Prescribing Responsibly

Considerations for Use of Prescription Stimulants

The following provides information from government sources about considerations for use of prescription stimulants. 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 stimulants are a class of drugs that includes amphetamine-containing and methylphenidate-containing medications. These stimulant medications are prescribed by healthcare professionals to manage the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD).1
  • 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.1
  • Even when used as prescribed by properly diagnosed patients, prescription stimulants carry risks that must be considered, such as misuse, abuse, and diversion.2 Other serious risks associated with the use of prescription stimulants include overdose, sudden death, stroke, heart attack, increased blood pressure and heart rate, and new or worse mental or psychiatric problems.1,2
  • Prescription stimulants are classified as 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

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

Some additional information on considerations for use of prescription stimulants is available on the following government websites:

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 of prescription medications means taking a medication in a manner other than prescribed; taking another person’s prescription, or taking a medication to feel euphoria.4
  • 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.5
    • The term misuse is increasingly preferred by healthcare professionals over abuse, which can carry connotations of stigma or shaming.6
  • Prescription stimulants are often misused to produce a sense of exhilaration or euphoria, improve mental or physical performance, reduce appetite, or to stay awake or alert.7
    • Of people ages 12 and over who misused prescription stimulants in 2018, approximately 34 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 (24 percent).8
    • Approximately 71 percent of people ages 12 and over who misused prescription stimulants in the past year gained access to the prescription stimulant they last misused through a friend or relative.8
    • Additional data on prescription stimulant misuse can be found in the Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Survey on Drug Use and Health.8
  • Medical Consequences of Misuse
    • Misuse of prescription stimulants can have serious medical consequences including psychosis, feelings of panic, hostility or agitation, paranoia sometimes accompanied by auditory and visual hallucinations, and cardiovascular issues, potentially leading to death.1,2
    • Misuse can also lead to substance use disorder, physical dependence, or overdose. If a person suddenly stops taking prescription stimulants, withdrawal symptoms such as depression, fatigue, and disturbed sleep patterns can occur.1,2

Diversion

  • Diversion refers to the unlawful channeling of controlled substances, such as prescription stimulants, from legal sources into the illicit marketplace.9
  • Diversion includes giving prescribed medications to other people, which is illegal.10

Substance Use Disorder

  • Substance use disorder occurs when a person’s use of a substance (drug) leads 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.11
  • Prescription stimulant use can lead to substance use disorder, even if taken as prescribed by a doctor.2

For information on addiction, 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 responsible use of prescription stimulants.4 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;4
  • Ask patients if they or a family member have ever misused prescription stimulant medications, or abused alcohol, prescription medicines, or street drugs;4
  • Use evidence-based screening tools to identify potential misuse or abuse;4
  • Counsel patients about the risks associated with prescription stimulant use, as outlined in product Medication Guides;12,13
  • Monitor patients on an ongoing basis while on therapy;4
  • Take note of rapid increases in the amount of prescription stimulant medication requested, or unscheduled or early refill requests;4
  • Check electronic health records to assess patients’ medical and prescription history;14
  • Check their state’s Prescription Drug Monitoring Program (PDMP) to identify individuals at risk for misuse and patients who are obtaining controlled substances from multiple providers;15
  • Use electronic prescribing for controlled substances to help improve efficiency, promote patient safety, and reduce diversion;16,17 and
  • Provide or refer patients to appropriate treatment if the patient has developed a substance use disorder 4

Tips for Pharmacists Include:

  • Help patients understand instructions for properly taking their prescribed stimulant medications, including providing patients with a product Medication Guide;12
  • Ensure patients understand how to properly store their prescribed stimulant medication;12
  • Be on the watch for falsified or altered prescriptions;4
  • Recognize patterns associated with misuse of prescription stimulant medication;4,5
  • Check their state’s PDMP to identify individuals at risk for misuse and patients who are obtaining controlled substances from multiple providers;4 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.18

Tips for Patients and Family Members Include:

  • Tell their doctors and pharmacists about all the medications your loved one is currently taking to help reduce the risk of dangerous drug interactions;4
  • Be aware of potential interactions between different medications;4
  • Follow the directions on the bottle label or explained by the clinician;4
  • Never change a dosing regimen without talking with their doctor;4
  • Do not drink alcohol while taking prescription stimulant medications;4
  • Never share medication with another person:4
    • Prescription stimulant medications should only be used as directed by the individual for whom the medication was prescribed;4
    • Sharing prescription stimulant medications is against the law;19 and
    • Sharing prescription stimulant medications can cause harm to the person for whom the medication was not prescribed.20
  • Store prescription stimulant medications properly:21
    • 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;21,22
    • Make sure the safety cap on medication containers is always locked;22 and
    • Tell your guests about medicine safety, and direct houseguests, and other visitors to keep purses, bags, or coats that have medicine in them away and out of sight when they are in your home.22
  • Properly dispose of unused prescription stimulant medications:18
    • Take-back options are the preferred way to safely dispose of most unneeded medications;18
    • There are periodic National Prescription Drug Take-Back events where temporary collection sites are set up for safe disposal, and there are authorized permanent collection sites, which may be in retail, hospital or clinic pharmacies and law enforcement facilities;18 and
    • If take-back programs or DEA-registered collection sites are not available, the FDA recommends disposing of prescription stimulant medications in the household trash by following the below steps:18
      • Mix medications with an unpalatable substance such as kitty litter or used coffee grounds;
      • Place the mixture in a container or sealed plastic bag;
      • Throw the bag into the trash; and
      • Remove or scratch out all personal information on the prescription label of the packaging and dispose.

