Abuse of Medications Employed for the Treatment of ADHD: Results From a Large-Scale Community Survey

Abstract

Objective

The objective is to assess abuse of prescription and illicit stimulants among individuals being treated for attention-deficit/hyperactivity disorder (ADHD).

Methods

A survey was distributed to patients enrolled in an ADHD treatment center. It included questions designed to gain information about demographics; ADHD treatment history; illicit drug use; and misuse of prescribed stimulant medications, including type of stimulant medication most frequently misused or abused, and how the stimulant was prepared and administered.

Results

A total of 545 subjects (89.2% with ADHD) were included in the survey. Results indicated that 14.3% of respondents abused prescription stimulants. Of these, 79.8% abused short-acting agents; 17.2% abused long-acting stimulants; 2.0% abused both short- and long-acting agents; and 1.0% abused other agents. The specific medications abused most often were mixed amphetamine salts (Adderall; 40.0%), mixed amphetamine salts extended release (Adderall XR; 14.2%), and methylphenidate (Ritalin; 15.0%), and the most common manner of stimulant abuse was crushing pills and snorting (75.0%). Survey results also showed that 39.1% of respondents used nonprescription stimulants, most often cocaine (62.2%), methamphetamine (4.8%), and both cocaine and amphetamine (31.1%). Choice of illicit drug was based on rapidity of high onset (43.5%), ease of acquisition (40.7%), ease of use (10.2%), and cost (5.5%).

Conclusions

The risks for abuse of prescription and illicit stimulants are elevated among individuals being treated in an ADHD clinic. Prescription agents used most often are those with pharmacologic and pharmacokinetic characteristics that provide a rapid high. This suggests that long-acting stimulant preparations that have been developed for the treatment of ADHD may have lower abuse potential than short-acting formulations.

Introduction

The US Drug Enforcement Administration (DEA) classifies stimulant medications used for the treatment of attention-deficit/hyperactivity disorder (ADHD) as controlled substances, assigning them a Schedule II rating. Nevertheless, stimulants are among the most frequently prescribed psychotropic agents for children and adolescents, particularly in the treatment of ADHD.[1] Prescriptions for stimulants have increased dramatically over the last 15 years.[2]

In 1996, more than 10 million prescriptions were written for methylphenidate, compared with approximately 3 million prescriptions in 1993.[3] Stimulant prescribing has increased for patients in all age groups, but particularly for those 5–14 years of age.[2,4] In addition, the number of stimulant formulations available for practitioners has increased in the last decade.[5,6]

Psychostimulants act on central dopaminergic pathways, and increases in brain dopamine levels following stimulant use account for the reinforcing effects and “high” experienced by humans administered these agents.[7] This effect appears to be particularly potent when drugs are administered intravenously, resulting in a rapid rise in drug serum concentrations and large increases in central nervous system (CNS) dopamine levels, which may increase the potential for abuse.[8] However, the relatively slow rate of delivery and reduced drug likeability associated with long-acting oral stimulants may reduce the potential for abuse associated with stimulants administered orally.[9] The fact that many stimulants used for the treatment of ADHD can be misused or abused by patients or diverted for misuse or abuse by others has raised concern among parents, teachers, healthcare providers, and the DEA.[10,11] The DEA expressed serious concern about the diversion and abuse of methylphenidate and has stated that this drug ranked in the top 10 most frequently reported controlled pharmaceuticals stolen from licensed handlers. The DEA also has indicated that the magnitude of methylphenidate diversion and trafficking is comparable to that for other abusable pharmaceuticals, such as morphine.[12,13]

Wilens and colleagues[10] reported that immediate-release methylphenidate was the stimulant most often reported by subjects who diverted (83%) or misused (75%) their medications, followed by immediate-release mixed amphetamine salts (33% for each outcome), although this study was conducted before the wide availability of long-acting stimulant preparations. The current study evaluated the abuse potential of short- and long-acting stimulants in patients receiving treatment for ADHD.

