Prescription drug diversion is defined as the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace.1 This includes transferring drugs to people they were not prescribed for.
Considering that prescription drugs are second, only to marijuana, over any illicit substance for misuse liability among young adults (Substance Abuse and Mental Health Services Administration, 2012), there is a critical need for policy-makers, physicians, educators, and families to address the issue of prescription stimulant misuse. A related concern is that more than 50% of nonmedical prescription stimulant users have been found to report using other prescription drugs (e.g., opioids, sedatives, tranquilizers) in conjunction with stimulants (Chen et al., 2014). A recent report indicates that users who obtained stimulants from illegal sources had the highest prevalence of misuse of other prescription drugs (66.3%), closely followed by those who obtained their stimulants via physician sources (58.8%) (Chen et al., 2014). Unfortunately, it does not appear to be common practice for universities and primary care physicians to discuss misuse, diversion, potential consequences, and side effects of other drug use along with prescription stimulant use (McCabe, Boyd, Couper, Crawford, & d’Arcy, 2002; Tarn et al., 2006).
The prevalence rate of stimulant misuse is estimated to range between 13 – 23%, approximating around 17% on average (Benson et al., 2015). Studies consistently indicate that the main motivation college students report for misusing prescription stimulants is cognitive and academic enhancement (Benson et al., 2015; Rabiner et al., 2009; Weyandt, et al. 2013). Interestingly, misuse of these medications appears to be negatively associated with academic performance, indicating that misuse may not necessarily lead to academic enhancement despite students’ perceptions of their benefits. Grade point average (GPA) has been found to be negatively correlated with stimulant misuse among college students (Benson et al., 2015; Weyandt et al., 2013).
According to Weyandt et al. (2013) and Benson et al. (2015), other less commonly endorsed motives include recreational reasons (e.g., getting “high”), weight loss, and curiosity, and as many as 40% of students may engage in misuse for more than one reason (Benson et al., 2015).
Another potentially even more common motivation is trying to facilitate a medication trial for a friend who suspects they may have undiagnosed ADHD. In this instance, we recommend our patients encourage their curious friends to take some of the free ADHD screening tests found on our website and schedule a free 15-minute consultation with us.
Prescription stimulants are classified as Schedule II substances by the DEA (Drug Enforcement Administration, U.S. Department of Justice, 2015). Despite their illegality, stimulant medications are typically regarded as easily accessible by college students (McCabe et al., 2005; Rabiner et al., 2009; Sharp & Rosen, 2007; Weyandt et al., 2009) and are usually procured from peers or family members holding a valid prescription (Benson et al., 2015; Weyandt et al., 2013).
Even if a patient with ADHD gives a friend some of their stimulant medication without any sale, and even if they have the best intentions, they can technically still be prosecuted for ‘distributing’ a controlled medication. It is our intention to help our patients avoid a very rare but potentially sticky situation by recommending our patients carefully protect their prescriptions.
Our clinic policy will always be to enforce full patient-provider confidentiality. We do not communicate with law enforcement concerning non-violent acts of any kind unless under a direct court order.
In the state of WA, the distribution (giving away) of a schedule 2 controlled substance (e.g., Stimulant medications for ADHD) of any quantity can theoretically result in:
Students who are given or who purchase or receive gifted prescription stimulants from others are also taking a risk regarding the authenticity of the stimulant, the dose, side effects, and not knowing whether they have underlying cardiovascular problems that may be exacerbated by psychostimulant use (Nissen, 2006).
The lethal dose of Adderall—that is, a dose powerful enough to have fatal consequences—is about 1,400 milligrams for the average 154-pound adult. This is about 25 times the standard dose.
General Toxicity Risk Ranges:
<6 years: an accidental overdose of <2 mg/kg rarely causes serious toxicity