Study finds that adults are using stimulants more for nonmedical purposes and visiting emergency rooms.

New research from the Johns Hopkins Bloomberg School of Public Health suggests that while the number of prescriptions of the stimulant Adderall among young adults has remained the same, the misuse of the drug and the emergency room visits associated with it have increased dramatically in this age group.

Aesthetic evidence suggested that Adderall abuse was most prevalent among adolescents and older children. However, a new study published in The Journal of Clinical Psychiatry found otherwise. The study looked at trends between 2006 and 2011 and found that most Adderall misuse occurs among 18-to-25-year-olds, who get the drug from friends and family without a doctor’s prescription.

Ramin Mojtabai is a professor at the Bloomberg School of Mental Health and a co-author of the study. He says that young adults are experiencing a growing problem. These drugs are often used in college to help students study and stay awake all night. Many people who take these drugs think they are smarter and better at studying. We must inform this group of the potential dangers associated with these medications.

Lian-Yu Chen MD, who graduated with a PhD from Bloomberg School in 2014, says: “The number of prescriptions for Adderall have decreased, but we’re seeing more medical issues from its use.” This indicates that diversion is the primary cause of emergency room visits and drug misuse. People are taking medications that were prescribed for someone else. “Physicians need to be more aware of the situation and take action to stop it.”

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. Adderall can also increase the risk of mental health issues, such as depression, bipolar disorders, and strange behaviors, including hostility or aggression. The long-term effects are not well studied. 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.

Researchers examined three different sets of data for their study: the National Survey on Drug Use and Health (a population-based survey on substance use); the Drug Abuse Warning Network (a survey on emergency department visits); and the National Disease and Therapeutic Index (a survey on office-based practices, including prescribing).

The researchers found that, in adults over the six years of the study, the number of treatment visits with Adderall remained unchanged. However, nonmedical Adderall use (i.e., taking the drug without a prescription) increased by 67 percent, and emergency room visits rose by 156 percent. In adolescents, over the same period, Adderall treatment visits decreased, nonmedical usage was stable, and emergency room visits dropped by 54 percent. The trends for methylphenidate, sold under Ritalin, among others, and another prescription stimulant prescribed for attention-deficit/hyperactivity disorder, were unchanged over the period.

Family and friends primarily use Adderall. Two-thirds obtained it on prescription.

Researchers found that 60 percent of Adderall use by 18-to-25-year-olds was nonmedical.

Mojtabai believes that drugs such as Adderall, from the public health perspective, should be monitored similarly to prescription painkillers. He believes that prescriptions should go into a database, which a doctor can check before he writes a prescription. This will ensure the patient receives only one medication from different doctors.

He says it would also be beneficial to launch informational campaigns for teenagers explaining the negative effects of the drug. He says that many college students believe stimulants such as Adderall to be harmless study aids. “But there are serious health risks, and they should be more aware.”

The article “Prescriptions and Nonmedical Use of Prescription Stimulants and Emergency Department Visits Associated with Prescription Stimulants” was written by Lian Yu Chen, MD and Ph.D., Rosa M. Crum, MD, and MPH, Eric C. Strain MD and G. Caleb Alexander MD and MS, Christopher Kaufmann MHS, and Ramin Mojtabai MD, MPH, and Ph.D.

This study was funded by the National Institute on Drug Abuse of the National Institutes of Health (K24DA023186), the Agency for Healthcare Research and Quality(RO1HS01899600 and the National Research Service Award F31AG044052.

Alexander is Chair of the FDA Peripheral and Central Nervous Systems Advisory Committee. He is also a consultant for IMS Health and a member of its scientific advisory board. Johns Hopkins University has reviewed and approved this arrangement by its conflict of interest policy. Mojtabai received research grants and consulting fees from Bristol-Myers Squibb and Lundbeck.

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