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Study examines risk for misuse of ADHD
stimulant medications
Identifies characteristics of those
likely to sell or abuse stimulants, suggests potential strategies
BOSTON - March 30, 2006 - A major concern regarding the use
of stimulant medications to treat attention-deficit hyperactivity
disorder (ADHD) in adolescents and young adults has been the risk
that they will be misused or diverted to those for whom they have
not been prescribed. A new study from Massachusetts General Hospital
(MGH) researchers has found that, while the great majority of young
people with ADHD use their medications appropriately, a small percentage
are likely to abuse or to sell prescribed stimulants. The report,
appearing in the April 2006 Journal of the American Academy of
Child and Adolescent Psychiatry, also identifies factors that
may characterize those most likely to misuse their drugs and suggests
potential strategies to reduce the risk.
"In finding that misuse of stimulants prescribed for ADHD typically
takes place in the context of abuse of other substances, our results
show remarkable convergence with previous surveys of stimulant abuse
among college students," says Timothy Wilens, MD, director
of Substance Abuse Services in MGH Pediatric Psychopharmacology,
who led the study. "By putting a face on these patients, we
can start to address the problem with targeted strategies."
The current investigation enrolled participants in a long-term study
of young men treated with medications for a variety of behavioral
and psychiatric disorders. Ten years after originally joining that
study, 98 participants - 55 with ADHD and 48 who did not have ADHD
- were interviewed about their overall progress and current symptoms.
The young men, with an average age of 21, also completed a confidential
questionnaire asking whether they had sold their medications or
had misused them - including taking too much, getting high on their
medication, or taking them in combination with alcohol or other
substances of abuse - during the past four years. Of the 98 surveyed
participants, 46 also met the criteria for substance use disorder
and 21 for conduct disorder.
The results showed that participants with ADHD were more likely
than those without ADHD to report misusing their medication, with
11 percent admitting selling their drugs, 22 percent reporting they
took too much, 10 percent getting high and 31 percent admitting
they had taken their medication along with alcohol or other drugs.
Among those without ADHD, none reported selling their medications,
5 percent said they had taken too much or had gotten high, and 25
percent admitted using their medication with other drugs.
All of the ADHD participants who sold their medications also had
either substance use disorder or conduct disorder, and 83 percent
of those who reported misusing also had one of the other disorders.
Another key finding was that immediate release stimulant formulations
were most likely to be misused or diverted, while no participant
reported misuse or diversion of extended release stimulant medications.
"Now that we know who misuses those drugs and which are most
likely to be misused, we can pursue efforts to make sure they are
appropriately prescribed and monitored," says Wilens. "Our
results strongly signal that we should be more careful about what
we prescribe to patients who also have conduct disorder and substance
use disorder and also support a higher risk of misuse of immediate
release stimulants, which is consistent with other
recent studies.
"While we need additional research to make definitive recommendations,
from my own experience I'd suggest that physicians prescribe extended
release formulations and consider non-stimulant drugs for those
at increased risk. And I suggest to my college-age patients that
they store their drugs securely, don't advertise that they're taking
stimulants and never make them available to others."
Wilens is an associate professor of Psychiatry at Harvard Medical
School. His co-authors are Michael Monuteaux, ScD, Allison Swezey,
and Joseph Biederman, MD, all of MGH Pediatric Psychopharmacology;
and Martin Gignac, MD, of the University of Montreal. The study
was supported by grants from the National Institute on Drug Abuse.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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