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Medication Abuse and Diversion

Parents of children and teenagers who have been prescribed medication for the treatment of ADHD are rightly concerned about the appropriate use and possible abuse of these medications. This concern is shared by educators and others who are involved in children's daily lives. At the heart of this concern is ensuring that children who have been correctly diagnosed with ADHD and—in the judgment of their physicians and parents might benefit from ADHD medication—receive the full benefit of these medications to help manage the symptoms of ADHD and to help them lead more full and successful lives.

When properly prescribed and administered, medications approved for the treatment of ADHD have been shown to be highly safe and effective. CHADD recognizes, however, that the medications used to treat ADHD can, like any medication, be abused in a variety of ways. The National Institute on Drug Abuse defines prescription drug abuse as
   taking a prescription medication that is not prescribed for you;
   taking a prescription medication for reasons or in dosages other than prescribed.

Adults who take prescription medications are responsible for taking them as prescribed. Children and adolescents, on the other hand, need the guidance of parents and other adults to help them understand the benefits of taking medication, along with the serious consequences of failing to take their medication properly.

Most ADHD medications are stimulants and categorized by the Drug Enforcement Administration as Schedule II Medications. This means that any improper use of them—including providing them to someone without a prescription or taking them without a prescription—is a federal crime.

What is medication diversion?

One of the potential ways in which prescribed medications may be abused is known as diversion. This refers to the situation in which a medication prescribed for one person ends up in the hands of another. This diversion from one person to another may come about through various circumstances. This is a very serious issue.

For example, a child may be showing off at school and may share his or her medication with others. A child may also be coerced into giving away or even selling his or her medication. In a report prepared for the Judiciary Committee of the US House of Representatives, the Government Accounting Office stated that 8 percent of high school and middle school principals reported at least one instance of diversion or abuse of a medication used to treat ADHD. Most of these principals reported knowing of only a single incident.

College-age students face unique challenges concerning potential diversion. Some students who do not have ADHD may seek out stimulant medications with the desire to enhance their academic performance or experiment with any possible physical reaction to taking the medications. This places an even greater burden on those students for whom the medication is prescribed to be diligent in ensuring that it is used properly.

Adapted from Medication Abuse and Diversion,
prepared by the National Resource Center on ADHD: A Program of CHADD
Created 2010 / Updated 2012

What can parents do to prevent diversion?

CHADD provided the following guidance to parents and young adults in Attention magazine in The Diversion of ADHD Medication: What You Need to Know. CHADD's National Resource Center on ADHD also provides a related FAQ titled, Is it illegal to carry ADHD medication?
 

	Get the facts and avoid the myths associated with ADHD medication from your doctor.
	Educate your child about his or her medication, the laws that govern its use, and how it can interact with other substances.
	Speak with your child about respecting the purpose of the medication and using it only for its prescribed and intended purpose.
	Stress the importance of reporting any side effects to you and your treating physician.
	Consult with your child’s doctor and develop a solid medication plan that will work at home and school. Revisit that plan if and when your child goes away to college.
	Make sure your child understands that he or she is taking what is considered a controlled substance that is illegal to all others.
	Make sure that the school is aware of the medication that your child is taking, even if it is not dispensed by school medical personnel. This is especially important if your child is away at college.
	Make sure your child understands the need to keep medication safeguarded inside its prescription container at all times.
	Plan ahead, along with your child, for prescription renewals. Schedule II medications cannot be refilled verbally, or without a new prescription.
	Provide your prescribing physician’s contact information to the school along with the prescription information itself in the event that any emergencies arise.

	Know that your ADHD meds are a controlled substance. Possession of these medications without a prescription is illegal.
	Safeguard your medication from theft on campus. It is an important tool to management of your ADHD symptoms and it should be there when you need it.
	A gift is a sale. In the eyes of the law, giving a controlled substance to someone who does not have the legal or medical authority to possess it is the same as selling it.
	Don’t share your medication with others. Giving controlled substances to your friends is not only illegal, but can cause them harm if they are not being supervised by a doctor.
	Follow your medication plan. Changing your plan without consulting your doctor can have medical consequences and can create a surplus of pills that can lead to trouble. If you don’t feel that you need to take your meds on the schedule prescribed, tell your doctor and modify the plan with his or her guidance.
	Have local resources. If you are away at school, have your prescribing doctor coordinate with a doctor located near your school to address any issues that may come up or emergencies.

From "The Diversion of ADHD Medications: What You Need to Know," by Robert M. Tudisco, in the June 2010 issue of Attention magazine. Copyright © 2010 by Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). All rights reserved. Reproduction in whole or in part without written permission from CHADD is prohibited.

Articles on Medication Abuse and Diversion in CHADD Publications

The Diversion of ADHD Medication: What You Need to Know - Recent media reports raised an alert on the availability of stimulant medications  used to treat students with ADHD and the alarming percentage of students with no diagnosis or prescription who are using ADHD medications. Robert Tudisco, a practicing attorney and director of the Edge Foundation, outlines the problem and gives practical advice on this serious issue to parents and young adults.

Substance Abuse, ADHD, and Medications: The Real Issues - CHADD Leadership Blog by Ruth Hughes, PhD, CEO of CHADD.

Attention Articles on Substance Abuse and ADHD

When ADHD and Substance Abuse Collide  - Both substance abuse and ADHD are related by their relationship to the neurotransmitter dopamine. Not surprisingly, studies of adolescents and adults with an addiction indicate an over-representation of ADHD.

ADHD Medication and Drug Abuse, an Ask the Expert chat with Nora Volkow, MD, director of the National Institute on Drug Abuse.

Changing Minds About the Brain - If you believe that addiction is a character flaw, neuroscientist Nora Volkow would like to change your mind.

Drug Abuse in Youth with ADHD  - Join Brooke Molina, PhD, in CHADD's Ask the Expert chat to learn about substance abuse and ADHD.

The Effects of ADHD Medication on Future Substance Abuse  - One area that has received considerable attention in both the mainstream press and the scientific literature is the potential risk of medication in general, and stimulants in particular, on the development of substance abuse.

ADHD, Substance Abuse, and Addiction: When the Solution Becomes a Problem - Research clearly shows that people with ADHD are more likely to run into trouble with drinking, drugs, or other addictive behaviors, especially when their ADHD is untreated.

Insights from the Addiction Battleground  - Ten tips for dealing effectively with substance abuse.

Resources on Other Websites

Prescription Drug Abuse - National Institute on Drug Abuse (NIDA)

Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings

Attention Deficit Hyperactivity Disorder: State of the Science - Best Practices
Peter Jensen, MD, and James M. Cooper, MD, editors. Chapter 20, "Diversion, Trafficking, and Abuse of Methylphenidate."

Abuse, Diversion and Consequences of Methylphenidate
Bibliography from the National Library of Medicine

Talking to Children about Medication
Ideas and suggestions from David Rabiner, PhD.

Attention Disorder Drugs: Few Incidents of Diversion or Abuse Identified by Schools
Report of the General Accounting Office (PDF). September 2001.