Adolescent Non-Medical Use of Prescription Stimulants: Prevalence, Route and Drug Acquisition

Prescription stimulants often prescribed for attention deficit hyperactivity disorder have been highlighted by regulatory agencies and others as emerging drugs of misuse/abuse. Non-medical use (NMU; use in any way other than prescribed, including misuse/abuse) of prescription stimulants was characterized using the Comprehensive Health Assessment for Teens (CHATTM), a clinical tool which gathers self-reported substance use history from adolescents entering substance abuse treatment. Of the 20,305 assessments collected from 01 January 2010-30 September 2017 by centers in 36 states, 753 (3.7%) reported past 30-day NMU of a prescription stimulant. Of the NMU subset, 11% were 10-14 years of age and 88% age 15-18 years. Most were male (61%), Caucasian (83%) and currently enrolled in school (77%). About 49% reported current use of medication for emotional, behavioral, or learning problems. Overall reporting rate for NMU of a prescription stimulant was 3.71 cases per 100 assessments (95% CI 3.45, 3.97); drug utilization adjusted rate was 0.33 cases per 100,000 prescriptions dispensed (95% CI 0.31, 0.35). Routes of NMU included oral (54%), snorting (30%) and injecting (4%). A substantial proportion of NMU patients also reported injection of other drugs (80%), including prescription opioids and heroin. Means of prescription stimulant acquisition included family/friend (36%), dealer (19%), and own prescription (11%). Among adolescents entering substance abuse treatment, NMU of prescription stimulants is of concern, particularly considering the substantial amount of use via non-oral routes, diversion and polysubstance use. Awareness of these risks is important for prescribers of these important medications as well as addiction specialists.