Methods

Subjects

Subjects for survey completion were recruited from a private ADHD treatment center located in a suburb of Richmond, Virginia, which draws patients from urban, suburban, and rural surrounding areas. Subjects included males and females ≥ 13 years of age who may or may not have been diagnosed with ADHD (confirmed by administration of the ADHD Rating Scale for adults),[14] but who had been prescribed short-acting (immediate-release) or long-acting stimulant medications and/or had abused these agents. Individuals who used illegal or illicit stimulants were also eligible for inclusion. There were no exclusion criteria.

Data Collection

The study survey (Appendix) was distributed to patients in an ADHD treatment center before or after their scheduled appointments or was mailed/faxed to patients for completion at home. The survey included questions designed to gain information about demographics (eg, age, education, clinical status); smoking status; illicit drug use; and misuse of prescribed stimulant medication, including the type of stimulant medication most frequently misused or abused (short-acting or long-acting), and how the stimulant was prepared and administered (eg, crushed and inhaled, crushed and injected, heated in a microwave to melt and then snorted).

Data Analysis

Descriptive statistics were used for a summary of all subject characteristics and types of stimulants abused. The manner in which each type of stimulant had been abused was also tabulated.

Results

Demographics and Clinical History

Approximately 750 surveys were distributed, and 545 were completed and returned. An interim analysis of these data evaluated 335 completed surveys.[15] Results presented here are based on all 545 completed surveys, which included 486 (89.2%) subjects with ADHD and 59 (10.8%) subjects without ADHD. The demographic characteristics of the survey respondents are summarized in Table 1. The majority (56.3%) of subjects participating in the survey were ≤ 25 years of age and either were attending or had graduated from high school. Most respondents (62.0%) were currently employed.

Table 1.

Demographic Characteristics of Survey Participants

Characteristic	Percent of Subjects (N = 545)
Sex, n (%)
Male	344 (63)
Female	201 (37)
Age (years)
12–17	20.7
18–25	35.6
26–34	18.0
35–39	6.6
≥ 40	16.9
Not recorded	2.2
Smoking status
Yes	49.4
No	48.8
Not recorded	1.8
Educational level
Did not graduate	7.2
High school	46.8
General Educational Development (GED) diploma	5.3
Associate's degree	10.6
Bachelor's degree	19.3
Master's degree	4.6
Doctoral degree	.9
Licensure	1.5
Certification	1.7
Currently in college	25.1
Not recorded	2.2
Employment
Yes	62.0
No	36.3
Not recorded	1.7
Marital status
Single	64.6
Married	19.1
Divorced	5.0
Widowed	.4
Separated	2.0
Cohabitation	5.0
Not recorded	4.0
History of arrest
Yes	31.9
No	65.7
Not recorded	2.4
Driver's license revoked
Yes	23.9
No	73.6
Not recorded	2.6

The clinical histories for the subjects included in this survey are summarized in Table 2. Overall, 89.2% of those surveyed had been diagnosed with childhood-onset ADHD, and 43.7% had begun taking stimulant medications when they were < 18 years of age. Most subjects surveyed were currently receiving stimulant therapy for ADHD, and most individuals were currently being treated with mixed amphetamine salts (Adderall = 13.8% of subjects) and mixed amphetamine salts extended release (Adderall XR = 64.2% of subjects).

Table 2.

ADHD History for Survey Participants

Characteristic	Percent of Subjects (N = 545)
Diagnosed with ADHD
Yes	89.2
No	10.8
Age began taking stimulants for ADHD (years)
6–12	20.4
13–17	23.3
18–24	17.2
≥ 25	26.8
Not recorded/did not recall	12.3
Current stimulant medication
Mixed amphetamine salts	13.8
Mixed amphetamine salts extended release	64.2
Methylphenidate	1.8
Methylphenidate long acting	0.2
OROS-methylphenidate	0.7
Dexmethylphenidate	1.1
Dexmethylphenidate extended release	1.3
Other	2.4
None	0.7
Not recorded	13.8

