Young adults’ Adderall misuse and related emergency room trips have risen dramatically even as their prescriptions for the stimulant hold steady, research shows. The study, published online by the Journal of Clinical Psychiatry, rebuts the common perception that Adderall misuse is worse among adolescents and older children than among 18-to-25-year-olds.
The study examined trends from 2006 through 2011 and found that it was mainly the young adults inappropriately taking Adderall, primarily getting the medication from family and friends and without a physician recommendation or prescription.
The growing problem is among young adults, says co-author Ramin Mojtabai, a professor of mental health at the Johns Hopkins University’s Bloomberg School of Public Health. Adderall is legitimately prescribed as part of treatment for attention deficit/hyperactivity disorder or narcolepsy, a particular type of sleep disorder.
But Misuse Is Common
“In college, especially, these drugs are used as study-aid medication to help students stay up all night and cram,” Mojtabai says. “Our sense is that a sizeable proportion of those who use them believe these medications make them smarter and more capable of studying. We need to educate this group that there could be serious adverse effects from taking these drugs and we don’t know much at all about their longterm health effects.”
Says study first author Lian-Yu Chen, a former graduate student at the Bloomberg School:
“The number of prescriptions for Adderall has fallen and yet we are seeing more medical problems from its use. This suggests that the main driver of misuse and emergency room visits related to the drug is the result of diversion, people taking medication that is legitimately prescribed to someone else. Physicians need to be much more aware of what is happening and take steps to prevent it from continuing.”
Adderall, the brand name for dextroamphetamine-amphetamine, does improve focus, Mojtabai says, but it can also cause sleep disruption and serious cardiovascular side effects, such as high blood pressure and stroke. It also increases the risk for mental health problems, including depression, bipolar disorder, and unusual behaviors including aggressive or hostile behavior.
There is little research on the drug’s long-term effects. In 2006, the Food and Drug Administration put a black box warning on dextroamphetamine-amphetamine due to cardiovascular risks.
Getting Them From Family and Friends
The researchers examined three separate data sets: the National Survey on Drug Use and Health, a population survey of substance use; the Drug Abuse Warning Network, a survey of emergency department visits; and the National Disease and Therapeutic Index, a survey of office-based practices including prescribing.
They found that in adults, over the six-year study period, treatment visits involving Adderall were unchanged, while non-medical use of Adderall (that is, taking the drug without a prescription) rose 67 percent and emergency room visits went up 156 percent.
Over the same period, in adolescents, treatment visits involving Adderall went down, nonmedical use was stable, and emergency room visits declined by 54 percent. The trends for methylphenidate, sold under the brand name Ritalin among others and also prescribed for attention deficit/hyperactivity disorder, were unchanged over the period.
Abusers’ major source for nonmedical use of Adderall was family or friends; in two-thirds of cases, those family or friends had obtained the drug by prescription.
The researchers found that of all Adderall nonmedical use, from age 12 and up, 60 percent was among 18-to-25-year-olds.
Mojtabai says drugs like Adderall should be monitored in the same way that prescription painkillers have in recent years. Prescriptions should be entered into a database that a physician could check to make sure a patient isn’t receiving multiple medications from multiple physicians, a warning sign of diversion or abuse, he says.
He also says it would be helpful to institute informational campaigns for young adults explaining the drug’s adverse effects.
“Many of these college students think stimulants like Adderall are harmless study aids,” he says. “But there can be serious health risks and they need to be more aware.”
Lian-Yu Chen, MD, PhD; et al.
Prescriptions, Nonmedical Use, and Emergency Department Visits Involving Prescription Stimulants
J Clin Psychiatry 2016 10.4088/JCP.14m09291