The Use, Misuse and Diversion of Prescription Stimulants Among Middle and High School Students

Abstract

This present study investigated the prevalence and the factors associated with the use, misuse, and diversion of prescribed stimulant medication for attention-deficit hyperactivity disorder (ADHD) in a sample of middle and high school students. As part of a school-based, self-administered web survey in May 2002, students from a Midwestern public school district in the United States in grades six through eleven (n = 1536) reported on three aspects of prescription stimulants; they reported on their use, misuse, and diversion (e.g., trading, selling, offering) of stimulant medication for ADHD. The total student sample was 57% White, 40% African American, and 3% from other racial and ethnic groups. Gender and school level were approximately equally distributed in the student sample, and 81% of students had plans to attend college. The illicit use of stimulant medication was reported by 4.5% of the overall sample. Of the students who reported prescription stimulant use, 23.3% reported being approached to sell, give, or trade their prescription drugs. After adjusting for sociodemographic factors, the odds for illicit use of stimulant medication was lower among African American students and higher among those students with no plans for attending college. When compared with students who did not use stimulants or who did not misuse their own prescriptions, students who reported illicit use of stimulant medications also reported significantly higher rates of alcohol and other drug use. High schools students had the highest odds for being approached to divert their stimulant medications. Our findings suggest that community-based approaches are needed to reduce the illicit use and diversion of stimulant medications within middle and high school student populations.

• Prescription stimulants
• Illicit use
• Diversion
• Middle school
• High school
• Students

Resumen

Este estudio investiga la frecuencia y los factores asociados con el uso, el abuso y el desvío de los estimulantes medicinales que son recetados para el Trastorno de Déficit de Atención e Hiperactividad (con siglas en inglés: ADHD–attention deficit hyperactivity disorder), tomando una muestra aeleatoria de estudiantes al nivel de escuela intermedia y de escuela secundaria. Como parte de una actividad escolar, 1536 estudiantes de un distrito de escuelas públicas del mediooeste de los Estados Unidos participaron en una encuesta autoadministrada en la web. Los estudiantes, al nivel escolar del sexto al onceavo cursos, informaron sobre tres aspectos de los estimulantes de receta. Su información se basaba en el uso, abuso y variedad de adquisición (por ejemplo: intercambio, venta, oferta, etc.) de los medicamentos con estimulantes para el Trastorno de Déficit de Atención e Hiperctividad (ADHD). La muestra del cuerpo estudiantil se componía de un 57% de raza blanca, el 40% era afroamericana y el 3% de varias razas y grupos étnicos. La distribución sexual y el nivel escolar del grupo de muestra estaba muy igualada y un 81% de los estudiantes planeaba seguir con estudios universitarios. El 4.5% del total del grupo de muestra dio información sobre el uso ilegal de los estimulantes medicinales. De los estudiantes que informaron sobre el uso de estimulantes medicinales, el 23.3% indicó que se les había ofrecido la venta, regalo o intercambio de medicinas de receta. Después de haber hecho los ajustes necesarios de los factores sociodemográficos, la probabilidad del uso de estimulantes era más baja entre los estudiantes afroamericanos y más alta entre los estudiantes que no pensaban seguir con estudios universitarios. Al comparar a los estudiantes que no usaban estimulantes o que no abusaban de los estimulantes recetados, los estudiantes que informaron acerca del uso ilegal de estimulantes también informaron de una frecuencia más alta del uso del alcohol y otras drogas. La probabilidad de ofertas para el desvío de los estimulantes recetados era más alta entre los estudiantes al nivel de escuela secundaria. Los resultados de este estudio indican que es necesario ofrecer servicios comunitarios para disminuir el uso ilegal y el desvío de los estimulantes medicinales entre el cuerpo estudiantil al nivel de escuela intermedia y escuela secundaria.