Stimulant Abuse

Prescription stimulants. Survey results indicated that 14.3% of respondents abused prescription stimulants (Figure 1A). Of those who abused prescription stimulants, 67.9% abused a single stimulant; 21.4% abused 2 stimulants; 4.8% abused 3 stimulants; and 6.0% abused 4 or more stimulants (Figure 1B). Survey results indicated that 79.8% of respondents who abused prescription stimulants abused short-acting agents; 17.2% abused long-acting stimulants; 2.0% abused both short- and long-acting agents; and 1.0% abused other medications (Figure 1C). Specific agents abused are shown in Figure 2. Those abused most often included mixed amphetamine salts (40.0%), mixed amphetamine salts extended release (14.2%), and methylphenidate (15.0%). The most common method of stimulant abuse was crushing pills and inhaling/snorting (75.0%), followed by crushing and injecting (6.3%), microwaving/melting to snort (6.3%), and other methods (12.5%) (Figure 3).

Figure 1A.

Abuse of prescription stimulants.

Figure 1B.

Number of prescription stimulants abused.

Figure 1C.

Characteristics of prescription stimulant abused.

Figure 2.

Specific prescription stimulants abused.

Figure 3.

Method of stimulant abuse.

Survey results indicated that 16.5% of respondents shared their prescription ADHD medications with others, most often friends (67.0% of those who shared) or relatives (28.4%).

Illicit stimulants. Survey results indicated that 39.1% of respondents used nonprescription (illicit) stimulants and that 42.6% of them had begun using these drugs before they were 18 years of age. The illicit stimulants used most often were cocaine (62.2%), methamphetamine (4.8%), or both cocaine and amphetamine (31.1%). Choice of illicit drug was based on the rapidity of onset of “high” (43.5%), ease of acquisition (40.7%), ease of use (10.2%), and cost (5.5%) (Table 3). Both prescription and illicit stimulants were used by 5.9% of all individuals surveyed.

Table 3.

Characteristics of Illicit Drug Use

Characteristic	Percent of Subjects (N = 545)
Used illicit stimulants
Yes	39.1
No	59.3
Not recorded	1.7
Age began use of illicit stimulants (years)
11–17	42.6
18–25	51.7
26–34	4.3
≥ 35	1.4
Illicit stimulant/s abused
Cocaine	62.2
Methamphetamine	4.8
Cocaine and methamphetamine	31.1
Cannabis	1.4
Other	0.5

Discussion

Results summarized in the preceding section indicate that approximately 15% of the respondents abused stimulants used to treat ADHD, and that short-acting agents were used significantly more often than long-acting agents (approximately 80% vs 17%, respectively). Study results also showed that nearly 40% of respondents used illicit stimulants.

The results from this large-scale survey are generally consistent with those from other studies that have addressed diversion and abuse of stimulant medications used to treat ADHD. Results from a survey of 161 children with ADHD indicated that 16% had been approached, either to sell or to give away their prescribed medication; however, the rates of diversion were not reported.[16]

