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Young Adults Diverting ADHD Drug Increase ED Visits

BALTIMORE – If you’ve wondered why patients presenting to your ED with adverse effects from dextroamphetamine-amphetamine look a lot older than the typical kid with an attention deficit/hyperactivity disorder, a new study offers some explanation.

A study published recently in The Journal of Clinical Psychiatry finds that misuse of the drugs isn’t primarily among older children and adolescents, although that is the common misconception. Instead, inappropriate use by young adults, 18-25, is fueling the problem.

Johns Hopkins Bloomberg School of Public Health researchers and colleagues analyzed trends from 2006 to 2011 and found that the abusers tended to be getting the medication from friends and family and didn’t have prescriptions themselves.

The study also notes that 18- to 25-year-olds were responsible for 60% of all nonmedical use of dextroamphetamine-amphetamine, among users age 12 and older.

"The growing problem is among young adults," explained co-author Ramin Mojtabai, MD, MPH, PhD, professor of mental health at the Bloomberg School. "In college, especially, these drugs are used as study-aid medication to help students stay up all night and cram. Our sense is that a sizeable proportion of those who use them believe these medications make them smarter and more capable of studying. We need to educate this group that there could be serious adverse effects from taking these drugs and we don't know much at all about their long-term health effects."

While dextroamphetamine-amphetamine, marketed as Adderall, improves focus, it also can cause sleep disruption and serious cardiovascular side effects, such as high blood pressure and stroke, according to the study. The drug also can increase the risk for mental health problems, including depression, bipolar disorder, and unusual behaviors, including aggressive or hostile behavior.

Researchers mined three sources of data for the study: the National Survey on Drug Use and Health, a population survey of substance use; the Drug Abuse Warning Network, a survey of emergency department visits; and the National Disease and Therapeutic Index, a survey of office-based practices including prescribing.

In the six-year study period, routine treatment visits involving Adderall were unchanged for adults, but nonmedical use of dextroamphetamine-amphetamine shot up 67%, and ED visits relating to that use rose 156%. At the same time, treatment visits involving the drug went down for adolescents, who also had stable nonmedical use and a drop in ED visits of 54%.

Trends for other stimulants, such as methylphenidate, sold under the brand name Ritalin, were unchanged, according to study authors.

The researchers urge monitoring of stimulants similar to prescription painkillers so that physicians could check a database before writing a prescription.

First author Lian-Yu Chen, MD, PhD, said the results suggest that “the main driver of misuse and emergency room visits related to the drug is the result of diversion, people taking medication that is legitimately prescribed to someone else.”

Chen emphasized in a Johns Hopkins press release that emergency physicians and other healthcare professionals need to be much more aware of the trend in order to help prevent it.

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