ANN ARBOR—Teens who take prescribed stimulant medications such as Ritalin, Adderall, Concerta and methylphenidate within a medical context early in life are at lower risk for developing substance use problems in adolescence, according to a new University of Michigan study.

When these medications are used early for nonmedical purposes, such as taking someone else’s prescription, the teens are more likely to develop substance use problems in adolescence.

“These findings are notable because the prescribing of stimulant medications, nonmedical use of prescription stimulants and related health consequences have increased significantly among youth in the United States over the past two decades,” said Sean Esteban McCabe, the study’s lead author and a research professor at the U-M Institute for Research on Women and Gender.

McCabe and colleagues examined how the context (medical versus nonmedical) plays a critical role in the relationship between early exposure to attention-deficit/hyperactivity disorder (ADHD) stimulant medication and the risk of substance use problems for adolescents.

The study included responses from 4,755 Detroit-area secondary school students who completed a web survey about substance use, such as cigarette smoking, binge drinking, marijuana use, nonmedical use of other prescription medications (anti-anxiety, pain and sleeping medications), and other drug use (LSD, heroin, Rohypnol, ecstasy). ADHD and substance use problems were also assessed. More than one in every 10 students in this sample had been diagnosed with ADHD.

There is significant state-to-state variability in the type of treatment for ADHD, and Michigan has the highest rate of medication treatment among children with ADHD in the U.S., McCabe said.

The late use of medical prescription stimulants are associated with greater odds of past year substance use problems when compared to their peers who use prescription stimulants within a medical context earlier in life and peers who do not use stimulants in a medical context, the study showed.

Both early and late use of nonmedical stimulants are associated with increased risk of substance use problems compared to peers who did not use simulants in a nonmedical context.

“The findings provide strong support that any nonmedical stimulant use among youth is a signal for potential substance use problems,” McCabe said. “The study also indicates the importance of carefully assessing and monitoring substance use behaviors among those prescribed stimulant medications for the first time in adolescence.”

McCabe collaborated with Philip Veliz, an IRWG research assistant professor, and Carol Boyd, a research professor at IRWG and the Deborah J. Oakley Collegiate Professor of Nursing.

The findings appear in the current issue of Drug and Alcohol Dependence. The study was supported by research grants from the National Institute on Drug Abuse, National Institutes of Health.

More information:

• Sean Esteban McCabe
• Philip Veliz
• Carol Boyd
• Drug and Alcohol Dependence