A survey of 283 students at the Massachusetts College of Liberal Arts, in North Adams, Massachusetts, indicated a high rate of stimulant abuse: 16.6% of respondents had used methylphenidate recreationally, and 12.7% had snorted the drug. In addition, 35.7% of those surveyed indicated that they knew of students from whom they could purchase methylphenidate.[17] These findings are similar to those reported by White and colleagues[18] in a study of 1025 students at a university in the Northeast that showed that 16% of the respondents abused or misused stimulant medications, and that 96% of the respondents who abused stimulants preferred methylphenidate. Most (55%) respondents who abused or misused stimulant medications swallowed pills, and 40.3% used these medications intranasally.[18] In a study involving structured psychiatric interviews of 98 subjects receiving psychotropic medications for ADHD, 11% reported selling their drugs and 22% had misused their medications.[10] Results from a Canadian survey of 13,549 students indicated that of the 5.3% who reported stimulant use in the year before the survey, 14.7% reported having given away and 7.3% having sold some of their prescribed stimulants.[19] Results from a large-scale analysis carried out by the American Association of Poison Control Centers Toxic Exposure Surveillance System for 1993–1999 indicated 759 cases of stimulant abuse for individuals 10–19 years of age.[20] Of these, 42.7% of cases were reported for children and adolescents 10–14 years old, and 70.0% involved methylphenidate only. Results from this study also indicated that the frequency of stimulant abuse increased 7-fold vs the period from 1993 to 1999.[20] A review of drug abuse calls to Texas Poison Control Centers from 1998 to 2004 indicated that 6798 calls involved methylphenidate, and that 9% of these calls were related to abuse of this stimulant.[21] A large-scale survey of nonmedical use of prescription stimulants and other substance use behaviors, on the basis of self-reports from 10,904 randomly selected college students in 2001, indicated that the lifetime prevalence of nonmedical prescription stimulant use was 6.9%; previous-year prevalence was 4.1%; and previous-month prevalence was 2.1%. Rates of nonmedical stimulant use in college students were higher among males, whites, members of fraternities and sororities, and those with lower grade point averages.[22] A survey of 9161 university students indicated that 8.1% had illicitly used stimulant medications intended for the treatment of ADHD.[23] An analysis of data extracted from the National Survey on Drug Use and Health indicated that, in 2002, an estimated 21 million persons aged 12 years or older had misused at least 1 prescription stimulant during their lifetime. In an estimated 7.3 million persons (34.7%), the prescription stimulant abused was one used for the treatment of ADHD, and this figure represents nearly half of those misusing a nonmethamphetamine stimulant.[24]

Although only a small number of studies have evaluated the relative risks for abuse of various stimulant formulations, available data are consistent with those from the present study that indicate that long-acting or controlled-release formulations are less likely to be abused than short-acting agents.[10] The practice parameters for treatment of ADHD from the American Academy of Child and Adolescent Psychiatry indicate that extended-release stimulants are less likely to be misused or diverted than immediate-release agents.[3] There are several possible reasons for lower risk for abuse for long- vs short-acting stimulant medications used to treat ADHD. The kinetics of immediate-release stimulant formulations more closely match those of agents that have been demonstrated to be euphorigenic. Short-acting methylphenidate has reinforcing effects, characterized by a rapid rise in serum concentrations and concomitant increases in CNS dopamine levels.[8,25] These effects are readily achieved with an immediate-release formulation, but less so with an extended-release preparation. These findings are supported by significant differences in brain imaging/dopamine transporter occupancies for extended- and immediate-release methylphenidate. Results from 12 healthy adults randomly assigned to receive single doses of either immediate-release methylphenidate or osmotic-release methylphenidate indicated that, despite similar maximum plasma concentrations, osmotic-release methylphenidate had a prolonged time to maximum concentration and maximum CNS dopamine transporter occupancy vs immediate-release methylphenidate.[9] These findings suggest that the abuse potential of oral methylphenidate is strongly influenced by its rate of delivery and that the extended-release formulation of the drug has less abuse potential than immediate-release methylphenidate.[9]

The lower risk for abuse of extended-release formulations of methylphenidate or amphetamine may also be related to the fact that active components cannot be readily extracted from the beaded or osmotic extended-release preparations of these stimulants.[10] The active compound contained in the osmotic-release oral system (OROS)-methylphenidate preparation is very difficult to obtain by crushing, thus diminishing the abuse potential of methylphenidate, whereas the other 3 long-acting stimulant formulations comprise long-acting beads that are not conducive to abuse by snorting, sniffing, or injecting active drug.[5,9] These findings are consistent with a report on a group of adolescents with ADHD and a substance abuse disorder who were unable to achieve a high when attempting to inhale a preparation made from OROS methylphenidate.[26]

Conclusions

Results from this survey of patients enrolled in an ADHD treatment center indicated that abuse of stimulants employed for the treatment ADHD is common, and that abuse occurs much more often with short-acting preparations. These results suggest that careful selection of agents for the treatment of patients with ADHD has the potential to limit drug diversion and abuse. Use of extended-release stimulants, particularly in high-risk groups – such as those with a comorbid substance abuse disorder – may be useful for reducing the diversion and misuse of stimulant medication.

