The United States has experienced a recent increase in stimulant prescriptions – and with it a rapid rise in prescription stimulant misuse in youth aged 12–17 years old and in young adults of 18–25 years of age, a problem that many fear is fast becoming comparable to the opioid crisis.
Prescription stimulants are generally used to treat conditions such as attention-deficit hyperactivity disorder (ADHD) and narcolepsy, helping increase energy, attention, and alertness in patients. However, these substances come with serious risks, including misuse that can lead to stimulant use disorders. Studies show that over 97% of those who misuse prescription stimulants by age 18 have also used at least one other illicit substance. Two-thirds of high school seniors with a history of stimulant misuse also used other substances at the same time – usually alcohol or marijuana.
Risks for prescription stimulant misuse include: being White, 18–25 years old and achieving higher grade levels. They may have a family member or friend who is a source of the prescription stimulant and may also feel pressure to succeed academically.
Stimulant misuse is associated with serious medical issues. Short term misuse can cause elevated body temperature, seizures, and irregular heart rate. Chronic misuse can result in stimulant use disorder, heart failure and psychosis.
The challenges facing treatment centers
The unique risk factors and medical issues associated with stimulant misuse provide several challenges for treatment centers wanting to intervene in and facilitate treatment. Additionally, prescription stimulant misuse is associated with struggles with other mental health conditions such as anxiety and depression as well as co-occurring substance use disorders.
Prescription stimulant misuse is associated with high relapse rates, and studies show that participation in more treatment sessions may be necessary to prevent relapse. Effective behavioral therapies, such as cognitive-behavioral therapy (CBT) have been shown to be useful in treating stimulant misuse. However, it can be challenging to engage patients in therapy and maintain their participation over time.
There is currently no FDA-approved medication for stimulant use disorders. Some medications can assist with withdrawal symptoms, as stimulant withdrawal can be uncomfortable and challenging.
The scale of the problem
While prescription stimulants are considered safe when used as directed by a healthcare professional, more people are gaining access to them through non-clinical means. More than 60 percent report they obtain them from a friend or relative, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The past few decades have seen a sizable increase in diagnoses of ADHD which, in turn, has led to increased access to prescription stimulants.
A study by Dr. Rabiner at Duke University found that 50 percent of college students diagnosed with ADHD had been approached to sell, trade or give away their medication. Some studies have also shown that young adults are especially prone to misusing prescription stimulants. The National Survey on Drug Use and Health (NSDUH) found that full-time college students (3.9 percent) and college graduates (4.3 percent) had the highest rates of prescription stimulant addiction.
The NSDUH identified that the key reason for stimulant misuse was to help people stay alert or awake, followed by wanting help to concentrate or to study. Other reasons included to experience euphoria, experimentation, and – less frequently – to help with weight loss.
Improving the safety net
The FDA has recently updated its guidelines, which aim to improve the safe use of prescription stimulants for the treatment of ADHD and other conditions while warning against the dangers of misusing and sharing these substances. Educating patients when they ask what are the side effects of stimulants can be an effective disincentive, as many wrongly believe these drugs are entirely safe.
State-run Prescription Drug Monitoring Programs (PDMPs) – electronic databases that track controlled substance prescriptions are an effective method for monitoring prescription histories and preventing the misuse of prescription stimulants. It is crucial to check the Prescription Drug Monitoring Program (PDMP) when prescribing for the first time and every three months thereafter. Collaborating openly with other healthcare providers and pharmacists in the region can also aid in preventing the misuse of prescription stimulants.
Although some studies have shown limited success treating some types of stimulant use disorder with fluoxetine or naltrexone, there is currently no medication approved by the FDA specifically for stimulant misuse. However, the new draft guidance “Stimulant Use Disorders: Developing Drugs for Treatment” from the FDA aims to assist sponsors in the clinical development of drugs for the treatment of stimulant use disorders. In the future, effective medication-assisted treatment may become available.
Both inpatient and outpatient treatment programs could be suitable, depending on the individual. However, due to the relatively high relapse rates, it will be important to continue providing support and treatment as part of an ongoing recovery process.
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