Rise, and pronounced regional variation, in methylphenidate, amphetamine, and lisdexamfetamine distribution in the United States

Background The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine are sympathomimetic drugs with therapeutic use. They are designated in the United States as Schedule II substances, defined by the 1970 Controlled Substances Act as having a “high potential for abuse”. Changing criteria for the diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and the approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. This report compared the pharmacoepidemiology of these stimulants in the United States from 2010–2017. Methods Distribution of amphetamine, methylphenidate, lisdexamfetamine were examined via weights extracted from the Drug Enforcement Administration’s (DEA) Automated Reports and Consolidated Ordering System (ARCOS). Median stimulant Daily Dosage per patient was determined for a regional analysis. The percent of cost and prescriptions attributable to each stimulant and atomoxetine in Medicaid from the “Drug Utilization 2018 - National Total” from the Centers for Medicare and Medicaid was determined. Results There was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) from 2010–2017. The change in methylphenidate (−3.0%) was modest. Persons/day stimulant usage was lower in the West than in other US regions from 2014-2017. There was a negative correlation (r(48) = −0.43 to −0.65, p < .05) between the percent Hispanic population per state and the Daily Dosage/population per stimulant. Methylphenidate formulations accounted for over half (51.7%) of the $3.8 billion reimbursed by Medicaid and the plurality (45.4%) of the 22.0 million prescriptions. Amphetamine was responsible for less than one-fifth (18.4%) of cost but one-third of prescriptions (33.6%). Lisdexamfetamine’s cost (26.0%) exceeded prescriptions (16.3%). Conclusion The rising amphetamine and lisdexamfetamine distribution may correspond with a rise in adult ADHD diagnoses. Regional analysis indicates that stimulant distribution in the West may be distinct from that in other regions. The lower stimulant distribution in areas with greater Hispanic populations may warrant further study.

Feigning Symptoms to Obtain Prescription Stimulants: A Vignette-Based Study on Its Conditions

This vignette-based study examined the willingness to feign symptoms to obtain a prescription following an analysis on who might use prescription stimulants to enhance performance ( N = 3,468). It experimentally manipulated three factors: the social disapproval of prescription stimulant use for enhancement purposes, the physicians’ diagnostic efforts, and the medical condition (attention-deficit/hyperactivity disorder and narcolepsy); respondent characteristics of self-control, personal morality, and self-efficacy were also measured. Our results showed that social disapproval of prescription drug use, a personal morality that disapproves of drug use, high self-control, and high self-efficacy were negatively associated with the willingness to use. Willingness increased especially in situations of social approval when there was a stronger personal approval of drug use, or surprisingly when physicians’ diagnostic efforts were higher. The feigning willingness was lower in situations of social disapproval and when personal morality disapproved of feigning. Thus, personal and situational characteristics are relevant to understand both behaviors.

Prescription Stimulant-Induced Neurotoxicity: Mechanisms, outcomes, and relevance to ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a relatively prevalent neuropsychiatric and neurodevelopmental condition characterized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ) as difficulty sustaining attention and maintaining tasks at hand, heightened distractibility, and other deficits in executive functioning. Prescription stimulants—amphetamine (AMP) and methylphenidate (MPH)—are the first-line treatment(s) for ADHD in both pediatric and adult populations and exist in many formulations. Troublingly, the non-medical use (NMU) of amphetamine and methylphenidate is more prevalent in the American population, especially on college and university campuses, than the condition of interest. The neurotoxicological profile and NMU epidemiology of prescription stimulants is of direct relevance to primary care physicians and psychiatrists as they are the providers most frequently tasked with the treatment of ADHD and the surveillance of substance misuse behaviors in the young adult population. As comprehensive literature reviews of the mechanisms and potential adverse sequelae of prescription stimulant-induced neurotoxicity intended for medical clinicians have been quite sparse in the last decade—especially given the gravity of the issue—this article includes a brief primer on ADHD etiology and pathophysiology; considers the current state of NMU epidemiology; reviews the mechanisms of action of AMP and MPH; and, finally, summarizes known molecular and clinical manifestations of AMP and MPH neurotoxicity.

