MIAMI – College is “ground zero” for nonmedical use of prescription stimulants.
But most college students who use stimulants do so only on occasion to enhance studying or boost concentration. More frequent users are at increased risk for abusing other substances and for poor academic performance, according to two studies presented at the annual conference of the American Society for Addiction Medicine.
“A preponderance of use is reported for study, focus, or work, in contrast to 'getting high' or 'feeling good,'” Dr. Robert L. DuPont said.
Another distinction from other drugs of abuse is that most students obtain the stimulants for free from someone else. Researchers for a 2004 Harris Interactive Study compared about 1,900 online survey respondents who reported no nonmedical use of a methylphenidate product with 110 who reported such use. They found that 94% who used Ritalin (methylphenidate) for cognitive enhancement obtained it for free, as did 100% of people who reported taking Concerta (methylphenidate).
“This does not involve drug dealers. The transfer to the user is not related to any cost whatsoever, so it's a different pattern than we see with most drugs of abuse. It's quite striking,” said Dr. DuPont, president of the Institute for Behavior and Health, a nonprofit drug-policy research office.
“I don't think a lot of patients realize that giving controlled substances to someone else is illegal,” said Dr. DuPont, who served as the first director of the National Institute on Drug Abuse. “We need better awareness that there is a medical contract about use.”
Five major conclusions have emerged from a series of meetings held since 2003 by the Institute for Behavior and Health advisory committee on nonmedical use of stimulants:
▸ Nonmedical use of prescription stimulants is a substantial but unique part of drug abuse on college campuses.
▸ More than 75% of college students who report using stimulants nonmedically have done so 10 or fewer times in the previous year.
▸ Most use these agents to facilitate studying or concentration.
▸ More frequent nonmedical users of prescription stimulants on college campuses also use other illegal drugs, drink alcohol excessively, smoke cigarettes, and are likely to have lower grades than nonusers. “These are the people at the bottom of the academic population. They have higher rates of missing classes, and they use stimulants to catch up,” Dr. DuPont said.
▸ Adderall (amphetamine/dextroamphetamine) is associated with a substantially higher rate of nonmedical use, followed by Ritalin and Concerta, Dr. DuPont said. “Concerta is associated with the lowest abuse in this area, possibly because the capsule form is particularly resistant to abuse.”
A higher percentage of Ritalin users, 77%, reported using other drugs nonmedically in the previous 12 months, compared with 46% of Concerta users, according to the Harris study. In addition, 88% reported they used Ritalin for studying, compared with 28% of Concerta users.
Other researchers enrolled 1,253 randomly selected, first-year college students in the College Life Study in the fall of 2004. “This is a more sophisticated, ongoing study,” Dr. DuPont said. “It is a longitudinal look at all drug use over 4 years of college.”
A total of 45 participants were being treated for attention-deficit/hyperactivity disorder at baseline. “A higher percentage of those with ADHD use methylphenidate [nonmedically] more than 10 times per year,” Dr. DuPont said.
Students with an ADHD diagnosis were more likely to inhale a prescription stimulant, with 29% reporting doing so, compared with 14% of those without an ADHD diagnosis. They were also more likely to report marijuana use (77% versus 61%) and cocaine use (14% versus 5%).
“We have a lot of kids on campus complaining of learning disabilities at student health [services] to get stimulant prescriptions to counteract the memory problems associated with marijuana use,” Dr. Mark S. Gold said in another presentation at the meeting. Dr. Gold is professor of psychiatry, neuroscience, and community health and family medicine at the University of Florida, Gainesville. “We have a lot of methylphenidate use on college campuses,” Dr. Gold said. “This can give students an unfair advantage on the SAT and other tests, and could explain some of the disparities in test scores we see in some populations.”