by Robert M. Tudisco
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. Medication diversion has also been popularized in movies and television programs. In Juno, the main character offers one of her meds to a classmate who needs to get a report done on time. Characters in Desperate Housewives openly discuss taking their children’s stimulant meds to help them lose weight or get through the day. Campus news sources report students not diagnosed with ADHD taking stimulants for recreational use or to gain an academic advantage. What do the statistics really show, and what are the facts?
I’ve written and often read about the pitfalls many students with ADHD face as they struggle with transitions. This concept is not only important to bear in mind academically but behaviorally, as the students adapt to a medication plan at a particularly vulnerable time in their development. The diversion of ADHD medication to undiagnosed individuals who take it recreationally and without proper supervision is a dangerous problem that can have disastrous medical and legal consequences. Unauthorized use of ADHD medication can fuel the social stigmas we in the disability community have fought so hard against.
Traditionally, the most effective and widely used medications to manage ADHD symptoms are stimulant medications, such as methylphenidate and amphetamine. Pursuant to the Controlled Substances Act, both of these drugs are classified by the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) as Schedule II Controlled Substances. This classification puts stringent restrictions upon how these drugs are prescribed. While these medications have no “intoxicating” effects, they are unfortunately used recreationally for weight loss or to simulate the effects of other stimulants.
In the eyes of the law, the possession of a controlled substance without an authorized prescription is a crime. It is important to recognize and to alert students and their parents that possessing stimulant medications without a prescription is essentially the same as possessing any other controlled substance. In fact, in some states (such as New York) it is illegal—though not a criminal offense—to possess Schedule II controlled substance medication unless it is inside the prescription bottle issued by the pharmacy.
ADHD medication, like any medication, is safe only when prescribed and used under the supervision of a physician or other authorized prescribing professional. Unauthorized use or abuse of ADHD medication, or any other medication, can have serious medical consequences, depending upon how much is taken, how often it is taken, an individual’s chemistry, and what other substances or medications are taken with it.
It is also important to understand that far too many people in our culture stigmatize the diagnosis of ADHD and the medications that can effectively manage its symptoms. The myths about ADHD—as an excuse for poor behavior, bad parenting, and laziness—still hold back many bright students with ADHD from realizing their full potentials.
One of the most debilitating myths is that medication is a bad thing. Medication is a personal choice that should be made between the patient, their parents, and a qualified physician. It is also important to note that medication does not cure ADHD but, when taken under the supervision of a doctor, can effectively manage many of its symptoms. Medication should be considered as a part of a multimodal approach along with other behavioral management interventions and techniques, such as exercise, behavioral modification, and coaching.
Many students who take stimulant medication without a prescription claim that they do so to gain a competitive edge over other students. They claim the stimulant medications help them to complete their work and to raise their test scores.
It is important to understand that students who face challenges based upon the symptoms of their ADHD do not take medications to gain an advantage, but do so in order to have the ability to function in a school setting. While stimulant medication may enhance the performance of individuals with or without ADHD, in many cases, the ones actually diagnosed cannot function effectively without it. Thus, unauthorized diversion of ADHD medication not only has legal and medical consequences, as listed above, but it fuels the very social stigmas that the disability community has worked so hard to overcome.
Much of the concern over the increased use of ADHD medication is clouded by the rising numbers of diagnoses and prescriptions over the last ten to twenty years. As our understanding of the nature and nuances of the disorder improved, diagnosis and treatment of ADHD increased.
For instance, traditionally, ADHD was thought to present only in hyperactive boys. We now know that the disorder spans gender and does not always present with symptoms of hyperactivity. Inattentive-type ADHD carries many of the same challenges and is more frequently missed because of the lack of outward symptoms associated with hyperactivity.
Additionally, it was once thought that people grew out of ADHD, largely because hyperactive symptoms decline after puberty in many cases. It is now widely accepted that other symptoms—inattention, impulsivity, time perception, and disorganization—continue through the lifespan in many cases. According to the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, ADHD is diagnosed in an estimated 8 percent of children ages four through seventeen and in 2.9-4.4 percent of adults.*
The increase in diagnoses and prescriptions for ADHD medication is a separate issue from the unauthorized diversion of stimulant medication which is then taken recreationally by individuals who have not been diagnosed with the disorder and who are using the drug outside of the supervision of a physician. Nonmedical use typically refers to students who consume stolen, borrowed or stimulant medication purchased without a diagnosis, or a prescription from a treating physician.
Each year, the University of Michigan conducts a “Monitoring the Future” survey, which is funded by the National Institute on Drug Abuse. Data from the MTF surveys since 2001 shows that nonmedical use of stimulant medication has been falling between 25-42 percent at each grade level surveyed.**
Katie Couric’s recent 60 Minutes report discussed a study conducted at the University of Kentucky. The study showed that 34 percent of students polled admitted to taking stimulant medications without a prescription; in juniors and seniors, the percentage can be as high as 60 percent and as high as 80 percent among juniors and seniors in fraternities and sororities. Yet the study also showed that only 4 percent of the students using the drugs were doing so with a diagnosis and a prescription.
As alarming as these numbers are, they beg the question: Where are all of these nonprescribed stimulants coming from? According to the University of Kentucky study, the typical student who is prescribed stimulant medication does not take it as prescribed on a regular basis. This leaves a surplus of medication at the end of the month. This “surplus”—which is then either stolen, sold, or given to fellow students—is what makes the drugs readily available on campus.
Students must be made aware of the very serious potential medical consequences of unauthorized use of stimulant medications. They also need to understand that in the eyes of the law, money does not need to change hands in order for a gift or other exchange of a controlled substance to be considered a “sale.” While the criminal penalties for possessing controlled substances can be high, they are much higher for the sale of a controlled substance.
While some data suggest that the phenomenon may be declining, any unauthorized diversion of medication can have legal, medical, and social consequences. It is important that parents discuss ADHD medication with their children and impress upon them the strict requirements for their use imposed by law. Parents must also emphasize the dangers and consequences of sharing medication with friends or using it recreationally. This is especially important when students leave home to attend college. They often do not have instant access to the support and guidance of their parents and are also removed from their prescribing physicians. Extra care should be taken to ensure that these young adults act responsibly to follow their medication plans and safeguard their medication from unauthorized use.
*NIDA InfoFact sheet dated June 2009 citing Centers for Disease Control and Prevention. Mental Health in the United States: Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder–United States, 2003 Morb Mortal Wkly Rep 54(34); 842-847, 2005).
**The 2008 MTF survey, formulated and reported by the University of Michigan’s Institute for Social Research can be accessed at drugabuse.gov.
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