TY - JOUR
T1 - Systematic Review
T2 - Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies
AU - Faraone, Stephen V.
AU - Rostain, Anthony L.
AU - Montano, C. Brendan
AU - Mason, Oren
AU - Antshel, Kevin M.
AU - Newcorn, Jeffrey H.
N1 - Funding Information:
This analysis was funded by Arbor Pharmaceuticals, LLC.The authors wish to thank Sarah Thornburg, MS, and Rebecca Wylie, MSc, of Fishawack Communications Inc., for library research, some manuscript drafting, and editorial support in the form of copyediting and submission preparation, which was funded by Arbor Pharmaceuticals, LLC.Our review shows that the prevalence of prescription stimulant NMU ranges from 2.1% to 58.7%, depending on study design, population, and definition used. Although NMU often represents sporadic attempts at performance enhancement or brief experimentation, such use carries potentially serious risks, especially for cardiac events among nonmedical users who have not been screened for pre-existing cardiac conditions. This concern is supported by data from Poison Control Centers indicating that NMU has been associated with serious health outcomes including critical care hospitalizations, suicide, and other causes of death. Although the most adverse outcomes are rare, trends in NMU suggest they may increase, given that the NMU of AMP has increased over time (although NMU of MPH has remained constant or decreased).
Publisher Copyright:
© 2019 The Authors
PY - 2020/1
Y1 - 2020/1
N2 - Objective: 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. Method: 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. Results: 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. Conclusion: 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.
AB - Objective: 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. Method: 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. Results: 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. Conclusion: 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.
KW - abuse
KW - amphetamine
KW - attention-deficit/hyperactivity disorder
KW - methylphenidate
KW - misuse
UR - http://www.scopus.com/inward/record.url?scp=85075941676&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075941676&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2019.06.012
DO - 10.1016/j.jaac.2019.06.012
M3 - Review article
C2 - 31326580
AN - SCOPUS:85075941676
SN - 0890-8567
VL - 59
SP - 100
EP - 112
JO - Journal of the American Academy of Child Psychiatry
JF - Journal of the American Academy of Child Psychiatry
IS - 1
ER -