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1 National Institute on Drug Abuse. Drug Facts: Stimulant ADHD Medications: Methylphenidate and Amphetamines 2014. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/sites/default/files/drugfacts_stimulantadhd_1.pdf.
2 National Institute on Drug Abuse. Drug Facts: Prescription Stimulants 2018. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants.
3 United States Drug Enforcement Administration. Drug Scheduling. Accessed on February 2020. Retrieved from https://www.dea.gov/drugscheduling.
4 National Institute on Drug Abuse: Misuse of Prescription Drugs 2018. Accessed on February 2020. Retrieved from https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/2609-misuse-of-prescription-drugs.pdf.
5 U.S. Food and Drug Administration. Remarks Delivered Before FDA’s Scientific Meeting on Opioids 2017. Accessed on February 2020. Retrieved from https://www.fda.gov/news-events/speeches-fda-officials/remarks-delivered-fdas-scientific-meeting-opioids-07102017.
6 National Institute on Drug Abuse. The Science of Drug Use and Addiction: The Basics 2018. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics.
7 U.S. Department of Justice, Drug Enforcement Administration. Drugs of Abuse: Stimulants 2017. Accessed on February 2020. Retrieved from https://www.dea.gov/sites/default/files/2018-06/drug_of_abuse.pdf.
8 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: 2018. Accessed on February 2020. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabsSect6pe2018.htm.
9 U.S. Department of Justice: Drug Enforcement Administration: Diversion Control Division. Program Description. Accessed on February 2020. Retrieved from https://www.deadiversion.usdoj.gov/prog_dscrpt/index.html.
10 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 2020. Retrieved from https://dhs.iowa.gov/sites/default/files/PAOWhatIsAPrescribersRoleInPrevDrugDiv012313f.pdf?022020202118.
11 Medline Plus. Substance Use Disorder. February 2020. Accessed on February 2020. Retrieved from https://medlineplus.gov/ency/article/001522.htm.
12 U.S. Food & Drug Administration. Medication Guides for Certain Prescription Products. April 1, 2019. Accessed on February 2020. https://www.fda.gov/consumers/consumer-updates/medication-guides-certain-prescription-products.
13 National Institutes of Health, National Institute of Drug Abuse. Research Report Series: Prescription Drug Abuse. Revised October 2011. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/sites/default/files/rxreportfinalprint.pdf.
14 National Institutes of Health, National Institute of Drug Abuse. Drug Screening and Assessment Resources. July 2018. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-prevention.
15 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 2020. Retrieved from https://www.cdc.gov/drugoverdose/pdmp/states.html.
16 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.
17 Drug Enforcement Administration. Economic Impact Analysis of the Interim Final Prescription Rule. March 2010. Accessed on February 2020. Retrieved from https://www.deadiversion.usdoj.gov/ecomm/e_rx/eia_dea_218.pdf.
18 U.S. Food & Drug Administration. Disposal of Unused Medicines: What You Should Know 2018. Accessed on February 2020. Retrieved from https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm.
19 Legal Information Institute. 21 U.S. Code § 829 – Prescriptions. Accessed on February 2020. Retrieved from https://www.law.cornell.edu/uscode/text/21/829.
20 National Institute on Drug Abuse. Drug Facts: Prescription and Over-the-Counter Medications 2013. Accessed on February 2020. Retrieved from https://www.drugabuse.gov/sites/default/files/drugfacts_rx_otc_5_2_13_ew2_0.pdf.
21 Centers for Disease Control and Prevention. Put Your Medicines Up and Away and Out of Sight 2018. Accessed on February 2020. Retrieved from https://www.cdc.gov/Features/MedicationStorage/.
22 Drug Enforcement Administration. Prescription for Disaster: How Teens Misuse Medicine. Accessed on February 2020. Retrieved from https://www.dea.gov/sites/default/files/2018-11/DEA_PrescriptionForDisaster-2018ed_508.pdf.
23 U.S. Department of Justice: Drug Enforcement Administration: Diversion Control Division. Controlled Substance Public Disposal Locations – Search Utility. Accessed on February 2020. Retrieved from https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e2s1.
24 National Association of Boards of Pharmacy: Drug Disposal Locator 2019. Accessed on February 2020. Retrieved from https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/.

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