Objective: The purpose of this study is to fill the knowledge gap regarding nonmedical prescription stimulant use. The study has three aims: 1) to explore the temporal trends of prescriptions, nonmedical use, and Emergency Department (ED) visits for specific prescription stimulants; 2) to investigate the source of the misused stimulants and whether different sources correspond to different risk profiles; and 3) to identify subgroups among nonmedical prescription stimulant users by their concurrent problematic substance use in different age groups.
Method: National surveys across 2006 to 2011 were used in all three aims. Aim 1 used National Disease and Therapeutic Index (NDTI), National Survey on Drug Use and Health (NSDUH), and Drug Abuse Warning Network (DAWN) and ordinary linear square regression to assess the temporal trends in frequency of prescription, nonmedical use and ED visits involving Adderall and methylphenidate. Aim 2 used logistic regression models to compare the socio-demographic, mental health and behavioral problems and stimulant use-related problems according to source of nonmedically used stimulants using the NSDUH data. Aim 3 used latent class analysis to examine patterns of past-year problematic substance use in participants reporting past-year nonmedical prescription stimulant use in adult and adolescent participants in the NSDUH.
Results: Analyses for Aim 1 revealed that temporal trends in treatment visits involving stimulants do not correspond to trends in nonmedical use and ED visits. Prescription visits for Adderall did not change over time, while nonmedical use and ED visits grew dramatically among adults. The major source of misused stimulants was a physician for both Adderall and methylphenidates. Aim 2 showed that sources of misused stimulants were associated with onset, recency and severity of stimulant use, with illegal and physician sources both associated with earlier onset, greater odds of recent use and meeting the diagnostic criteria for stimulant use disorder. Aim 3 identified a four-class model in both adults and adolescents including a Low substance class, a Prescription drug class, an Alcohol/Marijuana class, and a Multiple substance class. Individuals in the three classes other than the Low substance class were more likely to report psychological and social outcomes.
Conclusions: The findings highlight the need to target drug diversion as a preventive strategy and a more nuanced preventive and treatment program that takes into account differences in risk profiles and needs of subgroups of nonmedical users of stimulants
