Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 59; no. 1; pp. 100 - 112
• Main Authors: Faraone, Stephen V., Rostain, Anthony L., Montano, C. Brendan, Mason, Oren, Antshel, Kevin M., Newcorn, Jeffrey H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020; Elsevier BV
• Subjects: abuse; Academic achievement; amphetamine; Attention deficit hyperactivity disorder; Central Nervous System Stimulants - adverse effects; Child & adolescent psychiatry; College students; Drug abuse; Health problems; Humans; Hyperactivity; Literature reviews; methylphenidate; misuse; Morality; Oral administration; Prescriptions - statistics & numerical data; Public health; Reviews; Risk Factors; Risk reduction; Risk Reduction Behavior; Stimulants; Substance-Related Disorders - epidemiology; Systematic review; amphetamine; methylphenidate; attention-deficit/hyperactivity disorder; abuse; misuse
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2019.06.012

To review all literature on the nonmedical use (NMU) and diversion of prescription stimulants to better understand the characteristics, risk factors, and outcomes of NMU and to review risk-reduction strategies. We systematically searched PubMed, PsycINFO, and SCOPUS from inception to May 2018 for studies containing empirical data about NMU and diversion of prescription stimulants. Additional references identified by the authors were also assessed for inclusion. A total of 111 studies met inclusion criteria. NMU and diversion of stimulants are highly prevalent; self-reported rates among population samples range from 2.1% to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to describe NMU, and most studies have examined college students. Although most NMU is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or minor, medical effects; however, adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes. Although academic and occupational performance enhancement are the most commonly cited motivations, there is little evidence that academic performance is improved by NMU in individuals without attention-deficit/hyperactivity disorder. NMU of stimulants is a significant public health problem, especially in college students, but variations in the terms used to describe NMU and inconsistencies in the available data limit a better understanding of this problem. Further research is needed to develop methods to detect NMU, identify individuals at greatest risk, study routes of administration, and devise educational and other interventions to help reduce occurrence of NMU. Colleges should consider including NMU in academic integrity policies.