Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.
OBJECTIVE
Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals.


METHODS
We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search.


RESULTS
We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment.


CONCLUSIONS
The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.
Wilens
Timothy E
TE
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System. Electronic address: twilens@partners.org.
Adler
Lenard A
LA
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Adams
Jill
J
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Sgambati
Stephanie
S
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Rotrosen
John
J
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Sawtelle
Robert
R
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Utzinger
Linsey
L
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Fusillo
Steven
S
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
D000293:Adolescent; D000328:Adult; D000662:Amphetamines; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D000697:Central Nervous System Stimulants; D002648:Child; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008774:Methylphenidate; D012646:Self Administration / Q000523:psychology / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States
D000662:Amphetamines; D000697:Central Nervous System Stimulants; D013287:Illicit Drugs; D008774:Methylphenidate