Baltimore—Why have emergency department visits gone up dramatically for young adults using dextroamphetamine-amphetamine, even though prescription rates have remained steady?

A study published recently in The Journal of Clinical Psychiatry finds that misuse of the drugs isn’t primarily among older children and adolescents—as conventional wisdom has suggested—but, instead, that inappropriate use by young adults, aged 18 to 25 years, is driving the problem.

Researchers led by the Johns Hopkins Bloomberg School of Public Health analyzed trends from 2006 to 2011 and found that the abusers tended not to have prescriptions but were getting the medication from family and friends.

In fact, the study finds that 18-to-25-year-olds made up 60% of all nonmedical use of dextroamphetamine-amphetamine, from age 12 and up.

“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. A black box warning was added to the label in 2006, the authors point out.

In addition, the report notes that the drug also increases the risk for mental health problems, including depression, bipolar disorder and unusual behaviors, including aggressive or hostile behavior.

For the study, researchers focused on three sources of data: 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.

Results indicate that in the 6-year study period, 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%. For adolescents, meanwhile, treatment visits involving the drug went down, nonmedical use was stable, and ED visits dropped 54%.

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

The study calls for stimulants to be monitored 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 healthcare professionals need to be much more aware of the trend in order to help prevent it.

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