PMC:1524735 / 3862-15565 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/1524735","sourcedb":"PMC","sourceid":"1524735","source_url":"http://www.ncbi.nlm.nih.gov/pmc/1524735","text":"Prevalence of non-medical use of prescription stimulants: college settings\nRegarding college prevalence data and policy, the most frequently studied prescription stimulant is methylphenidate. From 1990 to 2000, use of methylphenidate increased five-fold in the United States, which consumes approximately 90% of all methylphenidate [12,15]. The Monitoring the Future research group has been studying the annual prevalence of use of methylphenidate (measured as \"Ritalin,\" as a stand-alone question) among teens and emerging adults since 2001 [[16]; also see [17]]. The annual prevalence among 8th, 10th, and 12th graders has averaged 2.7%, 4.3%, and 4.5%, respectively, over the period from 2001 to 2004. Its use among college students has averaged 5.0% over this period, whereas its use among non-college emerging adults has averaged approximately 2.9% over this period. (About 25% of these users use methylphenidate about once a month [16,17].)\nIts use remains at approximately 3.5% through 24 years age. At 25 years of age its use decreases to 1.5% and then below 1% at 29–30 years of age [16]. Thus, use of this study drug appears to peak from the ages of 16 to 24 years of age (older adolescence through emerging adulthood), following the same course of use prevalence as other drugs such as alcohol and illicit drugs [also see [18]]. Males are relatively likely to use methylphenidate (3.7% versus 1.6%), and use appears slightly higher in the southern states in the Monitoring the Future survey (2.8% versus 2.0–2.5%), and in very large urban areas (about 3.0% versus 1.9–2.7%). Methylphenidate appears most likely to be used by male college students in large cities [16].\nSeveral studies have been completed to discern prevalence and reasons for non-medical use of prescription stimulants. Simoni-Wastila \u0026 Strickler [19] examined 1991–1993 data from the National Household survey on Drug Abuse (NHSDA), a nationally representative, randomized-block selected household sample of 12-year olds and older. They found that 1% of the U.S. population had used prescription stimulants non-medically in the past year, and a fifth of them reported problem use (e.g., inability to cut down use), though they failed to find significant demographic, health status, or drug use correlates of illicit problem stimulant use. Certainly, the age range of highest lifetime use of prescription stimulants is from 18–25 [20], approximately 5%, and at least doubling percentage figures among other age categories viewed across multiple years of this survey.\nIn a more recent study, McCabe and colleagues [12] examined the prevalence rates and correlates of non-medical use of prescription stimulants (methylphenidate, D-amphetamine, or D,L-amphetamine) among U.S. college students. One hundred and nineteen nationally representative 4-year colleges in the United States were selected and a sample of 10,904 randomly selected college students in 2001 were examined via self-report surveys. The life-time prevalence of non-medical prescription stimulant use was 6.9%, past year prevalence was 4.1% (but ranged from 0% to 25% across colleges), and past month prevalence was 2.1%. A total of 5.8% of males and 2.9% of females reported annual use of non-prescribed stimulants. In addition, 2.8% of males (1.6% of females) reported use in the past month. Whites were relatively likely to misuse prescription stimulants compared to African American, Asian, or other groups (annual use: 4.9% versus 1.6%, 1.3%, and 3.1%, respectively). The prevalence of non-medical use of prescription stimulants among students attending historically African American colleges and universities was low [12].\nPast year rates of non-medical use ranged from zero to 25% at individual colleges. Non-medical use was higher among college students who were members of fraternities and sororities (annual use: 13.3% if living in a fraternity or sorority house, 3.5%-4.5% otherwise; 8.0% versus 1.8%–2.5% last month use), and earned lower grade point averages (annual use: B or lower average, 5.2%; B+ or higher, 3.3%). Rates were higher at colleges located in the north-eastern region of the U.S. (6.3% annual use), and southern region (4.6%), then other regions (2.8–3.2%), and colleges with more competitive admission standards (5.9% versus 1.3–4.5% annual use). Non-medical prescription stimulant users were more likely to report use of alcohol, cigarettes, marijuana, ecstasy, and cocaine, raising the possibility that use of prescription stimulants for non-medical purposes may be related as much to an addiction disorder as to an aid to study.\nThese studies examined a variety of prescription stimulant drugs, not just methylphenidate. Thus, arguably, a 4.1–5.4% annual prevalence represents the most accurate statement regarding those at highest prevalence of non-prescription use.\nSeveral single-university sample surveys of college students have reported a range of use reports. Massachusetts, Michigan, New Hampshire, Maine, Florida, Pennsylvania, Wisconsin, and Texas samples are reported herein. In one random sample at a Massachusetts college of liberal arts (n = 283), 16.6% of the sample reported having taken methylphenidate for fun (non-medical purposes), and 12.7% reported having snorted methylphenidate; a majority of the self-reported users were under 24 years of age [21].