Appendix: Survey

Study Title: Survey Evaluation of the Misuse Potential of Short-Acting vs. Long-Acting Prescription Stimulants in ADHD

Sponsor: Shire Pharmaceuticals, Inc. (Shire)

Approval: November 17, 2005

Investigator: George M. Bright, M.D., Adolescent Health Center

Please take the time to read this informed consent form carefully and ask the research staff at Adolescent Health Center to explain any information that you do not clearly understand. Please make sure all your questions are answered before you sign the form. The information obtained from this form and from talking to the research staff may help you decide if you want to take part in this clinical research study. If you choose to take part in this study you must complete the information on page 4. Please remove this top page to keep for your records and return the remainder of the pages (3-14) stapled together to the Adolescent Health Center staff.

Introduction

You are being asked to take part in a clinical research study that involves answering questions in a written survey format (questionnaire). Please note that your responses will be kept strictly confidential and that we ask for your responses to be as open and honest as possible.

Purpose

To compare the potential for abuse and/or misuse of common prescription attention-deficit/hyperactivity disorder (ADHD) stimulant medications, including:

• Short-acting or Immediate-release stimulants; and

• Long-acting or Extended-release stimulants.

Nature

The study is being conducted by distributing a written questionnaire that addresses the potential for misuse and/or abuse of short-acting/immediate-release vs. long-acting/extended-release prescription stimulants. The questionnaire also surveys any history of use of illegal stimulant drugs and the use of these drugs in combination with prescribed stimulant medications. Finally, the questionnaire will ask for basic demographic information such as age, level of education achieved, employment history and marital status.

Patient Population

The goal is to collect and evaluate a minimum of 1000 surveys from different patients that are diagnosed with ADHD who have a history of prescribed stimulant medication use and/or illegal/illicit stimulant use. The patients will include adolescents (at least 13 years old) and adults.

Inclusion Criteria

Male and Female patients, at least 13 years of age at the time of completion of the questionnaire, who have been diagnosed with ADHD and who have used short-acting/immediate-release and/or long-acting/extended-release stimulant medications either as prescribed or through abuse/misuse and/or who have used illegal stimulant drugs.

Exclusion Criteria

• Any person less than 13 years old.

• Any person who has never been diagnosed with ADHD.

• Any person who has never used any legal (prescribed) stimulant drug or illegal/illicit (non-prescribed) stimulant drug.

Procedures

To identify and survey 1000 participants with DSM-IV diagnosed ADHD with or without a history of stimulant drug use. The questionnaire will be given to participants that meet the inclusion criteria and will be completed while at their regularly scheduled office visit. Some participants may return the completed survey in a postage paid envelope provided by study staff.

Risks

There are no known risks to participants since the review of the survey information will be conducted as a statistical analysis with no ability to reveal any participant's identity with demographic information. Any participant under the age of 18 should have parental or guardian consent before the survey is provided to the minor patient due to the sensitive nature of questions regarding illicit drug use. All responses to survey questions will be kept entirely confidential.

Benefits

We can not guarantee that participants will benefit in any specific way from taking part in this study. It is our belief that such clinical research studies provide valuable information that may improve treatment used for ADHD.

Confidentiality

The participant's signature (or the signature of their parent/guardian, if they are under 18 years old) on page 4, authorizes the study staff to collect, analyze and disseminate for academic or clinical purposes the information provided through responses in the following questionnaire. Because this is a survey based clinical assessment intended to provide information for statistical purposes, every effort will be made to maintain anonymity of participants. It is our intent to keep all information about the participants confidential to the extent permitted by applicable laws and/or regulations.

Signatures

The participant's signature (and the signature of their parent/guardian, if they are under 18 years old) on page 4 confirms that they have thoroughly read and understand the information provided in this consent form on pages 1-2. The signature(s) further verify that the participant (and parent/guardian, if applicable) has been provided clear answers to any and all questions they have presented to study staff. The participant's voluntary informed consent documented by completing and signing page 4, allows George M. Bright, M.D., and the study staff to retrieve, review and statistically analyze data from their medical records including, but not limited to, this questionnaire.

