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Categories: 2010, June
by Robert M.
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
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
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
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
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