用于治疗注意力缺陷多动障碍的兴奋剂的滥用与转移：文献系统综述
Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.
作者信息
Wilens Timothy E, Adler Lenard A, Adams Jill, Sgambati Stephanie, Rotrosen John, Sawtelle Robert, Utzinger Linsey, Fusillo Steven
机构信息
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
Dr. Wilens, Ms. Sgambati, Mr. Sawtelle, Ms. Utzinger, and Mr. Fusillo are with the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School; Drs. Adler, Adams, and Rotrosen are with the New York University School of Medicine and VA New York Harbor Healthcare System.
出版信息
J Am Acad Child Adolesc Psychiatry. 2008 Jan;47(1):21-31. doi: 10.1097/chi.0b013e31815a56f1.
OBJECTIVE
Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals.
METHOD
We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search.
RESULTS
We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment.
CONCLUSIONS
The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.
目的
近期研究提供了关于青少年和青年人群中兴奋剂转移以及非处方和处方兴奋剂药物使用频率和背景的多样信息。本系统文献综述的目的是评估注意力缺陷多动障碍（ADHD）患者和非ADHD患者中兴奋剂滥用和转移的程度及特征。
方法
我们对现有研究文献进行了系统综述，以滥用、转移、兴奋剂、非法使用和ADHD药物作为搜索关键词，查找处方ADHD药物的滥用和转移情况。
结果
我们确定了21项研究，涉及113,104名受试者。这些研究报告称，小学和高中年龄段儿童过去一年非处方使用兴奋剂的比例为5%至9%，大学年龄段个体为5%至35%。有兴奋剂处方的学生中，终身转移药物的比例为16%至29%，这些学生被要求赠送、出售或交易他们的药物。近期研究表明，白人、兄弟会和姐妹会成员、平均绩点较低的个体、与缓释制剂相比使用速释制剂的个体，以及报告有ADHD症状的个体，滥用和转移兴奋剂的风险最高。报告的使用、滥用和转移兴奋剂的原因包括集中注意力、提高警觉性、“兴奋”或尝试。
结论
文献表明，患有和未患有ADHD的个体都会滥用兴奋剂药物。近期研究已开始记录那些使用、滥用和转移兴奋剂风险最高的人群的背景、动机和人口统计学特征。文献强调需要仔细监测高危个体使用非处方兴奋剂的情况，并教育ADHD患者了解兴奋剂滥用和转移的陷阱。
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