**Pull off this top page (pages 1-2) to keep for your information and records. Return the remainder of this document (pages 3-14) to a study staff member at the office where it was provided to you or via the postage paid envelope that was provided to you (if applicable).

BLANK COVER PAGE

Leave this page in place to conceal the following information during collection of questionnaires.

The preceding informed consent form and the associated clinical research study has been explained to me, I have had the opportunity to ask questions and have received complete and clear answers from study staff, and I agree to disclose my medical records including, but not limited to, my responses to this questionnaire for the purpose of a review of pertinent data, analysis of data and presentation of findings.

Informed Consent Signatures
To be completed by participant or parent/guardian (if participant is <18 y/o):
Participant Name (Please Print)
Participant Signature (for participants >17 y/o)	Date
Parent/Guardian Name (for participants <18 y/o) (Please Print)
Parent/Guardian Signature (for participants <18 y/o)	Date
To be completed by clinical research/office staff:
Clinical Research Staff Member Name (Please Print)
Clinical Research Staff Member Signature	Date

Please complete the following confidential demographic information to help ensure we do not enroll a participant more than once. The information will also assist us in contacting you if we require additional information or clarification of a response (e.g., a missed or incomplete response) or if we wish to provide the participant with follow up information.

Participant Demographics
This information will be kept confidential in a secure location separate from your questionnaire!
XXX - -	/ /
Social Security No. (last 6 digits only)	Date of Birth (dd/mm/yyyy)	Email Address (johnsmith@comcast.net)
( )	( )	( )
Home Phone	Cell Phone	Other Phone
Street Address		Apt./Suite No.
City	State	Zip Code

Thank you for your cooperation and time investment in this clinical research study.

Please answer the following questions as completely and honestly as possible. Your responses will be stored in a secure data format with complete anonymity. Page 4 with the identifying participant demographic information will be separated from the remainder of the questionnaire and stored in a different location.

1. Have you ever been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and return the survey - you are done.)

2. Have you ever been prescribed and taken a stimulant medication for the treatment of ADHD? (See page 13 for a list of examples of prescription stimulant medications.)

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #10.)

3. How old were you when you were first prescribed a stimulant medication for the treatment of ADHD? (Please check one of the following age ranges. If you remember the specific age, please also write it in the space provided. For example, 6–12 years old; 10 years old.)

• Do not recall or know

• 6–12 years old

• 13–17 years old years old (exact age)

• 18–24 years old

• 25 years or older

4. Which of the following stimulant medications have you been prescribed and taken for the treatment of ADHD (include past and present medications, check all that apply)?

• Adderall (amphetamine)

• Adderall XR (Extended-release amphetamine)

• Ritalin (methylphenidate)

• Ritalin LA (Long-acting methylphenidate)

• Concerta (methylphenidate hydrochloride)

• Focalin (dexmethylphenidate hydrochloride)

• Focalin XR (Extended-release dexmethylphenidate hydrochloride)

• Other (Please fill in the name.)

5. Which stimulant medication were you prescribed first for the treatment of ADHD? (Check only one.)

• Adderall (amphetamine)

• Adderall XR (Extended-release amphetamine)

• Ritalin (methylphenidate)

• Ritalin LA (Long-acting methylphenidate)

• Concerta (methylphenidate hydrochloride)

• Focalin (dexmethylphenidate hydrochloride)

• Focalin XR (Extended-release dexmethylphenidate hydrochloride)

• Other (Please fill in the name.)

• Do not recall or know

6. Which stimulant medication(s) are you currently prescribed for the treatment of ADHD? (Check all that apply.)

• Adderall (amphetamines)

• Adderall XR (Extended-release amphetamines)

• Ritalin (methylphenidate)

• Ritalin LA (Long-acting methylphenidate)

• Concerta (methylphenidate hydrochloride)

• Focalin (dexmethylphenidate hydrochloride)

• Focalin XR (Extended-release dexmethylphenidate hydrochloride)

• Other (Please fill in the name.)

