Student Perceptions of Methylphenidate Abuse at Public Liberal Arts College

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Pharmacotherapy. Author manuscript; available in PMC 2007 February 6.

Published in final edited grade as:

PMCID: PMC1794223

NIHMSID: NIHMS14382

Illicit Use of Specific Prescription Stimulants Amongst College Students: Prevalence, Motives, and Routes of Administration

Christian J. Teter, Pharm.D., Sean Esteban McCabe, Ph.D., M.South.Westward., Kristy LaGrange, Pharm.D., James A. Cranford, Ph.D., and Carol J. Boyd, Ph.D., R.N.

Abstract

Objectives

To explore the illicit employ of specific prescription stimulants among higher students and add together 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 all-encompassing listing 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 appraise the motives and routes of administration associated with illicit use of prescription stimulants.

Results

Lifetime and past-twelvemonth 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 by-year illicit users of prescription stimulants reported using an amphetamine-dextroamphetamine combination agent (e.grand., Adderall) in the past yr, and approximately one fourth (24.v%) reported using methylphenidate (e.m., Ritalin, Concerta, Metadate, Methylin). Past-yr illicit use of prescription stimulants was more than 3 times more likely among Caucasians (odds ratio [OR] 3.i, 95% confidence interval [CI] 1.five–6.6) and Hispanics (OR 3.8, 95% CI ane.half-dozen–9.three) compared with African-Americans, and more twice every bit likely amongst Caucasians (OR 2.one, 95% CI 1.three–3.four) and Hispanics (OR 2.6, 95% CI 1.four–5.1) compared with Asians. The most normally reported motives for illicit use were to aid with concentration (65.2%), help study (59.viii%), and increment alacrity (47.5%). Other motives included getting high (31.0%) and experimentation (29.9%). Near every illicit user (95.3%) reported oral administration, and 38.1% reported snorting prescription stimulants.

Conclusion

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

Keywords: prescription stimulants, illicit use, college students, motives, amphetamines, methylphenidate, route of administration

The illicit use of prescription stimulants by college students has been well documented over the by 5 years.^{1 – 5} However, with the exception of methylphenidate formulations, of which Ritalin (Novartis Pharmaceuticals Corp., E Hanover, NJ) has received the most attending in medical literature, little information is available regarding which specific stimulants are used illicitly by higher students. We know of only 2 college-based studies^{ii , 6} that have examined the illicit utilize of selected prescription stimulants other than methylphenidate. The outset study, which used a convenience sample of 150 undergraduate higher students, establish slightly higher rates of illicit use for methylphenidate but (seven.three%) compared with amphetamine-dextroamphetamine simply (Adderall; Shire US Inc., Newport, KY) (4.0%).² Most notably, it was found that using both methylphenidate and Adderall was the most prevalent course of illicit use of prescription stimulants (24.0%). The second written report used 26 "purposefully selected" students who were familiar with drug utilize.^{half dozen} According to these students' perceptions, Adderall was used more than other prescription stimulants on their campus due to its availability and lower occurrence of "ups and downs." Students in this sample were not representative of the unabridged educatee trunk, and cocky-reported prevalence rates were not provided. To our knowledge, these studies, although limited in their design, are the only published higher-based investigations that have specifically examined illicit use of amphetamine-dextroamphetamine combination products.

Limited data exist regarding which specific prescription stimulants are used illicitly amidst students in other historic period groups. For example, a 2004 study reported the following past-year prevalence rates of illicit amphetamine apply among loftier school seniors: 2.3% Ritalin, 1.nine% methamphetamine, 0.7% Dexedrine, 0.two% Benzedrine, 0.2% Methedrine, 0.1% Preludin, and 0.one% Dexamyl.⁷ Every bit with studies of the general population,⁸ that report did not assess illicit employ of amphetamine-dextroamphetamine formulations. Considering these formulations are among the most usually prescribed stimulants for treatment of attending-arrears–hyperactivity disorder (ADHD), it is crucial to decide the extent of their illicit use.

