Recreational Use of Stimulant Therapies More Common in Schools With High Rates of Prescription Use of Stimulants

In a study designed to examine the risk factors for recreational use of prescription stimulants at secondary schools in the United States, investigators found that recreational use of stimulants was more likely to occur in schools with higher rates of prescription use of stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD). These findings were published in JAMA Network Open.

Nearly 1 out of 9 US students in the 12th grade reports lifetime stimulant therapy for ADHD, indicating a ready supply of stimulants in US schools. However, there is limited information regarding the prevalence of both prescription stimulant therapy for ADHD and recreational use of prescription stimulants at the school-level among US secondary school students.

The cross-sectional study sourced data from the Monitoring the Future (MTF) study, a nationally representative multicohort survey of secondary schools in the US that was started in 1975. In the current study, the investigators surveyed 8th, 10th, and 12th grade students (N=231,141) attending 3284 public and private schools between 2005 and 2020 about their use of stimulant therapy for ADHD and recreational use of prescription stimulants.

The study population included 50.8% girls; 53.1% White students, 16.2% Hispanic students, 11.8% Black students, and 19.0% who identified as another race/ethnicity. Of the total population,79.4% had a B-minus grade point average (GPA) or higher, 14.5% used marijuana in the past 30 days, 13.9% engaged in binge drinking in the past 2 weeks, and 9.9% used cigarettes in the past 30 days.

At the school level, the average use of stimulants for medical purposes was 7.9% and the rate of recreational use of prescription stimulants was 5.7%.

Past-year recreational use of prescription stimulants differed significantly as a function of school-level characteristics. Schools with a higher rate of prescription stimulant use for ADHD also had a higher rate of recreational use of prescription stimulants (7.6%) compared with schools where no students used prescription stimulants for ADHD (3.6%). Overall, recreational use of prescription stimulants was highest among students from public schools (5.9%) compared with those from private (4.6%) or Catholic (4.5%) schools; increased with age, from 3.6% among 8th graders to 7.2% among 12th graders; was higher in rural (6.1%) and suburban (6.0%) schools compared with urban schools (4.8%); and was highest in the Midwest (6.2%) and South (6.1%) compared with in the West (5.5%) or Northeast (4.6%).

The investigators’ model combined individual- and school-level predictors, which showed that past-year recreational use of prescription stimulants was associated with multiple predictors, including the following: marijuana use (adjusted odds ratio [aOR], 3.93); cigarette smoking (aOR, 3.12); binge drinking (aOR, 2.76); location in the South (aOR, 1.52), West (aOR, 1.40), or Midwest (aOR, 1.36) vs the Northeast; high (aOR, 1.64), medium (aOR, 1.39), or low (aOR, 1.29) use of stimulants for ADHD vs no use; and having a C-plus GPA or lower vs B-minus or higher GPA (aOR, 1.33). Past-year recreational use of prescription stimulants was also more strongly associated with data collected in 2015-2020 (aOR, 1.24) or 2010-2014 (aOR, 1.08) vs 2005-2009.

The investigators’ final model included both individual and school-level risk factors to assess individual-level past-year recreational use of prescription stimulants. In this model, past-year recreational use of prescription stimulants was associated with individual-level current (aOR, 2.34) or previous (aOR, 2.44) use compared with no use and with school-level high (aOR, 1.36), medium (aOR, 1.27), and low (aOR, 1.23) stimulant use for ADHD compared with no use.

Study limitations include the exemption of students who were home-schooled, dropped out or were absent the day of data collection. Students are also likely to underreport sensitive, ongoing substance use, affecting reported estimates of stimulant use or distribution.

The investigators concluded, “[T]here is a wide variation in the prevalence of [recreational use of prescription stimulants] between US secondary schools (0% to more than 25%), highlighting the need for individual schools to assess their own student body rather than relying solely on regional, state, or national results.” They continued, “These findings suggest that school-level stimulant therapy for ADHD and other school-level risk factors were significantly associated with [recreational use of prescription stimulants] and should be accounted for in risk-reduction strategies and prevention efforts.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.