Considerations for Use of Prescription Stimulant Medications

The following provides information from government sources about considerations for use of prescription stimulant medications. It should not serve as medical guidance, but rather as a resource to introduce topics and terms related to the use of these medications.

  • Prescription stimulant medications are a class of drugs that include amphetamine-containing and methylphenidate-containing medications, which healthcare professionals may prescribe, in conjunction with other treatments and support, to manage the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD).1,2
  • A multi-modal approach to treatment may include use of prescription stimulants in conjunction with behavioral therapy, to manage and mitigate the symptoms and impact of ADHD.
  • Prescription stimulant medications are Schedule II controlled substances by the Drug Enforcement Administration (DEA), and have a high potential for abuse which may lead to severe psychological or physical dependence.3 Even when used as prescribed, they have associated risks including misuse, abuse, and diversion, severe psychological or physical dependence, overdose, sudden death, stroke, heart attack, increased blood pressure and heart rate, and new or worsening mental or psychiatric problems.1,4
  • In addition, common side effects of prescription stimulants include decreased appetite, insomnia, and nausea.

Prescribers, pharmacists, patients, and family members should be encouraged to learn more about the risks associated with prescription stimulant medications, including misuse, as well as tools available to support safe and responsible use.

Misuse, Abuse, Diversion and Substance Use Disorder

Misuse and Abuse

  • According to the National Institute on Drug Abuse (NIDA), a federal scientific research institute under the National Institutes of Health, U.S. Department of Health and Human Services, misuse includes use of prescription medications by someone other than who it’s intended for, using prescriptions in ways or amounts other than prescribed or to get high, taking another person’s prescription, or taking a medication to feel euphoria.5
  • Abuse is defined by the U.S. Food and Drug Administration (FDA) as the intentional, non-therapeutic use of a drug product or substance, even once, to achieve a desirable psychological or physiological effect.6
    • The term misuse is increasingly preferred by healthcare professionals over abuse, which can carry connotations of stigma or shaming.7
  • Prescription stimulant medications are often misused to produce a sense of exhilaration or euphoria, improve mental or physical performance, reduce appetite, or to stay awake or alert.8
    • Of people ages 12 and over who misused prescription stimulant medications in 2019, approximately 30 percent reported their main reason for last misuse was to be alert or stay awake; the second most common reason for last misuse was to help concentration (28 percent).9
    • Approximately 76 percent of people ages 12 and over who misused prescription stimulant medications in the past year gained access to the prescription stimulant medication they last misused through a friend or relative.9
    • Additional data on prescription stimulant medication misuse can be found in the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Survey on Drug Use and Health.9
  • Medical Consequences of Misuse
    • Misuse of prescription stimulant medications can lead to psychosis, anger, paranoia, and heart, nerve, and stomach problems. These issues could result in a heart attack or seizures.1,3
    • Misuse can also lead to substance use disorder, physical dependence, or overdose. When a person stops taking prescription stimulant medications they may experience withdrawal symptoms including depression, fatigue, and sleep problems may can occur.1,3

Diversion

  • Prescription drug diversion is the unlawful channeling of prescribed medications from legal sources into the illicit marketplace such as prescription stimulant medications.10
  • Diversion includes someone sharing their prescribed medications with people for whom the medications were not prescribed.11

Substance Use Disorder

  • Substance use disorder occurs when a person’s use of a substance (drug) causes to health issues or problems at work, school or home. The exact cause of substance use disorder is not known. A person’s genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.12
  • Prescription stimulant medication use can lead to substance use disorder, even if taken as prescribed by a doctor.3

For information on substance use disorder, misuse, abuse, and diversion of prescription medications, please visit the National Institute on Drug Abuse. SAMHSA’s confidential and anonymous Behavioral Health Treatment Services Locator can be accessed here, and their free and confidential National Helpline can be reached through 1-800-662-HELP (4357) and 1-800-487-4889 (TTY).

Supporting Responsible Prescription Stimulant Use

The following information, from NIDA and other government organizations, includes ways to support the safe and responsible use of prescription stimulant medications.5 This is not an exhaustive list. Healthcare professionals and patients should review these resources in their entirety and patients should discuss any questions they may have with their healthcare professional.