Information are also scarce with regard to the prevalence of illicit use of specific prescription stimulants in both loftier schoolhouse and higher students. In add-on, comprehensive surveys of motives for illicit stimulant drug use are needed, particularly in light of a growing body of show indicating several possible motives for illicit use of prescription stimulants. In one study, the principal reasons students provided for illicitly using prescription stimulants were to help concentrate, increase alacrity, and get high.⁹ Of note, many students also wrote in "to study" as a motive that was not provided as a fixed item in the survey; this motive needs to be empirically tested. Finally, at least one other written report that we are aware of has assessed routes other than oral administration for stimulant drugs among college students.ⁱ According to that study, virtually thirteen% of 283 students sampled had used methylphenidate intranasally.

Development of clinical, prevention, policy, and educational strategies for reducing prescription stimulant abuse requires knowledge of which agents are being abused and insight into motives for drug apply and the routes by which these agents are being administered. We sought to address these gaps in knowledge by assessing the prevalence of illicit utilise of specific prescription stimulants within a large, randomly selected sample of undergraduate college students. Nosotros also examined students' reasons for illicit use of prescription stimulants, using a comprehensive list of motives that evolved from earlier research,^ix and explored the routes of illicit drug administration.

Methods

Design

This study was approved by the institutional ethical review lath at a large midwestern university and was conducted at that academy during a two-calendar month period in January and February of 2005. A random sample of 5389 full-fourth dimension undergraduate students was drawn from the full undergraduate population of 20,138 total-time students (10,339 women, 9799 men). In add-on, we oversampled 652 Hispanic, 634 African-American, and 244 Asian undergraduate students in order to produce reliable prevalence estimates for these racial and ethnic groups. The entire sample was mailed a prenotification letter with $2 enclosed. This letter described the study and invited students to cocky-administer a confidential Web survey by using a URL accost and a unique countersign. Nonrespondents were sent up to three reminder due east-mails. The survey was maintained on an Internet site with the secure socket layer protocol to ensure privacy and security. Past participating in the survey, students became eligible for a sweepstakes that included cash prizes, travel vouchers, field passes to athletic events, and iPods. The final response rate was 66%, which exceeded the average response rate for national college-based studies of alcohol and other drugs.¹⁰ Similar Web-based study designs and procedures are described in more item elsewhere.¹¹

Sample

The final sample consisted of 4580 undergraduate students and closely resembled the demographic characteristics of the overall pupil population. 50 pct were women. The sample consisted of 65% Caucasians, xiii% Asians, 7% African-Americans, 4% Hispanics, and 11% Native-Americans and other racial categories. The mean ± SD age of students in the sample was 20 ± 2.0 years.

Measures

As shown in Figure one, computerized skip logic was used to guide students through survey questions pertaining to illicit use of prescription stimulants. Students received follow-up questions only if they acknowledged having illicitly used prescription stimulants during their lifetime. Survey questions about motives for illicit use of prescription stimulants were based on our earlier work⁹ and were not mutually exclusive (i.east., students could report more than than one reason). It should be noted that our survey items included both generic and brand names in order to increase clarity for respondents. Withal, we use generic names exclusively in our description of our findings.

Period diagram representation of measures and skip logic used during cocky-administration of the Web-based survey.

Statistical Analysis

In the initial analysis, the overall prevalence rates for lifetime and past-year illicit use of prescription stimulant drugs were examined. We also calculated prevalence rates for illicit use of prescription stimulants for subgroups divers past sex, race-ethnicity, and historic period of onset. Data were weighted to account for the overall student population sampling fractions. We used multiple logistic regression analyses to examine associations between these subgroups and illicit apply of prescription stimulants. Prevalence rates of motives for illicit use of prescription stimulants among lifetime users were also calculated, and χ² analyses were used to test for differences in motives by sex, race-ethnicity, and age of onset. Finally, prevalence rates for routes of administration of prescription stimulants by lifetime users were calculated, and χ^two analyses were performed to exam for differences in routes of assistants by sex, race-ethnicity, and age of onset. An α level of 0.05 was used for each statistical test.

Results

Prevalence of Illicit Apply of Specific Stimulants

Three-hundred eighty-two (8.iii%) of the 4580 respondents had used illicit prescription stimulants in their lifetime, and 269 (5.ix%) had used illicit prescription stimulants in the past year. As shown in Table i, approximately 3 of every four (75.8%) illicit prescription stimulant users reported taking amphetamine-dextroamphetamine in the by year, and approximately ane in four (24.v%) reported using methylphenidate products. Less than 3% each was reported for modafinil, amphetamine, methamphetamine, or pemoline. There were no differences in the past-twelvemonth illicit apply of prescription stimulants between men and women. However, there were statistically pregnant ethnic-racial differences in past-year use: Hispanics 8.5%, Caucasians seven.0%, Asians iii.4%, African-Americans one.ix%, and those categorized as other three.6% (χ² 39.7, df=4, p<0.001; Figure two).