\nTeter, McCabe and colleagues [22] administered a survey to 2250 randomly selected undergraduates at the University of Michigan (in 2001) and found a 3% annual prevalence of illicit methylphenidate use, which was positively associated with other licit and illicit drug use (but not with gender or ethnicity). The same research group [23] assessed the prevalence and motives for illicit use of prescription stimulants (methylphenidate [two brands], D-amphetamine, and D, L-amphetamine) to a random sample of 9,161 undergraduate college students at the University of Michigan (surveyed in 2003). Of the study participants, 8.1% reported lifetime and 5.4% reported past-year illicit use of prescription stimulants. The most prevalent motives given for illicit use of prescription stimulants were to (1) help with concentration (58% of lifetime illicit users), (2) increase alertness (43%), and (3) provide a high (43%). Eighty-six percent reported not being prescribed these drugs in their lifetime. Men were more likely than women to report illicit use of prescription stimulants (9.3% versus 7.2%), and Whites and Hispanics (9.5% and 8.9%, respectively) were more likely to use them than African American or Asian students (2.7% and 4.9%, respectively). Illicit use of prescription stimulants was associated with elevated rates of alcohol and other drug use, and total number of motives endorsed and alcohol and other drug use were positively associated.\nThese same authors [13] reported an additional study of prescription drug misuse and diversion (i.e., diverting use from those prescribed the medication to those not prescribed the medication), in the same cohort as the Teter et al. [23] study. The annual illicit use of stimulant medication was 5%, and the illicit use-medical use ratio for stimulant medication (overall = 2.45) was the highest among the four classes of prescription drugs examined (overall ratios for the other three drug types, sleeping, sedative/anxiety, and pain medications were less than 1.0). Medical users of stimulants for attention deficit hyperactivity disorder were the most likely to be approached to divert their medication (54% of them reported being approached to sell, trade, or give away their medication). Illicit users of medical stimulants were relatively likely to use other drugs (odds ratios varied from 6.00 for binge drinking to 21.25 for annual cocaine use).\nWhite, Becker-Blease, \u0026 Grace-Bishop [5] examined illicit use of stimulant medication among undergraduate and graduate students at the University of New Hampshire. Of 1,025 randomly sampled participants, 16% reported misusing stimulant medication (96% of those that specified a medication preferred to misuse methylphenidate, 2% misused D, L-amphetamine). Ninety-percent of these subjects reported never receiving an ADHD diagnosis. Results failed to differ as a function of gender. Most used pill form (55%), but 40% had used intranasally. Of those that misused prescription stimulants, about 50% reported misuse 2–3 per year, whereas the other 50% reported misuse at least once per month. Reasons for misusing prescription stimulant medication (i.e., illegal use) included improving attention, partying, reducing hyperactivity, and improving grades.\nIn a convenience sample survey of 150 undergraduates at a small U.S. college (in Maine), 35.5% took prescription amphetamines (D,L-amphetamine, methylphenidate, or D-amphetamine) illegally. A total of 24% of the illicit users used amphetamines to study, but 19.3% used them in combination with alcohol for recreational reasons [24].\nThere have been several unpublished surveys conducted by individual colleges. For example, Kapner [1] summarized four unpublished surveys of methylphenidate use from college reports, and found that 1.5% of students surveyed at the University of Florida in 2002 reported using methylphenidate recreationally in the last 30 days, 9% of those undergraduates surveyed at the University of Pennsylvania in 2000 had used someone else's ADHD prescription medication, 20% of those students surveyed at the University of Wisconsin, Madison, in 1998, had illegally taken an ADHD medication at least once, and 2% and 1.5% of those students surveyed at the University of Texas in 1997 had used methylphenidate illegally in their lifetimes and the past year, respectively. The sampling details of these reports were not disclosed and could not be located; thus, these results must be taken with caution. In the studies involving college students, college student participation rates among those \"randomly\" selected varied from 20–60%. Thus, replication studies with recruitment of a greater percentage of the targeted sample still are needed, if this can be accomplished in college settings.\nTo summarize, lifetime, past year, and past month illicit use of prescription stimulants among emerging adults appears to vary widely while averaging approximately 7%, 4%, and 2%, nationally. Use is most prevalent among white or Hispanic male college students, who are associated with fraternities, struggling with their grades, and who generally live in larger urban areas (though not always) in northeastern or southern regions of the U.S. These youth also tend to use other drugs particularly cannabis, alcohol, MDMA, and cocaine [also see [25]]. They use study drugs to enhance their study and social life, and sometimes to stay awake while using another drug such as alcohol.\n\nRoutes of Administration\nPrescription stimulants have been misused through oral, intranasal, and intravenous routes of administration. Oral misuse of prescription stimulants results in noticeable symptoms if taken in high doses. Encapsulated extended-release formulas can be misused and abused as well as the older shorter-release formulas by breaking open a capsule and snorting the contents. A series of case studies have indicated intranasal and injection abuse of study drugs [4,26,27]. In one study of New Hampshire undergraduate and graduate students [5], the preferred method of use among study drug misusers was oral (55%), intranasal (40%), and \"Other\" (4%). The route of administration of the \"other\" category was not specified, but it is possible that intravenous use was being referred to. More disconcerting, 79% of illicit users were not at all concerned about using these study 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