Tips for Prescribers Include:

  • Ask patients about other medications they currently take to identify potential misuse;5
  • Ask patients if they or a family member have ever misused prescription stimulant medications, or abused alcohol, prescription medicines, or street drugs;5
  • Use evidence-based screening tools to identify potential misuse or abuse;5
  • Counsel patients about the risks associated with prescription stimulant medication use, as outlined in product Medication Guides;13,14
  • Monitor patients for sign of abuse and dependence while on therapy;5
  • Take note of rapid increases in the amount of prescription stimulant medication requested, or unscheduled or early refill requests;5
  • Check electronic health records to assess patients’ medical and prescription history;15
  • Check their state’s Prescription Drug Monitoring Program (PDMP) to identify individuals at risk for misuse and patients who are obtaining prescription stimulant medications or other controlled substances from multiple providers or pharmacies;16
  • Use electronic prescribing because it can improve patient safety by reducing medication errors caused by illegible prescriptions or oral miscommunication. It can also improve public health and safety by reducing abuse and diversion;17,18 and
  • Provide or refer patients to appropriate treatment if the patient has developed a substance use disorder.5

Tips for Pharmacists Include:

  • Encourage patients to read the Medication Guide that accompanies their stimulant prescription medication, which includes FDA approved information that can help patients prevent serious side effects. Information about possible misuse, development of a substance use disorder, and overdose is also included;1,3
  • Educate patients and their families on proper handing, storage and disposal of medications, and the risks of accidental exposure, or diversion, including sharing medicines;1,5
  • Be on the watch for falsified or altered prescriptions;5
  • Recognize patterns associated with misuse of prescription stimulant medication;5,6
  • Check their state’s PDMP to identify individuals at risk for misuse and patients who are obtaining prescription stimulant medications or other controlled substances from multiple providers or pharmacies;5 and
  • Ensure patients are aware of how to properly dispose of unused prescription stimulant medications, including drug take-back programs or DEA-registered collection sites.19

Tips for Patients and Family Members Include:

  • Tell doctors and pharmacists about all the medications you or your loved one are currently taking to help reduce the risk of dangerous drug interactions;5
  • Be aware of potential interactions between different medications;5
  • Follow the directions on the bottle label or explained by the clinician;5
  • Don’t make changes to your prescribed dose by yourself. Your doctor is the only one that can evaluate whether an adjustment to your dose is needed;5
  • Never share medication with another person:5
    • Prescription stimulant medications should only be used as directed by the individual for whom the medication was prescribed;5
    • Sharing prescription stimulant medications is against the law;20 and
    • Sharing prescription stimulant medications can cause harm to the person for whom the medication was not prescribed.21
  • Store prescription stimulant medications properly:22
    • Put all medications away and out of reach, preferably in a locked cabinet or box; never leave medications on the kitchen counter or other easily accessible places;22,23 and
    • Lock the safety cap before putting prescription stimulant mediations away, and if the bottle has a locking cap that turns, twist it until the bottle click or cannot twist any further;23
  • Properly dispose of unused prescription stimulant medications:19
    • The best way to dispose of prescription stimulant medications is through drug take-back programs or registered collection sites. You can learn more about this at https://takebackday.dea.gov/;19
    • Medicine take-back programs allow the public to take unused medications to collection sites for proper disposal. These programs may be available through local law enforcement or household trash and recycling services;19
    • Use The National Association of Boards of Pharmacy’s Drug Disposal Locator Tool available at https://safe.pharmacy/drug-disposal/ to find a permanent collection site near you;24,25 and
    • Talk to your local pharmacist. Some pharmacies have a mail-back program or disposal kiosk for unused medications;
    • If no take-back program or authorized collector is available, patients should remove the medication from the original container and mix it with something undesirable like kitty litter or coffee grinds and place the mixture in something you can close (i.e., ziploc baggie, empty can or other container) and throw the container in the trash.

Ask Adlon

Adlon is committed to providing balanced and accurate scientific and clinical information to help you make informed healthcare decisions.

