Researchers Developing Strategies to Curb Recreational Stimulant Use by Young Adults

Recreational stimulant use among the nation’s young adult population is a growing challenge for policymakers, clinicians, and researchers alike.

In a session presented at the Cocaine, Meth and Stimulant Summit on Thursday, Ty S. Schepis, PhD, a professor from Texas State University in San Marcos, Texas, and Laura J. Holt, PhD, a research associate professor at Trinity College in Hartford, Connecticut, examined differences in rates of stimulant use among specific adult subgroups and presented innovations to prevent recreational stimulant misuse and medication diversion.

Ahead of their Stimulant Summit presentation, Dr Schepis and Dr Holt spoke with Addiction Professional by email to discuss the reasons why recreational prescription stimulant misuse is a problem among young adults, how this population acquires prescription stimulants, and interventions being developed.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: Why are young adults more prone to engaging in recreational prescription stimulant use? Are there subgroups within the young adult population who are even more likely to engage in such use?

Dr Ty S. Schepis and Dr Laura J. Holt: There are many reasons why young adults have the highest rates of prescription stimulant misuse. Overall, young adulthood is the period with the highest rates of use for most substances, and that explains high rates in part. In addition, though, young adulthood is the time of peak academic demands for many people, and the most common motive for prescription stimulant misuse is cognitive enhancement—or to help things like focus, attention, and studying. When combined with high availability of stimulant medication because of increased prescribing to young adults, these medications can be somewhat easily available to further facilitate misuse.

Within young adults, a variety of subgroups have higher rates: young adults in college or who recently graduated, young adults who use other substances—including those who misuse opioid or benzodiazepine medication, members of sexual or gender minority groups, and white males. 

AP: How do young adults typically acquire these medications? Are there particular prescription stimulants that are especially popular among this population?

TS and LH: The most common route to acquire these medications is from peers who have them, usually because they are prescribed the medication for attention-deficit/hyperactivity disorder (ADHD). Most young adults get stimulant medication from friends for free, though some offer to pay or trade for the medication. A trade example might be that the young adult gets medication in exchange for another drug, like alcohol or cannabis. The second most common source is an individual’s own medication. In this case, it is misuse because the person is using it in ways not intended by the prescriber—more often, at higher doses, or with another drug (like alcohol). Some young adults take the medication from family, peers, or roommates without asking, or buy the medication from a dealer, but these are somewhat less common.

There is a common belief that Adderall is the most commonly misused prescription stimulant, but this really has not been studied sufficiently to make any sort of judgment. The evidence for Adderall being the most common or popular stimulant for misuse is anecdotal, and it could be heavily influenced by the high rates of Adderall prescribing, relative to other prescription stimulants (especially methylphenidate formulations, like Ritalin). There is also a belief that longer-acting stimulant formulations are less likely to be misused than shorter-acting formulations, but again, this needs more research before we can be confident about this belief.

AP: Can you provide an example of an intervention that can prevent prescription stimulant misuse and/or diversion? Conversely, are there tactics that you have tried that have NOT been as successful as hoped?

TS and LH: One intervention that has shown promise is training for primary care providers who prescribe stimulants. This brief intervention, developed by Brooke Molina and colleagues at the University of Pittsburgh School of Medicine, focuses on enhanced patient education about the consequences of diversion, and strategies for monitoring medication and discussing diversion with patients. Encouragingly, patients whose prescribers took part in this training showed a decline in their willingness to divert their medication, the number of friends they told about their prescription, and the number of times they were approached for their medication. 

In addition, our research team (Drs Laura Holt, Ty Schepis, and Alison Looby) is currently testing a novel intervention aimed at reducing diversion and medication misuse among college students who are prescribed stimulants. We partnered with Kognito Solutions, a health simulation company, to develop a 30-minute web-based intervention that educates students on the lack of academic benefits associated with stimulant misuse, allows them to practice turning down requests for their stimulant medication, and encourages them to communicate with their prescriber about side effects, schedule changes, and other factors that might affect adherence to their medication.  

AP: Is there anything you’d like to add that we have not touched on?

TS and LH: While there are a host of interventions focused on alcohol and cannabis use for young adults, there is a dearth of interventions to prevent prescription stimulant misuse and diversion. Some strategies that have been effective in reducing other substance use likely could be adapted to address stimulant misuse; however, the most effective interventions for stimulant misuse likely will require a multi-pronged approach: addressing demand for the medications from non-prescribed students; improving adherence among prescribed students; and providing prescribers with tools to address diversion and nonadherence with their patients. 

Reference

Schepis TS, Holt LJ. Reference: Recreational prescription stimulant use in young adults: causes, consequences, and preventive interventions. Presented at Cocaine, Meth and Stimulant Summit. November 2-4, 2022; virtual.