Novak Scott P, Kroutil Larry A, Williams Rick L, Van Brunt David L
RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
Subst Abuse Treat Prev Policy. 2007 Oct 31;2:32. doi: 10.1186/1747-597X-2-32.
Emerging evidence suggests that nonmedical use (NMU) of prescription attention deficit/hyperactivity disorder (ADHD) medications is rising, but many previous investigations have used clinical or regionally based samples or limited their investigations to stimulants rather than to medications specifically used to treat ADHD. Using an Internet-based epidemiological survey, this paper advances understanding of the prevalence and correlates of NMU of medications used to treat ADHD, sources of diverted medications, motivations for use, and consumption patterns.
The study used a self-administered Internet survey of civilian, noninstitutionalized adults (N = 4,297) aged 18 to 49 in the United States. National-level estimates were created using propensity scoring methods and weighting procedures using data from three nationally representative probability surveys: a random-digit dialed telephone survey, the current U.S. Census, and the National Survey on Drug Use and Health (NSDUH).
Past-year prevalence of NMU of ADHD medications was approximately 2%, with 4.3% reported among those aged 18 to 25 and 1.3% among those aged 26 to 49. Most respondents reporting NMU used on multiple occasions. Receipt of medications for ADHD was a significant correlate of past-year NMU, though most nonmedical users never had a prescription. Among persons who had never been prescribed medication to treat ADHD, friends or family members were the most common source. Productivity was the most frequently endorsed reason for NMU. Alcohol was the substance most commonly used in combination with ADHD drugs.
Because most prescription ADHD medications currently are highly regulated, policy options for supply-side reduction of nonmedical use may include identifying those medications with lower abuse liability for inclusion on insurance formularies. Patient and physician education programs also may be useful tools to heighten awareness of intentional and unintentional diversion of ADHD medications for nonmedical purposes.
新出现的证据表明，处方用注意力缺陷多动障碍（ADHD）药物的非医疗用途（NMU）正在增加，但之前的许多调查使用的是临床样本或基于地区的样本，或者将调查局限于兴奋剂，而非专门用于治疗ADHD的药物。本文通过一项基于互联网的流行病学调查，增进了对用于治疗ADHD的药物的非医疗用途的患病率及其相关因素、药物来源、使用动机和消费模式的了解。
该研究对美国18至49岁的非机构化平民成年人（N = 4297）进行了一项自填式互联网调查。使用倾向评分方法和加权程序，利用来自三项具有全国代表性的概率调查的数据创建了国家级估计值：一项随机数字拨号电话调查、当前的美国人口普查以及全国药物使用和健康调查（NSDUH）。
过去一年中ADHD药物非医疗用途的患病率约为2%，18至25岁人群中报告的患病率为4.3%，26至49岁人群中为1.3%。大多数报告有非医疗用途的受访者多次使用。过去一年使用ADHD药物的一个显著相关因素是曾接受过ADHD药物治疗，不过大多数非医疗使用者从未有过处方。在从未被开过治疗ADHD药物处方的人群中，朋友或家人是最常见的药物来源。提高工作效率是使用ADHD药物最常被提及的原因。酒精是最常与ADHD药物一起使用的物质。
由于目前大多数处方ADHD药物受到严格监管，减少非医疗用途的供应方政策选择可能包括确定那些滥用可能性较低的药物纳入保险处方集。患者和医生教育项目也可能是提高对ADHD药物用于非医疗目的的有意和无意转移的认识的有用工具。