A Preliminary Study Examining Self-Reported Invincibility, Alcohol Problems, and the Nonmedical Use of Prescription Stimulants in College Students

The nonmedical use of prescription stimulants (NMUPS) is becoming more common among college students. Identifying the variables associated with NMUPS is important for educational efforts and to promote wellness in vulnerable students. The present study examined the relationships between self-reported invincibility, alcohol problems, and NMUPS in 175 college students. Path analysis tested the hypotheses that males would report higher invincibility that would be related to alcohol use and alcohol problems. Using structural equation modeling, significant relationships were found between invincibility and alcohol-related problems. Alcohol problems may be related to NMUPS. A total effect of invincibility, mediated by alcohol use, may be a path whereby invincibility positively influences NMUPS. Students reporting high levels of invincibility may be at risk for the NMUPS and might benefit from efforts regarding the potential harmful consequences of taking these substances without a prescription.

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults.Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews.Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways.Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.

Nonprescription Stimulant Use at a Public University: Students’ Motives, Experiences, and Guilt

We examined the use of nonmedical prescription stimulants (NPSs) among students ( N = 1,208) at a large public university in southeastern United States. After students who had been prescribed stimulants had been removed from the sample, 202 of the remaining 1,067 students (i.e., 18.9%) reported having engaged in NPS use in their lifetime. NPS use was strongly associated with membership in Greek societies and with binge drinking behavior. NPS users overwhelmingly reported engagement in NPS use for academic rather than for recreational purposes, and as anticipated, NPS users with academic motives reported stronger academic benefits than NPS users with social/recreational motives. Reports of guilt were low, and frequent users reported less guilt than infrequent users. Implications for interventions are discussed.

The risks of sleep fragmentation on cognitive skills: a systematic review

Background: The sleep fragmentation may conduct to breakdown in neutral networks, which tends to affect cognitive abilities or cognitive skills (CS) and bring notable deficits to the subject’s typical neuronal functioning. Objectives: Analyze the academic discussion of this theme and how this sleep deprivation can incapacitate the CS elemental to properly functioning circadian rhythm, as well as its multifactorial causes may be related to the subject’s complaint. Methods: To this article, it has been accomplished a systematic review on PubMed and Virtual Health Library database, using the descriptors “Sleep” and “ Cognitive abilities”, using articles from the last two years. Nine articles were used to guide this study. Results: It was possible to analyze that there are multifactorial complements related to sleep disturbance - neurodegenerative disorders, lack of sleep, prescription stimulants. The studies show that it is essential to elaborate a therapeutic plan, to define which CS is affected and what is going to be done about it, since the existing especifities may be present in neural correlates or in different CS, which makes indispensable the therapeutic plan. Conclusion: After all, it is indispensable the continuity of studies that research affected neural correlates in front of sleep deprivation, in order to understand sleep dysregulation for cognitive skills and provide an effective therapy for society, which permeates, consequently, a better quality of life.

Professionals’ attitudes towards the use of cognitive enhancers in academic settings

Introduction and aims The non-medical use of prescription stimulants such as methylphenidate, dexamphetamine and modafinil is increasing in popularity within tertiary academic settings. There is a paucity of information on awareness, attitudes, and acceptability by professionals of use in this context. This study aimed to investigate professionals’ knowledge of and attitudes towards the use of cognitive enhancers (CEs) in academic settings, and their willingness to use a hypothetical CE. Design and methods A mail survey was sent to doctors, pharmacists, nurses, accountants and lawyers in New Zealand. These disciplines were chosen as they require professional registration to practice. The questionnaire comprised four sections: (1) demographics, (2) knowledge of CEs, (3) attitudes towards the use of CEs, and (4) willingness to use hypothetical CEs. Results The response rate was 34.5% (414/1200). Overall, participants strongly disagreed that it was fair to allow university students to use CEs for cognitive enhancement (Mdn = 1, IQR: 1,3), or that it is ethical for students without a prescription to use cognitive enhancers for any reason (Mdn = 1, IQR: 1,2). Professions differed in their attitudes towards whether it is ethical for students without a prescription to use CEs for any reason (p = 0.001, H 31.527). Discussion and conclusion Divergent views and lack of clear consensus within professions and between professionals on the use of CEs have the potential to influence both professionals and students as future professionals. These divergent views may stem from differences in the core values of self-identity as well as extrinsic factors of acceptability within the profession in balancing the elements of opportunity, fairness and authenticity in cognitive enhancement. Further research is required to inform the development of policy and guidelines that are congruent with all professions.