Past-yr prevalence of illicit use of prescription stimulants as a office of race-ethnicity (4478 students, weighted data). The dashed line represents overall prevalence rate for past-yr illicit use of prescription stimulants.

Tabular array i

Specific Prescription Stimulants Used in the Past Year by 269 Students (weighted information^a) Reporting Illicit Utilize of Whatsoever Prescription Stimulant

Stimulant	No. (%)b of Users
Amphetamine-dextroamphetamine (e.m., Adderall)	204 (75.eight)
Methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin)	66 (24.v)
Modafinil (e.thou., Provigil)	vii (ii.6)
Amphetamine (due east.thousand., Benzedrine)	seven (ii.4)
Methamphetamine (due east.chiliad., Desoxyn)	2 (0.viii)
Pemoline (eastward.g., Cylert)	0 (0.0)
Other	4 (1.6)
Don't know the names of some I take used	ix (3.two)
Rather non say or did not specify	29 (eleven.0)

The effects of race and ethnicity were further examined in a serial of multiple logistic regression analyses. Four dummy variables were constructed to stand for the information for the five-category race-ethnicity variable. When African-Americans were used equally the reference group, the odds of past-year illicit use of prescription stimulants were more than 3 times higher amid Caucasians (odds ratio [OR] 3.ane, 95% confidence interval [CI] 1.5–6.6) and Hispanics (OR iii.8, 95% CI one.half-dozen–9.3). There were no statistically significant differences between Asians and African-Americans in the odds of past-year illicit use of prescription stimulants. Analyses using Asians as the reference group showed that the odds of past-year illicit use of prescription stimulants were over twice as loftier amongst Caucasians (OR two.i, 95% CI i.three–3.4) and Hispanics (OR 2.half-dozen, 95% CI 1.4–5.one). A final analysis using Caucasians every bit the reference group showed that there was no statistically significant divergence betwixt Caucasians and Hispanics in the odds of by-year illicit employ of prescription stimulants.

Most lifetime illicit prescription stimulant users began using in college (65.ii%) compared with precollege (34.8%). Logistic regression analysis showed that students who began illicitly using prescription stimulants before college were nearly 3 times more likely than students who began using in college to written report illicit utilize of prescription stimulants in the past yr (OR 2.eight, 95% CI 1.viii–4.5).

Motives for Illicit Use

Equally shown in Table 2, the virtually commonly reported motives for illicit employ of prescription stimulants were to assistance with concentration (65.two%), help written report (59.viii%), and increase alacrity (47.5%). Other common motives were to get high (31.0%) and to experiment (29.9%).

Tabular array two

Motives and Routes of Administration for Illicit Employ of Prescription Stimulants Reported by 382 Lifetime Users (weighted data^a)

Variable	No. (%) of Users
Motive
Because it helps me concentrate	249 (65.ii)
Because it helps me study	228 (59.8)
Because it helps increase my alertness	181 (47.5)
Because it gives me a high	118 (31.0)
Because of experimentation	114 (29.9)
Because information technology helps me lose weight	37 (9.vii)
Other (specify)	19 (5.0)
Because it counteracts the effects of other drugs	eighteen (four.8)
Because it is safer than street drugs	17 (iv.5)
Considering I'm addicted	four (1.0)
Rather non say	2 (0.5)
Road of Administration
Orally	363 (95.3)
Snorting	145 (38.1)
Smoking	22 (five.6)
Inhaling	2 (0.6)
Injecting	0 (0.0)
Other (specify)	2 (0.4)

Sexual activity-based differences emerged for several categories of motives. To experiment was reported by 34.6% of men versus 18.2% of women (p<0.05), and to counteract the effect of other drugs was cited past 7.4% of men versus 1.viii% of women (p<0.05). In contrast, women were more likely than men to report using prescription stimulants to lose weight (eighteen.2% vs 3.2%, p<0.001), to help study (66.7% vs 54.8%, p<0.05), and to help increase alacrity (58.8% vs 38.7%, p<0.001). Finally, at that place were no sex differences in the most frequently reported motive, which was to help concentrate. Sex-based comparisons for the almost ordinarily reported motives are presented in Effigy 3.

