ADHD News & Research

The Deadly Repercussions of Stimulant Medication Misuse

The death of two Ohio State students earlier this month from suspected use of fake Adderall pills laced with fentanyl brings attention to the ongoing and potentially fatal problem of stimulant misuse on college campuses.

May 13, 2022

Last week, two Ohio State students died from suspected use of counterfeit stimulant medication laced with synthetic opioid. Though the university did not formally name the students’ causes of death, it did issue a public health warning — “an alert about fake Adderall pills, which appear to contain fentanyl, causing an increase in overdoses and hospitalizations.”

The death of these healthy young adults is shocking; their cause of death, unfortunately, is not. Stimulant misuse (a.k.a., nonmedical use of stimulants), defined as taking stimulants in a manner other than prescribed, has soared on college campuses in the past decade. The public health threat is serious however awareness is paltry. To better educate the public, and college students in particular, the United States Drug Enforcement Administration last year launched its “One Pill Can Kill” campaign, which warns of deadly counterfeit medications “often sold on social media and e-commerce platforms” and even includes photos of real and counterfeit Adderall pills.

This is a good start, but it’s not enough.

Stimulant Misuse: Scope & Context of the Problem

High school (~10%) and college (~17%) students are the most likely to misuse stimulant medications.1 2 College students generally overestimate the prevalence of stimulant misuse, which normalizes the behavior and makes them more likely to engage in stimulant misuse themselves. 3 4 5 Historically, these misused medications were obtained from family and friends.6 However, these illicit medications are increasingly being obtained via online drug markets and social media referrals.7

Students – especially college students – believe that stimulant medications will improve academic performance.8 Nonetheless, research suggests the opposite: college students without ADHD who misuse stimulants experience GPA declines over time.9 10 This erroneous belief (stimulant medications are an “academic steroid” for those without ADHD) has been remarkably difficult to discredit.11 Thus, until effective prevention interventions can be implemented, we are likely to see a continuation of this issue, especially on college campuses. As evidence of this, on any college campus, approximately twice as many students use a stimulant illicitly than for a prescribed medical reason.12 13 14 Academic “crunch” times (final exams in fall and spring semesters) is the highest-risk period for students to misuse stimulants.15

Counterfeit stimulant medications are especially concerning. Students who use counterfeit medications believe they are obtaining the actual medication as dispensed by a pharmacist. However, students obtaining counterfeit medications often purchase a product that is laced with potentially lethal amounts of drugs, usually fentanyl and/or methamphetamine. Fentanyl is especially concerning. A lethal dose of fentanyl is roughly the size of a few grains of salt.

Stimulant Misuse: Risk Reduction Strategies

Stated succinctly: The single most effective way to avoid counterfeit medication is to only use stimulant medications dispensed by a registered pharmacy. Parents and healthcare providers should educate their students about the real risks that are involved with obtaining medication from a source other than a registered pharmacy. Parents could also continue to communicate with their child and monitor their child’s activities in the context of a warm, accepting, and supportive relationship. These parenting behaviors are associated with lowered risk for engagement in risky behavior16 such as obtaining counterfeit medications. Some universities offer fentanyl testing strips for free to students and this information should be readily conveyed.

Parents and healthcare providers also should be aware of the demographic and clinical risk factors for misusing stimulant medications. Among those with increased risk are individuals who have lower grades, are members of the Greek system, and have substance use histories.6 Knowing this, more targeted interventions could be directed toward those with a higher degree of risk.

Finally, it is conceivable that the tragedy at Ohio State University might increase pressure on students with ADHD to divert their stimulant medication. Stimulant diversion – the act of taking medication prescribed to one person and intentionally providing it to another person – is already a concern in the high school and college student ADHD population. Parents should continue to engage in ongoing conversations about the risks (including jail time) associated with giving away or selling their stimulant medication. Caregivers should also discuss diversion risk reduction behaviors such as not publicizing stimulant prescriptions to peers and storing medication in a concealed, locked container.

Conclusion

Over a decade ago, researchers concluded that stimulant medications had become a salient part of university culture.17 When misused, stimulant medications were typically obtained from family and friends. Increasingly, these illicit medications are being obtained via online drug markets and social media referrals. This raises the risk for counterfeit medications and additional tragic outcomes like the ones recently experienced at Ohio State University. At the same time, students and parents of students with ADHD should be careful not to “throw the baby out with the bathwater.” Stimulant medications are FDA-approved for the treatment of ADHD and are an evidence-based intervention when dispensed by a pharmacy and used appropriately.

Fake Adderall and Stimulant Misuse: Next Steps


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References

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2Cassidy TA, Varughese S, Russo L, Budman SH, Eaton TA, Butler SF. Nonmedical Use and Diversion of ADHD Stimulants Among U.S. Adults Ages 18-49: A National Internet Survey. J Atten Disord. 2015;19(7):630-640.

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4DeSantis AD, Anthony KE, Cohen EL. Illegal college ADHD stimulant distributors: characteristics and potential areas of intervention. Subst Use Misuse. 2013;48(6):446-456.

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10Arria AM, Caldeira KM, Vincent KB, et al. Do college students improve their grades by using prescription stimulants nonmedically? Addict Behav. 2017;65:245-249.

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12McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use and diversion of prescription stimulant medication. J Psychoactive Drugs. 2006;38(1):43-56.

13McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use, and diversion of abusable prescription drugs. J Am Coll Health. 2006;54(5):269-278.

14 McCabe SE. Screening for drug abuse among medical and nonmedical users of prescription drugs in a probability sample of college students. Arch Pediatr Adolesc Med. 2008;162(3):225-231.

15Hanson CL, Burton SH, Giraud-Carrier C, West JH, Barnes MD, Hansen B. Tweaking and tweeting: exploring Twitter for nonmedical use of a psychostimulant drug (Adderall) among college students. J Med Internet Res. 2013;15(4):e62.

16Kumpfer KL, Alvarado R. Family-strengthening approaches for the prevention of youth problem behaviors. Am Psychol. 2003;58(6-7):457-465.

17DeSantis A, Noar SM, Webb EM. Speeding through the frat house: a qualitative exploration of nonmedical ADHD stimulant use in fraternities. J Drug Educ. 2010;40(2):157-171.

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