangers of Stimulant Misuse
Demand for prescribed stimulants to treat ADHD symptoms increased substantially from 2020 to 2021, a recent U.S. Centers for Disease Control and Prevention (CDC) report found. According to the CDC report, prescription stimulant fills were highest among males and females aged 5–19 and 15–24 years, respectively. 4
Previous studies have reported that more than half of adolescents who misuse prescription stimulants get the medication for free from friends or relatives. 5 However, illicit medications are increasingly obtained via online drug markets and social media referrals, making it harder to differentiate real and counterfeit medications. 6
“The drug supply has rapidly changed,” said National Institute on Drug Abuse Director Nora Volkow in a press release about the study. “What looks like medications — bought online or shared among friends or family members — can contain fentanyl or other potent illicit substances that can result in overdoses. It’s important to raise awareness of these new risks for teens.”
Students who use counterfeit medications often believe they are obtaining the actual medication as dispensed by a pharmacist, explained Kevin Antshel, Ph.D., professor of psychology at Syracuse University. “However, students obtaining counterfeit medications may purchase a product that is laced with potentially lethal amounts of drugs, usually fentanyl or methamphetamine,” Antshel said. “Fentanyl is especially concerning. A lethal dose of fentanyl is roughly the size of a few grains of salt.”
In May 2022, two Ohio State students died from suspected use of counterfeit stimulant medication laced with a synthetic opioid.
The University of Michigan researchers recommended that caregivers educate teens about the consequences of drug diversion (selling or sharing prescribed medications). “Nearly a quarter of adolescents who are prescribed stimulant therapy will be approached to divert their stimulant medications by their peers before the completion of high school (and more than half [54%] during college),” they wrote. 7, 8
Theresa E. Laurie Maitland, Ph.D., coordinator of the Academic Success Program for Students with learning differences and ADHD at the University of North Carolina, Chapel Hill, learned first-hand how widespread medication diversion is on college campuses.
“I asked a graduating senior if he had any advice for me. He said, ‘There’s one topic I wish you’d talk about with all students taking ADHD medication: How to handle the demand they will face to give away or sell their pills!’
“I was shocked but hid my reaction and listened attentively,” she said. “The student had been open about stimulant use, and the news spread quickly among his peers and classmates. He was often approached to sell or hand over ‘just one pill.’”
The FDA classifies stimulants as Schedule II controlled substances. Most state laws follow federal laws, with criminal penalties for possession without a prescription.
“Even if no money is exchanged, sharing your medication is, technically, ‘dealing drugs,’ and anyone who expects you to do it isn’t a true friend,” said Susan Yellin, Esq., Director of Advocacy and Transition Services at The Yellin Center for Mind, Brain, and Education in New York.
How Parents Can Help Teens
“The diversion of stimulant medication has serious legal and health risks for undiagnosed students and major personal, legal, and financial consequences for teens diagnosed with ADHD,” Maitland said. “We must inform those with ADHD about this important issue.”
Maitland offered the following suggestions to caregivers and teens:
1. Talk to Family Physicians
“For middle and high school students, doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants,” she said.
2. Value Your ADHD Diagnosis
It’s important that adolescents understand and accept their ADHD diagnosis, and that parents include them in healthcare decisions. “When students accept their diagnoses and value their medication, they have no desire to give or sell their pills to others,” Maitland said.
3. Use Discretion
Teens must store their ADHD medications in a lockbox or other secure device. They should also use discretion when sharing information about their stimulant use. “Many students have told me it is best not to discuss one’s stimulant use until they make friends (or maybe not at all),” Maitland said.
4. Foster Open Dialogue
Parents should talk with their children about the health and legal risks of misusing, sharing, or selling medication and potential scenarios they may encounter.
Teens can even role-play what to say if a family member, friend, or stranger asks them for pills. “Have teenagers rehearse several scripts to prepare them to say ‘no’ and to deal with pressure,” Maitland said.
Most importantly, Maitland continued, “Young people need to know they can turn to us in awkward situations and talk with us about something they regret having done.”
View Article Sources
1McCabe, S.E., Schulenberg, J.E., Wilens, T.E., Schepis, T.S., McCabe, V.V., and Veliz, P.T. (2023). Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020. JAMA Netw Open. (4):e238707. doi:10.1001/jamanetworkopen.2023.8707
2Garfield, C.F., Dorsey, E.R., Zhu, S., et al. (2012) Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000-2010. Acad Pediatr. 12(2):110-116. https://pubmed.ncbi.nlm.nih.gov/22326727/
3Xu, G., Strathearn, L., Liu, B., Yang, B., and Bao, W. (2018) Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open. 1(4):e181471. https://10.1001/jamanetworkopen.2018.1471
4Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023). Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. https://doi.org/10.15585/mmwr.mm7213a1
5Compton, W.M., Han, B., Blanco, C., Johnson, K., Jones, C.M. (2018) Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. Am J Psychiatry. 175(8):741-755. https://doi.org/10.1176/appi.ajp.2018.17091048
6Moyle, L., Childs, A., Coomber, R., and Barratt, M.J. (2019). #Drugsforsale: An Exploration of the Use of Social Media and Encrypted Messaging Apps to Supply and Access Drugs. Int J Drug Policy. 63:101-110. https://doi.org/10.1016/j.drugpo.2018.08.005
8McCabe, S.E., West, B.T., Teter, C.J., Ross-Durow, P., Young, A., and Boyd, C.J. (2011). Characteristics Associated with the Diversion of Controlled Medications Among Adolescents. Drug Alcohol Depend. 118(2-3):452-458. https://doi.org/10.1016/j.drugalcdep.2011.05.004