Adolescents who abuse or misuse stimulants that are prescribed for ADHD patients are more likely to be male and to have other substance abuse problems, such as alcohol abuse and/or the abuse of other drugs, such as marijuana and cocaine. Some abusers mix the stimulant with other drugs. Drugs such as methylphenidate can be taken orally, intranasally ("snorting"), or by injection. Abusers seek to attain a state of euphoria from the drug.

Evans and her colleagues suggest several practical interventions for physicians who suspect that ADHD patients are diverting their medication to others. One suggestion is to use a random drug screening for the stimulant. The drug should show up in the urine, and if it does not, the patient may be diverting the drug to others rather than taking it him- or herself. In some cases, asking the school to control the administration of the drug is a solution, rather than allowing an adolescent to take the drug at home.

Physicians (and parents) may also wish to do random pill counts of the number of the pills left in the container from the pharmacy, to determine whether the number of pills that remains in the container is equivalent to the number that should be left. For example, if a drug was to be taken once a day starting on March 1, and the patient was given 30 pills on the first of the month, there should be 15 pills left on March 15 if the drug was taken as directed. If there are significantly fewer drugs in the container (such as only five or six pills or fewer, in this example), this may indicate that the patient either is taking too many pills or may be giving or selling them to others. If there are too many pills, this indicates the patient is noncompliant; this is also important information for parents and physicians.

Some physicians who are concerned about the diversion of stimulants will circumspectly view the arms of the patient's parents to see whether there are needle marks, indicating possible diversion of the stimulants, which can also be injected when used illegally. However, it is more likely that diverted drugs are going to other adolescents.

It is also important for physicians to advise children who take stimulants, as well as their parents, teachers, and others, to avoid talking openly about the child's stimulant therapy because interested parties may often overhear and may then seek to obtain the child's drugs through whatever route they consider most effective. Say Evans, and associates, "If this information ends up in the wrong hands, patients' homes may become targets for break-ins or children may become targets on the playground."

References:

1)         American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 2000.

2)         Evans, Charity, et al. "Use and Abuse of Methylphenidate in Attention-Deficit/Hyperactivity Disorder." Canadian Pharmacists Journal 137, no. 6 (July-August 2004): 30-35.

3)         Kessler, Ronald C., et al. "The Prevalence and Correlates of Adult ADHD in the United States: Results from the National Comorbidity Survey Replication." American Journal of Psychiatry 163, no. 4 (April 2006): 716-723.

4)         McCabe, S. E., C. J. Teter, and C. J. Boyd. "The Use, Misuse and Diversion of Prescription Stimulants among Middle and High School Students." Substance Use and Misuse 39, no. 7 (2004): 1,095-1,116.

5)         National Institute of Mental Health. "The Numbers Count: Mental Disorders in America." Rockville, Md.: National Institutes of Health, 2006.

6)         Poulin, Christiane. "Medical and Nonmedical Stimulant Use among Adolescents: From Sanctioned to Unsanctioned Use." Canadian Medical Association Journal 165, no. 8 (2001): 1,039-1,044.

7)         Wilens, Timothy E., M.D. "Attention-Deficit/Hyperactivity Disorder and the Substance Use Disorders: The Nature of the Relationship, Subtypes at Risk, and Treatment Issues." Psychiatric Clinics of North America 27 (2004): 283-301.

8)         Wilens, Timothy E., et al. "Characteristics of Adolescents and Young Adults with ADHD Who Divert or Misuse Their Prescribed Medications." Journal of the American Academy of Child & Adolescent Psychiatry 45, no. 4 (2006): 408-414.

9)         Wilens, Timothy E., M.D., et al. "Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the Literature." Pediatrics 111, no. 1 (2003): 179-185.

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