Relationships between the most commonly reported motives for illicit utilise of prescription stimulants and sexual practice (A) and age of initiation of illicit employ of prescription stimulants (B) among 382 students reporting lifetime illicit use of prescription stimulants (weighted data).

Some indigenous-racial differences were also observed with regard to motivation. To become high was not reported by whatsoever African-Americans, whereas information technology was cited by significant percentages of prescription stimulant abusers in other categories: Caucasians 32.iv%, Asians 21.9%, Hispanics 21.4%, and others 46.two% (χ² nine.6, df=4, p<0.05). Like results were plant for the motive to experiment; that is, Caucasians, Asians, Hispanics, and others were more than likely than African-Americans to written report this every bit a motive (χ² 10.8, df=4, p<0.05). Nigh African-American illicit prescription stimulant users reported to assist concentrate (8 students) and to assist report (six students) every bit their motive for employ.

Finally, there were differences in motives based on when students began illicit use of prescription stimulants (Figure iii). Compared with students who started earlier college, students who started during college were more than likely to report the motives of improving concentration (70.vii% vs 55%, p<0.01) and helping to report (66.5% vs 48.9%, p=0.001). Conversely, precollege illicit users of prescription stimulants were more likely than their counterparts to written report using these agents to get high (46.6% vs 22.viii%, p<0.001), to lose weight (xv.iii% vs vi.five%, p<0.01) and to experiment (42.0% vs 24.0%, p<0.001).

Routes of Administration

As shown in Table 2, nigh every illicit prescription stimulant user (95.3%) reported oral administration, and 38.ane% reported snorting these agents. A much smaller proportion of illicit users reported smoking stimulants (5.6%), and less than 1% was reported for other routes of administration, such every bit inhalation and injection.

We examined associations between sexual practice, race-ethnicity, grade of onset, and the iii most frequent routes of administration (oral, intranasal, and smoking). Neither sex nor race-ethnicity was significantly associated with any road of administration. There was too no difference in rates of oral administration between students who started during higher versus earlier college. However, students who began illicitly using prescription stimulants before higher were more likely to written report snorting prescription stimulants (54.2%) than those who started during higher (30.5%) (χ² xx.25, df=1, p<0.01). Further, those who reported precollege onset of illicit prescription stimulant use were more likely to report smoking these agents (11.5%) than those whose onset was during college (2.8%) (χ² 11.52, df=1, p<0.01).

Discussion

Prevalence of Illicit Employ of Specific Prescription Stimulants

The lifetime and by-year prevalence rates of illicit use of prescription stimulants plant in our written report resemble findings from unmarried-establishment⁹ and national studies^{4 , 5} of college students that used similar survey items. To our knowledge, this is the start study to provide prove that amphetamine-dextroamphetamine is existence illicitly used by college students at higher rates than methylphenidate. In fact, amphetamine-dextroamphetamine was reported more oftentimes than any other stimulants assessed in our study. Two hundred four (75.8%) of the 269 past-year illicit users reported having taken amphetamine-dextroamphetamine, whereas only 66 (24.v%) reported having taken methylphenidate. Forty-8 students (18.0%) reported using both amphetamine-dextroamphetamine and methyl-phenidate.

In the simply other study of college students that provided prevalence rates for illicit apply of amphetamine-dextroamphetamine, students reported using methylphenidate at higher rates than amphetamine-dextroamphetamine (7.iii% vs 4.0%), and the utilize of both was reported past 24% of respondents, thus exceeding the prevalence of either drug lone.² The departure in findings may be explained by irresolute trends in illicit use of specific prescription stimulants or by differences in survey methodology.