Résumé

Cette étude a examiné le courant et les facteurs associés à l’usage, au mauvais usage et au détournement de médicaments stimulants prescrits pour le traitement de trouble de déficit d’attention/hyperactivité, TDAH, (en anglais: ADHD), dans un échantillon d’élèves de collèges et de lycées. Dans le cadre d’un sondage administré aux élèves par l’école, sur le web, les élèves d’une école publique d’un district du Midwest des Etats Unis, des niveaux de 6ème à 11ème (n=1536) se sont exprimés sur trois aspects des stimulants prescrits: leur usage, mauvais usage et détournement (par ex: l’échange, la vente, l’offre, etc…) de médicaments stimulants prescrits pour traiter TDAH. L’échantillon total des élèves comprenait 57% de Blancs, 40% d’Africains Américains et 3% d’autres groupes raciaux et ethniques. Le genre et le niveau scolaire on été répartis à peu prés également dans l’échantillon des élèves et 81% de ceux-ci projetaient d’aller à l’université. L’usage illicite de médicaments stimulants a été rapporté par 4.5% de l’échantillon total. Parmi les élèves qui ont indiqué qu’ils utilisaient des médicaments stimulants prescrits par leur médicin, 23.3% ont rapporté qu’on les avait abordés pour leur demander de vendre, donner ou échanger leurs médicaments. Aprés ajustement pour des raisons de facteurs sociodémographiques on a trouvé que les risques d’usage illicite de médicaments stimulants étaient moins élevés dans la population Africaine Américaine et plus élevés parmi les élèves qui n’avaient pas l’intention de poursuivre leus études à l’université. Comparés aux élèves qui n’utilisaient pas de stimulants ou qui ne faisaient pas mauvais usage de leur propre ordonnance, les élèves qui ont rapporté faire un usage illicite de médicaments stimulants ont aussi rapporté faire un usage illicite de taux significativement plus élèves d’alcool et d’autres drogues. Les élèves de lycée avaient le plus de risques d’être abordés par des personnes leur demandant de leur faire profiter de leur médicament. Nos conclusions suggèrent que des approches organisées au niveau de la communauté sont nécessaires pour réduire l’usage illicite et le détournement de médicaments stimulants au sein des populations des élèves de collège et de lycée.

Additional information

Notes on contributors

Sean Esteban McCabe

Dr. Sean Esteban McCabe is an educator, social worker, and research scientist at the University of Michigan Substance Abuse Research Center in his specialty of drug use and misuse. He received his M.S.W., M.A. and Ph.D. from the University of Michigan. His current research focuses on the etiology and prevention of substance use among adolescents and young adults. Dr. McCabe is interested in examining gender and racial/ethnic differences in risk factors for substance use among school-based student populations (middle school, high school, and college). He is currently working on several projects that examine the prevalence of illicit use and diversion of stimulant medications and other prescription drugs. Dr. McCabe specializes in using the Internet for survey research, and he is currently developing web-based intervention programs aimed at reducing substance use and misuse among adolescents. He is the author of several research articles published in peer-reviewed journals on topics related to drug use and misuse among adolescents and young adults. Dr. McCabe is a recent recipient of the junior investigator award and research recognition award from the Research Society on Alcoholism for his research examining gender differences in risk factors for heavy drinking.

Christian J. Teter

Dr. Christian J. Teter is a Post-Doctoral Research Fellow at the University of Michigan Substance Abuse Research Center and College of Pharmacy. He received his Pharm.D. from the University of Michigan, completed his Psychiatric Pharmacotherapy Residency at the University of North Carolina, and is a Board-Certified Psychiatric Pharmacist. His current research focuses on a multidisciplinary approach to drug abuse, and he is interested in using his clinical experience to guide his research agenda. His current projects include, among others, human clinical research evaluating the relationships between the pharmacokinetics and pharmacodynamics of nicotine when delivered by different routes of administration; survey-based research evaluating the prevalence and patterns of prescription drug abuse, misuse, and diversion; and observational research assessing the impact of inpatient hospitalization on the course of treatment among substance- and nonsubstance-abusing community mental health patients. Dr. Teter is the author of a variety of articles published in peer-reviewed journals on topics related to both prescription and illicit drug abuse. Dr. Teter is a recipient of the New Investigator Award from the National Institute of Mental Health for his work assessing the comparative effects of nicotine pharmacokinetics and pharmacodynamics when delivered by different routes of administration.

Carol J. Boyd

Dr. Carol J. Boyd is a Professor at the University of Michigan School of Nursing and Women's Studies and Director of the Substance Abuse Research Center. She received her MSN and Ph.D. from Wayne State University. The Substance Abuse Research Center is an interdisciplinary research center that includes more than 100 researchers and 14 disciplines. Her current research focuses on gender and substance use/abuse, including smoking and alcohol use. She has a great deal of experience using web-based approaches for collecting data among middle school, high school, and college student populations. In addition to her earlier work on illicit drug use and interpersonal relationships among women, her recent research focuses on HIV prevention programs among substance abusers, substance abuse treatment evaluation, and risky behaviors among adolescents and college students. Dr. Boyd has more than 20 years of experience working in the substance abuse field, directing and managing nationally funded grants. Dr. Boyd publishes extensively in interdisciplinary journals on topics related to drug, alcohol, and tobacco use; for example she has recently written on gender differences among college binge drinkers, ecstasy abusers, and middle and high school students who abuse asthma inhalers and Ritalin. Dr. Boyd was named as the Golden Apple Awardee by the University of Michigan as the most outstanding professor; she was the first woman to receive the award at the University of Michigan.