UPC Weekly Blog 8/31/12:Abuse of ADHD Medications

Abuse of ADHD Medications

As school starts, many students will return to school on ADHD
medications. Attention Deficit Hyperactivity Disorder is not uncommon;
roughly 8% of children and teens aged 4 to 17 years have the
condition. Consequences of untreated symptoms can be substantial.  The
goal of all of ADHD therapies is to help patients focus more, and
therefore improve their symptoms. However, some students abuse these
drugs to concentrate, stay awake longer, finish their work faster, get
better grades, and to lose weight.

Drugs for ADHD fall into several categories. Many ADHD drugs act by
stimulating such chemical neurotransmitters in the brain as dopamine
and epinephrine. Some of the most familiar ADHD medicines, called
methylphenidates, fall into this category including Concerta, Ritalin,
Metadate, Daytrana and dexmethylphenidate (Focalin).

In 2008, Monitoring the Future (MTF) researchers determined that 2.9%
of 10th-graders and 3.4% of 12th-graders abused methylphenidate.1

Abuse is more commonly found in another stimulatory class of drugs:
amphetamine-based ADHD medications. These include dextroamphetamine
(Adderall, Dextrostat, Dexedrine) and lisdexamfetamine (Vyvanse).
Amphetamine abuse rates are at least double those of methylphenidates.
According to the MTF, 6.4% of 10th-graders and 6.8% of 12th-graders
used prescription amphetamines nonmedically in 2008. Amphetamines
ranked third among 12th-graders for past-year illicit drug use.

Although it may seem illogical, stimulatory drugs like Ritalin and
Adderall (or “vitamin R” and “Addy,”) deliver a calming and focusing
effect on people with ADHD. The opposite is true for those who take
them without a physiologic need.
Amphetamine abuse continues to escalate well into the college years as
a means students use to perform better in school (Adderall is
sometimes referred to as “college crack” or “the Adderall advantage”
for this reason). As many as 20 percent of college students have used
Ritalin or Adderall to study, write papers and take exams, according
to recent surveys.

 In an April 20 blog post on Stanford University’s “Wellsphere”
website, a self-described recent college graduate identified as Amanda
T. provided a personal account of the perceived benefits of ADHD
medications among often overwhelmed students.

“Medications such as Adderall make an all-nighter seem easy. In fact,
in a world where the work load exceeds the amount of hours in a day,
such medications are often viewed as a miracle drug to many college
students,” she wrote. “You can cram for two exams all day and then are
still able to stay up all night and write that 50 page research paper
that you put off until the very last minute.”

Teens and young adults who take these drugs for their stimulatory
properties are at risk for serious side effects, including dangerously
high BP, irregular heartbeat, difficulty breathing, seizures and
tremors, and mood disorders. At consistently high levels or with
repeated use, stimulant-based ADHD drugs can cause stroke and such
cognition changes as confusion, hallucinations, delusions, and
paranoia. These drugs can be addictive, which means that sudden
abstinence can also lead to the onset of withdrawal symptoms. The
NSDUH also reports that teens abusing stimulants are twice as likely
to engage in delinquent behavior than teens of the same age who do not
use these drugs nonmedically.2

Some drugs used to treat ADHD are not stimulant-based. Examples
include atomoxetine (Strattera) and certain antidepressants, such as
bupropion (Wellbutrin). There is less potential for abuse with these
drugs, and they can be good options for treating children and teens
with known substance-abuse issues.

Some of the major symptoms of stimulant substance abuse include:
•       Behavioral changes
•       Problems in school, failure to complete homework
•       Change in activities or friends
•       Heightened attention, long periods of sleeplessness or not eating
•       Unusual behaviors, including secrecy and isolation, unexplained spending
•       Legal problems

Physical consequences include:
•       Memory lapses, fatigue, and depression
•       Heart problems and seizures
•       Psychological difficulties including confusion and delusions
•       Unusual behaviors, including secrecy and isolation
•       Aggressiveness, irritability, mood swings
•       Hyperactivity, euphoria
•       Weight loss
•       Dilated pupils, dry mouth and nose

Family members may notice money and other personal or household items
missing. Since teens can often buy stimulants from younger children
with legitimate prescriptions, parents should be instructed to keep a
mental note of friends and relatives with access to these medications.
It is also important to speak directly to youth about the need to make
sure all medications for personal use are taken only as prescribed.
Parents should be the sole party responsible for dispensing ADHD
medication outside of the school.

References
1. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring
the future national survey results on drug use, 1975-2006, volume 1,
secondary school students (NIH Publication No. 08–6418A). Bethesda,
Md.: National Institute on Drug Abuse, 2009: 450-453.
2. Substance Abuse and Mental Health Services Administration, Office
of Applied Studies. (February 28, 2008). The NSDUH Report—Nonmedical
Stimulant Use, Other Drug Use, Delinquent Behaviors, and Depression
among Adolescents. Rockville, Md.