1 National Institute on Drug Abuse. Drug Facts: Stimulant ADHD Medications. Methylphenidate and Amphetamines 2014. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/sites/default/files/drugfacts_stimulantadhd_1.pdf.
2 The National Institute of Mental Health. Attention-Deficit/Hyperactivity Disorder (ADHD): The Basics. https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml.
3 United States Drug Enforcement Administration. Drug Scheduling. Accessed on February 2021. Retrieved from https://www.dea.gov/drug-scheduling.
4 National Institute on Drug Abuse. Drug Facts: Prescription Stimulants 2018. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants.
5 National Institute on Drug Abuse. Drug Facts: Misuse of Prescription Drugs 2018. Accessed on February 2021. Retrieved from https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/2609-misuse-of-prescription-drugs.pdf.
6 U.S. Food and Drug Administration. Remarks Delivered Before FDA’s Scientific Meeting on Opioids 2017. Accessed on February 2021. Retrieved from https://www.fda.gov/news-events/speeches-fda-officials/remarks-delivered-fdas-scientific-meeting-opioids-07102017.
7 National Institute on Drug Abuse. The Science of Drug Use and Addiction: The Basics 2018. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics.
8 U.S. Department of Justice, Drug Enforcement Administration. Drugs of Abuse: Stimulants 2017. Accessed on February 2021. Retrieved from https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf.
9 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: 2019. Accessed on February 2021. Retrieved from https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables.
10 U.S. Department of Justice: Drug Enforcement Administration: Diversion Control Division. Program Description. Accessed on February 2021. Retrieved from https://www.deadiversion.usdoj.gov/prog_dscrpt/index.html.
11 Department of Health & Human Services – Centers for Medicare & Medicaid Services: Partners in Integrity: What is a Prescribers Role in Preventing the Diversion of Prescription Drugs? 2014. Accessed on February 2021. Retrieved from https://dhs.iowa.gov/sites/default/files/PAOWhatIsAPrescribersRoleInPrevDrugDiv012313f.pdf?022020202118.
12 Medline Plus. Substance Use Disorder. February 2020. Accessed on February 2021. Retrieved from https://medlineplus.gov/ency/article/001522.htm.
13 U.S. Food & Drug Administration. Medication Guides for Certain Prescription Products. April 1, 2019. Accessed on February 2021. https://www.fda.gov/consumers/consumer-updates/medication-guides-certain-prescription-products.
14 National Institutes of Health, National Institute of Drug Abuse. Research Report Series: Prescription Drug Abuse. Revised October 2011. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/sites/default/files/rxreportfinalprint.pdf.
15 National Institutes of Health, National Institute of Drug Abuse. Drug Screening and Assessment Resources. July 2018. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-prevention.
16 Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. What States Need to Know about PDMPs. Page last updated Oct 3, 2017. Accessed on February 2021. Retrieved from https://www.cdc.gov/drugoverdose/pdmp/states.html.
17 Porterfield A, Engelbert K. Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting. Perspectives in Health Information Management, Spring 2014.
18 Drug Enforcement Administration. Economic Impact Analysis of the Interim Final Prescription Rule. March 2010. Accessed on February 2021. Retrieved from https://www.deadiversion.usdoj.gov/ecomm/e_rx/eia_dea_218.pdf.
19 U.S. Food & Drug Administration. Disposal of Unused Medicines: What You Should Know 2018. Accessed on February 2021. Retrieved from https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm.
20 Legal Information Institute. 21 U.S. Code § 829 – Prescriptions. Accessed on February 2021. Retrieved from https://www.law.cornell.edu/uscode/text/21/829.
21 National Institute on Drug Abuse. Drug Facts: Prescription and Over-the-Counter Medications 2013. Accessed on February 2021. Retrieved from https://www.drugabuse.gov/sites/default/files/drugfacts_rx_otc_5_2_13_ew2_0.pdf.
22 Centers for Disease Control and Prevention. Put Your Medicines Up and Away and Out of Sight 2018. Accessed on February 2021. Retrieved from https://www.cdc.gov/patientsafety/features/medication-storage.html.
23 Drug Enforcement Administration. Prescription for Disaster: How Teens Misuse Medicine. Accessed on February 2021. Retrieved from https://www.dea.gov/sites/default/files/2018-11/DEA_PrescriptionForDisaster-2018ed_508.pdf.
24 U.S. Department of Justice: Drug Enforcement Administration: Diversion Control Division. Controlled Substance Public Disposal Locations – Search Utility. Accessed on February 2021. Retrieved from https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e2s1.
25 National Association of Boards of Pharmacy: Drug Disposal Locator 2019. Accessed on February 2021. Retrieved from https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/

Bitnami