High school seniors appear to be underreporting their nonmedical use of amphetamine, despite reporting using Adderall without a doctor's orders, finds a study by the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU Meyers College of Nursing.
"Our findings suggest that many young people are unaware that Adderall is amphetamine," said CDUHR researcher Joseph Palamar, PhD, MPH, the study's senior author and an associate professor of population health at NYU Langone Health. "In addition, such conflicting reports mean that prescription stimulant misuse may be underestimated."
Amphetamine is the most prevalent stimulant in the United States, commonly prescribed for attention-deficit/hyperactivity disorder (ADHD). Adderall, a combination of amphetamine salts, has been linked to enhanced cognitive function and academic performance, which, in part, has led to its "nonmedical" use - where it is taken on one's own without a doctor's supervision - among high school and college students.
Nonmedical use of amphetamine warrants concern due to its high potential for abuse and dependency, as well as potential adverse effects, including cardiovascular events and seizures. In addition, people who take prescription stimulants without a doctor's orders are more likely to engage in other drug use and risky behaviors.
Considering the popularity and potential dangers associated with use of amphetamine-based stimulants such as Adderall, Palamar and NYU colleague Austin Le sought to better understand nonmedical amphetamine use - and in particular, how accurately teens report their use.
In order to do this, the researchers compared whether teens reported nonmedical Adderall use and nonmedical amphetamine use when surveyed in the Monitoring the Future study (2010-2015), a nationally representative study of high school seniors. More than 24,000 high school seniors took part in the study.
Students were asked if they had used amphetamines on their own in the past year without a doctor telling them to take them. Adderall was included in the definition of amphetamine for the students. Later in the survey, students were asked if they had used Adderall in the past year without a doctor's orders.
While 6.9 percent of teens reported nonmedical Adderall use and 7.9 percent reportednonmedical amphetamine use, over a quarter (28.7 percent) of nonmedical Adderall users reported no nonmedical amphetamine use.
"Over a quarter of teens who reported using Adderall without a doctor telling them to take it contradicted themselves by saying they do not use amphetamine," said Palamar. "As a result, the estimated prevalence of nonmedical amphetamine use of 7.9 percent may be an underestimate; it may be as high as 9.8 percent, or one out of 10 high school seniors, when considering the discordant reporting we found."
Older students (ages 18 and up), Black students, and students with parents of lower educational attainment were more likely to report no nonmedical amphetamine use, despite reporting nonmedical Adderall use.
Because of the underreporting found in their study, the researchers recommend taking steps to ensure accurate and consistent responses in future surveys. For instance, researchers conducting drug surveys may benefit from providing images of specific substances, both to help participants recognize which pill is which and to help them identify the drug class.
"Alarmingly, we had similar findings regarding opioids in another study, with many teens appearing unaware that the Vicodin and OxyContin they took are opioids. Better drug education is needed to inform the public about common drugs like amphetamine and opioids," said Palamar.
"Accurate data on the prevalence of drug use is critical for informing prevention efforts, as over- or under-estimation may result in inadequate public health responses," said Austin Le, the study's coauthor and a DDS candidate at NYU College of Dentistry.
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