Ann Arbor, Michigan—Secondary schools that have high levels of stimulant therapy for ADHD also have more prescription stimulant nonmedical use.

That is according to a new cross-sectional study of 231,141 students in 3,284 secondary schools. The report in the Journal of the American Medical Association Network Open pointed out that school-level past-year prescription stimulant nonmedical use ranged from 0% to more than 25% across U.S. schools.

University of Michigan–led researchers advised that students attending schools with the highest rates of stimulant therapy for ADHD had a 36% increased odds of nonmedical use of prescription stimulants (NUPS) compared with students attending schools with the lowest rates.

“This study’s results suggest potential targets for strategies to reduce school-level prescription stimulant nonmedical use,” the researchers added.

Survey data for the study were collected between 2005 and 2020 as part of the Monitoring the Future study (data collected annually via self-administered survey in schools from independent cohorts). Statistical analysis was performed from July 2022 to September 2022.

Participants were from a nationally representative sample of 3,284 U.S. secondary schools. The mean (SD) response rates were 89.5% (1.3%) for 8th-grade students, 87.4% (1.1%) for 10th-grade students, and 81.5% (1.8%) for 12th-grade students. The results indicated that other significant school-level risk factors included those in more recent cohorts (2015-2020), schools with higher proportions of parents with higher levels of education, schools located in non-Northeastern regions, schools located in suburban areas, schools with a higher proportion of white students, and schools with medium levels of binge drinking.

“In this cross-sectional study of U.S .secondary schools, the prevalence of past-year NUPS varied widely, highlighting the need for schools to assess their own students rather than relying solely on regional, state, or national results,” the researchers concluded. “The study offered new evidence of an association between a greater proportion of the student body that uses stimulant therapy and a greater risk for  in schools. The association between greater school-level stimulant therapy for ADHD and other school-level risk factors suggests valuable targets for monitoring, risk-reduction strategies, and preventive efforts to reduce NUPS.”

Background information in the articles pointed out that the diagnosis of ADHD and prescribing of stimulant therapy have increased substantially in the United States over the past 2 decades. It cites recent estimates indicating one in every nine 12th graders reported lifetime stimulant therapy for ADHD.

“Although prescription stimulants are efficacious when used appropriately, there is growing concern regarding the acute and long-term adverse health effects (e.g., cardiovascular events, depressed mood, overdoses, psychosis, seizures, and stimulant use disorder) associated with nonmedical use of prescription stimulants (NUPS),” according to the study, which added, “The leading medication source for NUPS by US adolescents remains same-age peers.”

The authors decry the difficulty of reducing NUPS while providing necessary stimulant therapy.

“There is growing evidence that the majority of NUPS among older adolescents is primarily motivated by a desire to enhance academics and/or cognition and most often involves obtaining stimulants from friends at the same school,” the study noted. “NUPS is associated with an increased risk of substance use disorder, neuropsychological dysfunction, polysubstance use, depressed mood, and lower graduation rates.”

The researchers say their findings indicated a need for more research to examine “whether closely monitoring medical availability of prescription stimulants and reducing stimulant diversion among same-age peers could have a significant influence on reducing NUPS.”

They urged that adolescents who are prescribed stimulant therapy for ADHD should be educated and cautioned that about one-fourth of them will be asked to divert their stimulant medications by their peers before the completion of high school and that the percentage will increase to more than one-half by the time they are in college.

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