The popular press often identifies Adderall equally being one of the primary prescription stimulants used illicitly by high school and college students.^{12 – 14} Our study is the first to empirically certificate this claim using random sampling of an undergraduate educatee population. Furthermore, our findings suggest that other studies may benefit by asking specifically about amphetamine-dextroamphetamine products, equally studies that overlook these agents may seriously underestimate the prevalence of prescription stimulant abuse amid adolescents and young adults. However, it should be noted that differences in methodology often make it difficult to directly compare studies that assess the illicit use of prescription stimulants.¹⁵ Different studies have included various brand names and formulations in their surveys, and whereas some have listed the brand names equally private choices, other studies accept grouped multiple brand names together as a single item. For example, many national studies of prescription stimulant abuse have included methylphenidate and/or Ritalin as individual items, just they have not specifically included amphetamine-dextroamphetamine products.^{4 , 8}

Several hypotheses take been suggested as to why illicit use of amphetamine-dextroamphetamine appears to be growing relative to other stimulant formulations. These hypotheses generally fall into three categories: availability, pharmacokinetic differences betwixt stimulant drugs, and pharmacologic differences between stimulant drugs. For example, in one of the few other studies to specifically accost illicit employ of amphetamine-dextroamphetamine, college students reported that they believed Adderall was popular for illicit employ considering it was easily accessible, caused fewer emotional ups and downs (than alternative agents), and was believed to work better overall.⁶ Although that written report⁶ did not apply a random, representative sample of students or assess medical availability of stimulant drugs, it still provides insight as to why illicit amphetamine-dextroamphetamine use is growing on college campuses.

Pharmacokinetic differences among diverse formulations back up students' perceptions of experiencing less ups and downs with certain agents compared with others. For case, Adderall XR is an extended-release formulation with a elapsing of action of approximately 10–12 hours. This is significantly longer than the elapsing of activity of most methylphenidate formulations, with the exception of Concerta (methylphenidate; McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, PA). Firsthand-release methylphenidate lasts at about for vi hours; this short duration of action may contribute to perceived emotional fluctuations. In fact, amongst children with ADHD, this short duration of action and resultant multiple daily dosing has led to the and then-called roller coaster response.^sixteen

The mechanism of action of amphetamine-dextroamphetamine may also be a gene in its increasing popularity among illicit prescription stimulant users. Like methylphenidate, amphetamines increase dopamine levels in the brain by blocking the dopamine transporter. However, amphetamines also cause presynaptic release of dopamine. Thus, amphetamine-dextroamphetamine may generate higher dopamine levels in the brain than occur after taking methylphenidate products.¹⁷ Furthermore, amphetamine-dextroamphetamine increases levels of norepinephrine, which has been associated with improved cerebral operation.¹⁸ Some researchers have speculated that these differences in mechanism (i.eastward., college dopamine levels and the addition of noradrenergic furnishings) may explain why patients with ADHD respond differently to different stimulant drugs.¹⁹ College students may as well experience subjectively better responses to certain stimulants when illicitly using them to raise their academic functioning.

To our noesis, no study has specifically assessed the human relationship betwixt availability of specific prescription stimulants and their illicit use. However, every bit Adderall XR is the most commonly prescribed brand-name prescription stimulant in the United States,¹⁹ it is possible that increased availability has resulted in increased illicit use. This hypothesis is purely speculative until it can be adequately tested using valid data on medical availability.

The findings that African-Americans were less likely than Hispanics and Caucasians to report illicit prescription stimulant employ accordance with results from a national higher-based study^v and a national study of 8th, tenth, and 12th graders.^twenty Both studies constitute that African-American youths were less likely than other students to report illicit employ of methylphenidate. It appears that African-American students of various ages report less illicit employ of prescription stimulants. In fact, co-ordinate to a national survey of high school seniors, African-American students reported less substance use overall than most other racial-ethnic categories.²¹ Information technology is unclear why African-American students are reporting less drug use, including illicit utilise of prescription stimulants. African-Americans have more than conservative norms and attitudes toward the use of alcohol.²² Thus, information technology is possible that these attitudes are also held by African-American students with regard to illicit use of prescription stimulants.

