April 7, 2006

Risk for misuse of ADHD medications

A major concern regarding the use of stimulant medications to treat attention-deficit hyperactivity disorder (ADHD) in young people has been the risk that drugs will be misused or diverted to those for whom they have not been prescribed. A new study from MGH researchers finds that while the great majority of those with ADHD use their medications appropriately, a small percentage is likely to abuse or to sell prescribed stimulants. The report appears in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Now that we know who misuses those drugs and which are most likely to be misused, we can pursue efforts to make sure they are appropriately prescribed and monitored," says Timothy Wilens, MD, (at left) director of Substance Abuse Services in MGH Pediatric Psychopharmacology, who led the study.

The current investigation enrolled participants in a long-term study of young men treated with medication for a variety of behavioral and psychiatric disorders. Ten years after joining that study, 98 participants — half of whom had ADHD — were interviewed about their overall progress and current symptoms and completed a confidential questionnaire asking whether they had sold or misused their medications. The results showed that while participants with ADHD were more likely than those without ADHD to report misusing their medication, virtually all of those who sold or otherwise misused their medications also met criteria for conduct disorder or substance use disorder. Another key finding was that immediate release stimulant formulations were most likely to be misused or diverted.

"While we need additional research to make definitive recommendations, from my own experience I'd suggest that physicians prescribe extended release formulations and consider non-stimulant drugs for those at increased risk," Wilens says. His MGH co-authors are Michael Monuteaux, ScD, Allison Swezey, and Joseph Biederman, MD, all of MGH Pediatric Psychopharmacology.