title: From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: connecting the dots.
abstract: OBJECTIVE
  To describe the connections among the likelihood of attention deficit/hyperactivity disorder (ADHD), medical and non-medical methylphenidate and amphetamine use and the diversion of prescribed methylphenidate in the general adolescent population.
  
  
  METHODS
  Cross-sectional self-reported anonymous data from the 2002 Student Drug Use Survey in the Atlantic Provinces.
  
  
  METHODS
  The Atlantic provinces of Canada.
  
  
  METHODS
  A total of 12,990 students participated.
  
  
  METHODS
  The outcomes were a positive ADHD screening test, medical and non-medical use of methylphenidate, medical and non-medical use of amphetamine and the giving and selling of methylphenidate medication by students with a prescription. The Ontario Child Health Study Hyperactivity Scale was used to screen for ADHD.
  
  
  RESULTS
  The prevalence of a positive ADHD screening test was 6% with no significant gender difference. The prevalence of medical and non-medical methylphenidate use and medical and non-medical amphetamine use was 2.0%, 6.6%, 1.2% and 8.7%, respectively. A positive ADHD screening test was independently predictive of these four patterns of use. About 26% of students with prescribed methylphenidate gave or sold some of their medication. Students in a class where at least one student had given or sold some of their prescribed pills had a 1.52-fold increased risk of non-medical methylphenidate use than their counterparts in classes where no giving or selling had taken place.
  
  
  CONCLUSIONS
  Connections were demonstrated at the population level between ADHD, medical methylphenidate use, the diversion of prescribed methylphenidate and the non-medical use of methylphenidate. The appropriate assessment and management of ADHD are essential to minimize both the risk of diversion and of substance use associated with unrecognized or untreated ADHD.
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. christiane.poulin@dal.ca
authors.forename: Christiane
authors.initials: C
authors.lastname: Poulin
mesh_terms: D000293:Adolescent; D000662:Amphetamines / Q000600:supply & distribution* / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000600:supply & distribution*; D002648:Child; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000600:supply & distribution* / Q000627:therapeutic use; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D008774:Methylphenidate