Motives for Illicit Employ

This study builds on our before findings that college students are illicitly using prescription stimulants for a diverseness of reasons.⁹ In item, students report motivation to enhance their academic functioning, with near illicit users of prescription stimulants reporting improved concentration and help with studying as their motives for illicit use. Attention to motives for substance abuse is important because users' motives are often linked to other behaviors associated with drug utilize. For example, research on motivations for alcohol use has shown that mood regulation is an of import reason for drinking alcohol.²³ Our findings highlight the importance of the bookish environment (e.g., level of competitiveness) equally a gene that may increase motivations for illicit stimulant use. They besides illustrate the heterogeneous nature of motivations for stimulant corruption.^five

Our written report revealed several sex-based differences in motives for illicit stimulant employ. These findings disharmonize with our own previous findings⁹ too as those of other researchers.^{ii , 24} Of particular involvement is testify that bookish-related motivations for illicit prescription stimulant apply (i.e., to help written report or help increment alertness) are more salient for women than for men. To our cognition, this is the first study to report sex-based differences in motivations for illicit stimulant use. Discrepancies between our results and findings from earlier studies may be related to differences in survey methodology. For example, three items for which nosotros found sex-based differences in this report (to help report, experiment, and lose weight) were not included in our previous survey as fixed items.^nine All the same, two other motives for which we plant sexual practice-based differences in this study (increment alertness, counteracts the furnishings of other drugs) were included in our previous survey, which did not evidence sex-based differences. It may be that sexual activity-based differences in motives for illicit prescription stimulant use are increasing over time, but this hypothesis can exist tested only with longitudinal data.

Our study is likewise the first we are aware of to document ethnic-racial differences in students' motives for illicit prescription stimulant utilize. In particular, African-Americans who reported the illicit use of prescription stimulants were less likely to cite getting loftier or experimentation every bit motives than stimulant users in other ethnic groups. This finding may exist related to the lower prevalence rates of illicit use of prescription stimulants among African-Americans as compared with other student populations. These findings demand to be validated by other studies earlier business firm conclusions tin be made.

Finally, it is interesting that the motives to help study and to improve concentration were reported more frequently by students who began illicit utilise of prescription stimulants in college rather than earlier college. This finding suggests that some students are seeking academic operation enhancement through the help of prescription stimulants once they arrive at higher. It may be that some students are more vulnerable than others to the pressures of college life and are more likely to apply stimulants and other substances to cope with this pressure. Clearly, more work is needed to explore the implications of historic period of onset for illicit prescription stimulant use, especially with regard to the effects of stimulant use on bookish performance.

Routes of Assistants

Whereas nearly illicit prescription stimulant users reported oral administration, information technology is notable that 38% of illicit users reported snorting prescription stimulants. 1 other study assessed this behavior among college students and found that almost 13% of the students used methylphenidate intranasally.¹ Clearly, this form of drug use needs to be addressed through education and prevention, as the pharmacokinetics of prescription drugs can be dramatically altered when they are taken past routes other than the ones for which they are intended. For instance, the effects and hence the abuse liability of methylphenidate are increased when it is taken by routes that cause rapid increases in serum concentrations (e.chiliad., injection, insufflation).²⁵ Hence, college students who employ prescription stimulants by alternate routes of assistants, such equally intranasal, may be increasing their vulnerability for dependence on these drugs, even if they started for patently innocuous purposes (e.chiliad., to heighten studying).

Information about routes of illicit drug assistants is crucial to the development of clinical, prevention, policy, and educational efforts for reducing these behaviors and the negative consequences that may result. The United states Food and Drug Administration (FDA) has shown recent attention to the cardiovascular risks associated with prescription amphetamine-dextroamphetamine products. In fact, the FDA has developed a Web site (http://www.fda.gov/cder/drug/infopage/adderall/default.htm) that both patients and clinicians can access to learn more than almost the health risks associated with Adderall and Adderall XR. Whereas most individuals exposed to prescription stimulants are unlikely to experience serious agin events, students who illicitly use prescription stimulants without appropriate medical communication may be putting themselves at gamble, especially if they utilize an culling route of administration. Given the widespread illicit utilise of prescription stimulants reported on U.Due south. college campuses, students, clinicians, and others who collaborate with students must be educated about the potential adverse events associated with these potent psychostimulants.

Limitations

Several limitations should be considered before assessing the implications of our findings. Our sample consisted of students from a single university, which may limit the generalizability of our results. Although the prevalence rates of illicit use of prescription stimulants in this unmarried-institution study were comparable to those found in national surveys of college students,^{4 , 5} similar investigations need to be conducted in diverse samples, including young adults who are not attending college, to assess the generality of the findings.

