Misuse of stimulant medications by adults has declined “significantly” in the last two years, according to a new study. The largest drop is among young adults, reflecting a similar drop in misuse from when they would have been in high school.
The study reports that misuse of medication among adults under age thirty dropped to 3.7 percent from a previous 7.8 percent. The majority of adult medication misuse is among those younger than thirty. The most common reasons were to increase concentration or to stay awake and alert, followed by believing it would improve their ability to study or to lose weight. Some people misused the medications to either counter the effects of another medication or to see how the medication might affect them.
The researchers did not identify any studies noting long-term physical health effects stemming from the misuse. They did warn that additional studies do show that deliberate medication misuse—which is using medication in ways not prescribed by their medical professionals or not recommended as part of a treatment plan—increases the possibility of developing substance abuse later in life.
These findings fall in line with a previous study by the University of Michigan, published in 2023, on teenagers that demonstrated only a smaller percentage—less than two percent—of American high schools reported having a serious problem with the diversion or misuse of stimulant medications. The national cohort of teenagers for the University of Michigan study would now be among the cohort of young adults recently reported on by the Agency for Healthcare Research and Quality, sponsors of the new study.
Previous study showed a wide variation in medication misuse
The University of Michigan-led 2023 study on stimulant medication diversion—the sharing or selling of any prescription medication to someone other than the person for whom it was prescribed—collected information on student use and misuse of prescribed medication in 3,284 middle and high schools. It concluded that some schools had no instances of diversion or misuse of prescribed medication, and some schools had up to twenty-five percent of students misusing medication prescribed for ADHD.
The researchers also concluded that in high schools where more students than average were diagnosed with ADHD and prescribed medication, there was a greater chance of medication diversion or misuse. They defined this nonmedical use of medications as having shared or taken medication not prescribed for a student at least once in the previous year. The study authors also noted that schools in more affluent locations, and students whose parents had attained a higher level of education, were more likely to misuse or divert their medications.
“I can tell you that a student’s experience will be different at a school with no peers who misuse stimulants versus a school where 1 in 4 peers misuse stimulants,” says Sean Esteban McCabe, PhD, director of the University of Michigan Center for the Study of Drugs, Alcohol, Smoking and Health.
Max Wiznitzer, MD, co-chair of CHADD’s professional advisory board, looked deeper into how many schools in the study actually had students reporting up to twenty-five percent of medication misuse or diversion.
“It was only fifty-eight schools who reported a higher nonmedical use of prescription stimulants rate,” he says, referring to the schools included in the study. “It’s only a small number of schools who have a greater than twenty percent nonmedical use of prescription stimulants rate. That’s only a very small number of schools in a larger population.”
Students diverting their medications, and why
Margaret Sibley, PhD, is a member of CHADD’s professional advisory board and associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. She researches ADHD in young adults attending college, along with treatment and interventions that are effective for them. After reviewing the University of Michigan 2023 study, she says the results lined up with her expectations on medication misuse and diversion: Some regions and schools are contending with a higher rate of diverted medications and other regions and schools have a much lower rate of diversion, but there is not one given percentage of misuse that applies to every school.
“I think it’s important to point out places where it’s problematic, so it can be addressed,” says Dr. Sibley. “But it’s not a widespread problem. You need to assess your student body and not assume a national statistic applies to your school.”
The students who are likely to misuse the medications in high school resemble the college students in her research, she says. They tend to be involved in campus clubs and fraternities or sororities, already misuse or consume alcohol while underage, and have a low barrier to obtaining stimulant medications, either by faking symptoms or having classmates willing to share or sell their medications.
“There’s a correlation between people who use drugs and alcohol recreationally and people who misuse stimulant medications,” Dr. Sibley says. “Take that to high school and it’s the kids who are on that same track. There are going to be some locations where the factors are in place to create this, but those will be pockets. That doesn’t extrapolate to the rest of the United States. This paper even says that.”
Broader research has shown that students who are diverting stimulant medications or misusing them are generally not students with an ADHD diagnosis, she adds. The majority of students who have ADHD will not share or sell their medications, knowing the importance of maintaining their treatment plan and the educational and legal consequences of giving or selling prescribed medications.
“This [the 2023 study] is the biggest study of high school student use that I’ve seen,” says Dr. Sibley. “It confirms that in most schools, diversion is actually pretty low. It repeats the findings on college students, with a younger sample, on the factors that put someone at risk for this behavior.”
Dr. Wiznitzer points out that the 2023 University of Michigan study did not look into why students were seeking stimulant medications from their peers, or why some schools reported no misuse or diversion at all for ADHD medications.
“All this study tells us is that in high school there’s a concern for diversion,” Dr. Wiznitzer says. “If there’s a concern for diversion, we need to ask why the diversion is occurring and deal with the underlying reason.”
He also returned to the point in the study that broke down how many schools reported diversion and asked what are the characteristics of those schools. He noted that some schools reported not having any students who have ADHD—a statistical impossibility unless they are private schools that can select or reject potential students who demonstrate ADHD symptoms. On the other end of the possibilities, schools with a higher than statistically likely population of students with ADHD, Dr. Wiznitzer suggested, could be ones that have supportive programs for students with ADHD or learning disabilities, or they are schools for students who have had conduct problems.
Good data, but poor context
Dr. Wiznitzer, who frequently comments on ADHD research and concerns in the popular media on CHADD’s behalf, said the results of this study have been taken out of context in recent reporting. He did not like the way the news media reported on the University of Michigan study in 2023.
“It’s a very interesting paper that didn’t get granular enough to answer all the questions we need answered about these rates of diversion,” he says. “They just didn’t ask questions about the schools and the student population.”
Dr. Sibley also expressed disappointment in both the 2023 study conclusion and the reporting on the study.
“I believe the data,” she says, “but it has to be taken in context, and it was taken out of context. We also have to be aware that these data were collected during a really wide timespan. There could be changing landscapes over the years that influences this. That’s a question to raise: how has it changed through the years?”
The context of regional differences, individual schools, pressures placed on students, family resources, and local cultures were not included when determining the study’s conclusion, both Dr. Sibley and Dr. Wiznitzer noted. All of those factors would influence the level of diversion at an individual school, creating a higher or lower rate of diversion and misuse.
What does this mean for your high school student or new adult?
Most schools do not have a problem with diverted ADHD medications, according to the study released in 2023. When students let their peers know they have ADHD, both in high school and in college, there is the possibility that a friend or classmate will ask them for their medication.
“It’s an important thing to talk with your kids in high school about diversion,” advises Dr. Sibley. “They have to be ready for it and know that it’s not okay to share their medication.”
This includes talking with your teenager about the risks of taking medications that are not prescribed for them, including health issues and legal consequences. Practice role-playing with them about how to turn down a request from a friend to share or sell medications, and how to say no to an offer to take someone else’s medication for an academic booster or recreation. Begin these conversations before middle school and continue them through high school and into college or early career.
“Prescription stimulant therapy for ADHD does help millions of people, including in my own family, and students, friends and colleagues,” says Dr. McCabe, the study’s lead author. “It’s critical to balance the need for access to these medications while reducing the risk for misuse.”
More information on preventing the misuse of stimulant medications:
- Preventing Medication Abuse and Diversion
- What ADHD Medication Can and Can’t Do
- Don’t Have ADHD? Meds Won’t Improve Grades
- Medication Could Help Lower the Risk of Substance Abuse
- Steps to Take Before Sending Your Student to College
- Webinar: ADHD Medication and College Students
- The diversion of ADHD medication: what you need to know
- Benefits and Risks of Medication Treatment
- Anger, Shame, and Other Drugs