Attention Deficit Hyperactivity Disorder (ADHD), College Students, and Nonmedical Use of Prescription Stimulants via High Risk Routes of Administration

Regulatory agencies and others have highlighted prescription ADHD stimulant medications as emerging drugs of misuse/abuse. College students, an especially high-risk group for stimulant misuse/abuse, were recruited via an online panel to complete a survey regarding nonmedical use (NMU; use for any reason or in any way other than prescribed, including misuse/abuse) of prescription stimulants. 
Among 583 college students age 18-26 years reporting prescription stimulant NMU, 249 (43%) reported an ADHD diagnosis; of which 38% exaggerated/lied about symptoms to get an ADHD prescription and 59% had taken a prescription medication to treat ADHD. Of those with an ADHD diagnosis and history of prescription stimulant therapy (n=146), 64% reported modifying their ADHD medication (45% snorted, 42% chewed then swallowed, 40% dissolved in liquid then swallowed, 28% smoked, and 27% injected). 73% reported taking more medication than prescribed namely “to enhance performance at work/school” (61%), “for energy” (51%), “to treat ADHD/ regular dose wasn’t working” (44%), “to improve mood/elevate spirit” (35%), and “to get high” (22%). Motivations for NMU via oral routes were primarily to achieve a better effect on ADHD symptoms while motivations for non-oral routes were “to achieve a faster effect on ADHD symptoms” and “faster/more intense high”.  
A majority of college students with a history of ADHD and stimulant medication therapy reported modifying their prescription and engaging in NMU via non-oral routes. Targeted interventions, including development of medications that are difficult to manipulate into a form that permits non-oral use, may be useful to consider in college students with ADHD.