Although we achieved an adequate response rate, nonresponse may have introduced bias in our study. However, concerns regarding not-response were reduced because the demographic characteristics of the sample closely resembled those of the overall student population. In addition, we assessed the potential impact of nonresponse by administering a brief telephone survey to 159 nonrespondents and plant no significant differences in alcohol and other drug use between respondents and nonrespondents.

This report did not include an private survey particular for dextroamphetamine (e.thou., Dexedrine; GlaxoSmithKline, Research Triangle Park, NC). However, in a national survey of high school seniors that includes a survey item for Dexedrine, the annual prevalence rate of illicit use of Dexedrine has non risen higher up 1% since 1985.⁷ Furthermore, a contempo report using information from IMS Wellness's NPA Plus (1992–2002) demonstrates that the use of dextroamphetamine represents a small percentage of the overall number of filled stimulant prescriptions.²⁶ Therefore, it seems unlikely that the omission of dextroamphetamine products in our survey would have had a big touch on our findings. Also, our report did not distinguish between diverse formulations of each stimulant (e.g., Adderall vs Adderall XR), which may accept of import clinical and/or research implications. Finally, this study did not contain diagnostic information such as ADHD, which would assist u.s.a. determine which students may be self-medicating due to untreated ADHD.

Futurity Directions for Research

Studies to investigate the bear upon of psycho-stimulants on academic performance are needed; in particular, studies to explore whatever differences in bookish performance based on specific stimulants with varying mechanisms of activeness will contribute to our cognition regarding the illicit use of prescription stimulants. More than work is clearly needed to appraise indigenous-racial differences in the prevalence of illicit use of prescription stimulants in diverse populations, including nonacademic environments, in improver to validating our findings among other samples of college students. Hereafter work should examine whether intranasal administration increases a student's vulnerability for abuse and/or dependence. This should include an cess of age of initiation of illicit prescription stimulant use equally this was shown to have an impact on the road of assistants; precollege illicit users were more likely to study intranasal administration or smoking as a route of assistants for prescription stimulants. Information technology is unknown why precollege illicit stimulant users report higher rates of nonoral administration compared with college initiators, but it may be associated with differences in motives for use between the two groups. This also must be farther elucidated through enquiry efforts.

The touch on of pharmaceutical delivery systems on the abuse potential of prescription psycho-stimulants would clearly provide valuable information on this potential approach to decreasing the illicit utilize of these drugs. For example, 1 written report constitute that a once-daily osmotic controlled-release formulation of methylphenidate had less abuse potential than immediate-release methylphenidate.²⁷ Nevertheless, the affect of such commitment systems on long-term development of substance abuse and dependence are unknown.

Decision

Amphetamine-dextroamphetamine was clearly the most prevalent stimulant drug used illicitly by college students, at rates iii times higher than that of methylphenidate formulations (e.m., Ritalin, Concerta, Metadate, Methylin). Thus, studies that rely solely on methylphenidate as an indicator for illicit use of prescription stimulants may underestimate the prevalence of this grade of drug corruption.

Hispanic and Caucasian students had higher rates of illicit prescription stimulant utilize than Asians and African-Americans, simply no sexual activity-based differences in use were apparent. College students are illicitly using prescription stimulants for a variety of reasons, with academic performance ranking among the top. In fact, the three most commonly reported motives for illicit utilize of prescription stimulants seemed related to a desire for enhanced academic operation. Motives linked to bookish performance were higher in women than in men and in students who began illicit utilise of prescription stimulants in college versus before college. Our findings of high rates of intranasal utilize of prescription stimulants highlight the need for teaching and prevention efforts aimed at reducing this dangerous behavior.

Clinicians who prescribe stimulant drugs to their patients carry the responsibility of weighing the benefits and risks of these agents. Prescription stimulants are highly constructive for treating ADHD and other conditions. Nonetheless, if they are used without appropriate therapeutic monitoring and management, unsafe health consequences tin occur.

Acknowledgments

We would like to thank Dr. Margaret E. Gnegy for her consultation regarding the bones pharmacology of the psychostimulants.

Footnotes

Presented equally a affiche at the annual coming together of the American College of Clinical Pharmacy, San Francisco, California, October 23–26, 2005.

Supported by a research grant (R03 DA 018239) from the National Establish on Drug Abuse, National Institutes of Health, Bethesda, Maryland.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794223/

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