While the number of prescriptions for the stimulant Adderall has remained unchanged among young adults, misuse and emergency room visits related to the drug have risen dramatically in this group, new Johns Hopkins Bloomberg School of Public Health research suggests.
Anecdotal evidence had suggested the most severe problem of Adderall misuse was among older children and adolescents, but the new research - published Feb. 16 in The Journal of Clinical Psychiatry - finds otherwise. The study examined trends from 2006 through 2011 and found that it is mainly 18-to-25-year-olds who are inappropriately taking Adderall without a prescription, primarily getting the medication from family and friends and without a physician recommendation or prescription.
"The growing problem is among young adults," says study co-author Ramin Mojtabai, MD, MPH, PhD, a professor of mental health at the Bloomberg School. "In college, especially, these drugs are used as study-aid medication to help students stay up all night and cram. 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 long-term health effects."
Says first author Lian-Yu Chen, MD, who received her PhD in 2014 from 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 long-term effects. In 2006, the Food and Drug Administration (FDA) put a black box warning on dextroamphetamine-amphetamine due to cardiovascular risks. It is prescribed for conditions such as attention deficit/hyperactivity disorder and narcolepsy.
For their study, the researchers examined three separate sets of data: 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 it being prescribed) 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 another prescription stimulant prescribed for attention-deficit/hyperactivity disorder, were unchanged over the period.
Meanwhile, the major source for nonmedical use of Adderall was family or friends; two-thirds of those family or friends obtained it by prescription.
The researchers found that of all Adderall nonmedical use, from age 12 and up, 60 percent of it was among 18-to-25-year-olds.
Mojtabai says that from a public health perspective, drugs like Adderall should be monitored in the same way that prescription painkillers have started to be monitored in recent years. He says prescriptions should be entered into a database that a physician could check before writing a prescription to make sure the patient isn't receiving multiple medications from multiple physicians, a warning sign of diversion or abuse.
He also says it would be helpful to institute informational campaigns for young adults explaining the adverse effects associated with the drug. "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."
"Prescriptions, Nonmedical Use, and Emergency Department Visits Involving Prescription Stimulants" was written by Lian-Yu Chen, MD, PhD; Rosa M. Crum, MD, MPH; Eric C. Strain, MD; G. Caleb Alexander, MD, MS; Christopher Kaufmann, MHS; and Ramin Mojtabai, MD, MPH, PhD.
This study was supported by the National Institutes of Health's National Institute on Drug Abuse (K24 DA023186), the Agency for Healthcare Research and Quality (RO1 HS01899600 and a National Research Service Award (F31AG044052).
Alexander is Chair of the FDA's Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Mojtabai has received consulting fees and research grants from Bristol-Myers Squibb and Lundbeck.