Deserving of Your Attention: Teen Abuse of ADHD Meds
I’m covering this topic on the occasion of the opening of NIDA’s National Drug Facts Week to raise awareness — for teens and the adults in their lives — of something about which there are a lot of myths: prescription drug abuse, including ADHD meds.
Not too long ago, a patient of mine, an 18-year old named Martin, came back from college break for a checkup. He is an enterprising fellow, and I was glad to see he had settled in nicely for his first semester at college. However, he became upset when he reported that his roommate had found his ADHD medication, and had convinced him and his friends to take two or three pills each to stay up and study through the night just before midterms. This was a kid who’d been taking prescription medications responsibly since 9th grade and had always been careful to follow the correct dosages.
“Does this mean I’m addicted?” he asked sincerely, before adding, “Is taking these meds for fun really that dangerous?” Good kid. Tough questions.
As a pediatrician, you can bet that nearly every day I’m asked about treatment and medications for attention deficit/hyperactivity disorder (ADHD), such as stimulants Ritalin (aka methylphenidate) and Adderall (or amphetamine salts). Do no harm, right?
After alcohol, marijuana, and tobacco, prescription medications are the next most commonly abused drugs by adolescents. This happens more than you might think. Upwards of one in five high schoolers reported using prescription meds for nonmedical purposes. In cases like Martin’s, where prescription medications are used for purposes for which they were not intended. Ritalin or Adderall are often readily available drugs of abuse.
Stimulant medications boost the effects of neurotransmitters in the brain such as dopamine and norepinephrine and allow more distractible and hyperactive folks to concentrate and focus. When used to treat a medical condition such as ADHD, the goal of the health care provider is to prescribe the lowest dose of stimulant for the best effect, then adjust meds until a desired degree of attention improvement or impulse control is achieved.
In the medicine universe, stimulants are potent stuff. Adolescent and adult users can take them in pill form, or crush them for snorting (ick), or inject them (yikes). Higher doses of stimulants can derange the normal actions of neurotransmitters like the aforementioned dopamine, producing a euphoric-like high. Stimulant highs can be bewitching to those who seek them, heightening the risk of addiction. Ironically and rather cruelly, these medications decrease responses to normal dopamine, and require abusers to use more of the drug to get high over time.
Taking stimulants at higher doses, or in combination with over-the-counter medications or anti-depressants gets scary quickly. Short-term reactions to high dose stimulants can include potentially dangerous changes in heart rhythms, heart attacks, stroke, or seizures. Any of these can lead to devastating injury or death. Some users may become dangerously hostile or paranoid and pose a threat to themselves or others. Longer term, chronic abusers of stimulants may experience drug withdrawal symptoms with severe disorders of mood, declines in academic performance, depression, thoughts of suicide, and engaging in illicit or high risk behaviors to feed their drug craving. It ain’t pretty.
Like many adolescents and adults, Martin perceived a prescription medication as being a less risky prospect than a street drug. Prescription drugs, omnipresent in so many medicine cabinets and dorm rooms, render them familiar and less scary. Further, Martin fell under the spell cast by his roommate about the performance-enhancing aspect of “a little extra” Adderall. Other kids may take stimulants, or other prescription drugs to self-medicate (to relax or feel better), or out of curiosity (everyone else is doing it).
How do we prevent or respond to instances when family members, friends (or for that matter, patients in clinic) are considering or actively abusing prescription drugs? For starters, everyone benefits by including prescription medications on the agenda of any discussion about substance abuse. Stimulant medications, pain killers, and other prescription drugs should also be recognized for their potential for benefit for treating medical conditions when done right.
Research has continued to demonstrate that parents often share with their teens the perception that prescription medications are less risky, or that their kids would not engage in their misuse. It ain’t necessarily so. Martin was not the first teen I’d met with such a story, nor will he be the last. I have encountered more than a few instances where a relative poaches a child’s prescription for their own use or profit. Sad, but true. Potential prescription drugs of abuse–including pain-killers, stimulants, or other psychiatric meds–should be kept in secure places and supplies monitored no matter who they are for.
Likewise, it continues to be the responsibility of health care providers like myself to ensure that prescribed stimulants are being used correctly, for the right reason. These medicines are considered ‘controlled substances,’ and so may only be given out in limited amounts to any one person for specific amounts of time. As in any medical concern, we consider each case individually and consider the need to review drug use if an individual or family appears to be refilling a prescription too quickly, or ‘losing’ their pills once too often.
And so, back to Martin. Does this one time dalliance render him an addict? Unlikely, I told him, but his action did put him at risk–and could do so again. He pondered this while I reviewed how the abuse of prescription stimulants could pose a real threat to his well being, or that of his friends. He had a lot to think about.
Before we left, we refilled his Adderall medication. We’ve met a few times since. (And, for the record, he’s made his refills on time!) Martin reports he’s declined other offers from friends to have another “ADHD Pill Party.” And, for good measure, he keeps his own pills in a safe place.
And so we all do well to remember: the prescription drugs in our everyday medicine cabinets can help those for whom they are meant when used correctly. And we all must pay attention to this key fact: their abuse happens, and can lead to dangerous, or tragic results.
For more information on the misuse of prescription drugs or other questions on youth and adolescent substance abuse see the following links:
Great resource for teens: The Sara Bellum blog : http://teens.drugabuse.gov/blog/
NIDA’s National Drug Facts Week: http://teens.drugabuse.gov/index.php
Referrals to treatment programs: 1-800-662-HELP (a confidential hotline), or www.findtreatment. samhsa.gov
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