Nonmedical use of prescription stimulants among college students: Associations with attention-deficit-hyperactivity disorder and polydrug use

Study Objective. To define, among a sample of college students, the nature and extent of nonmedical use of prescription stimulants (NPS), including both overuse and use of someone else's drug, for attention-deficit-hyperactivity disorder (ADHD); to characterize NPS among individuals not medically using a prescription stimulant for ADHD; and to determine whether NPS and overuse of a medically prescribed stimulant for ADHD were independently associated with an increased risk of other illicit drug use and dependence on alcohol and marijuana. Design. Cross-sectional analysis of personal interview data. Setting. Large public university in the mid-Atlantic region. Participants. A cohort of 1253 first-year college students aged 17-20 years. Measurements and Main Results. All students completed a 2-hour personal interview to ascertain medical use and overuse of prescription stimulants, NPS, nonmedical use of other prescription drugs and illicit drug use, and dependence on alcohol and marijuana. Comparisons were made among nonusers, nonmedical users, and medical users of prescription stimulants for ADHD (ADHD+), some of whom overused their drug. Of 1208 students who were not using prescription stimulants medically for ADHD (ADHD-), 218 (18.0%) engaged in NPS. Of 45 ADHD+ students, 12 (26.7%) overused their ADHD drug at least once in their lifetime, and seven (15.6%) nonmedically used someone else's prescription stimulants at least once in their lifetime. Among 225 nonmedical users, NPS was infrequent and mainly associated with studying, although 35 (15.6%) used prescription stimulants to party or to get high. Lifetime NPS was associated with past-year other drug use. Both NPS and overuse of prescribed stimulants for ADHD were independently associated with past-year use of five drugs, holding constant sociodemographic characteristics; NPS was also associated with alcohol and marijuana dependence. Conclusions. Physicians should be vigilant for possible overuse and/or diversion of prescription stimulants for ADHD among college students who are medical users of these drugs, as well as the occurrence of illicit drug use with NPS. Initiation of comprehensive drug prevention activities that involve parents as well as college personnel is encouraged to raise awareness of NPS and its association with illicit drug use.