• None

7. What is the dose for each of the stimulant medications you are currently prescribed and are taking for the treatment of ADHD? If your dose varies (during the day or on different days), please describe your dose regimen/schedule (e.g., different dosages in the morning and evening, different doses at different times of the year, or additional doses as needed). Please circle the medication name, and fill in the concentration (dose/tablet), number of tablets taken for each dose, how often you take a dose (times/day) and your total amount per day.

Examples only:

	Stimulant	Dose/Tablet	No. Tablets	How Often Taken/Total
1	Adderall	30 mg/tablet	1 tablet	Two times per day (60mg)
2	Adderall XR	20 mg/tablet	1 tablet	One time per day (20mg)
3	Ritalin	10 mg, 5 mg	1 of each	Three times per day (45mg)
4	Ritalin LA	30 mg/tablet	2 tablets	Usually once a day (60mg)
5	Concerta	18 mg/tablet	2 tablets	One time per day (36mg)
6	Focalin	20 mg/tablet	1 tablet	Two times per day (40mg)
7	Focalin XR	5 mg/tablet	1 tablet	Two times per day (10mg)
8	Other Dexadrine	5 mg/tablet	1 tablet	Three times per day (15mg)

Provide your answers here:

	Stimulant	Dose/Tablet	No. Tablets	How Often Taken/Total
1	Adderall
2	Adderall XR
3	Ritalin
4	Ritalin LA
5	Concerta
6	Focalin
7	Focalin XR
8	Other

Use additional space here to further explain your dose regimen/schedule in detail (for example, if you take different dosages on different days of the week, at different times of the day, different parts of the school year, or if you take a supplemental dose as needed, etc.)

8. Have you ever shared your prescribed stimulant medication with someone else?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #10.)

9. Indicate below with whom you have shared your prescribed stimulant medication?

• Family member or Relative (parent, sibling, child, spouse, cousin, etc.)

• Friend or Roommate (someone you know well)

• Classmate (someone you know less than a close friend)

• Acquaintance (someone you barely know)

• Stranger

Please describe why or under what circumstances you shared your stimulant prescription with the person (or persons, if more than one) identified above.

10. Have you ever used a non-prescribed illegal or illicitly obtained stimulant drug such as cocaine or methamphetamines? Include illegal stimulants and stimulants not prescribed to you. (See page 13 for a list of examples of stimulant drugs.)

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #15.)

11. Which non-prescribed stimulant(s) (illegal or illicit) did you use? Include illegal stimulants and stimulants not prescribed to you. (See page 13 for a list of examples of stimulant drugs.)

• Cocaine

• Methamphetamine

• Other

• Other

• Other

12. How many times have you used the non-prescribed (illegal or illicit) stimulants that you indicated in Question #11? Include illegal stimulants and stimulants not prescribed to you. (See page 13 for a list of examples of stimulant drugs.)

Fill in the name of the drug(s) in the first row (at the top of each column) and place a check below it on the row that indicates your frequency of use. If you know the exact number of times or can reasonably calculate or estimate the number of times, write in the number below the drug on the last line of the table.

Drug Name:
Once
Twice
Few Times (3–9)
Several Times (10–20)
Many Times (20–100)
Too Many to Count (>100)
Calculated/Estimated No.

13. How old were you when you first used/took a non-prescribed (illegal/illicit) stimulant drug? Include illegal stimulants and stimulants not prescribed to you. (Please check one of the following age ranges. If you remember the specific age, please also write it in the space provided. For example, 18–25 years old; 21 years old.)

• Do not recall or know

• 11–17 years old

• 18–25 years old years old (exact age)

• 26–34 years old

• 35 years or older

14. From whom did you obtain the non-prescribed (illegal/illicit) stimulant drug listed above? Include illegal stimulants and stimulants not prescribed to you.

• Family member or Relative (parent, sibling, child, spouse, cousin, etc.)

• Friend or Roommate (someone you know well)

• Classmate (someone you know less than a close friend)

• Acquaintance (someone you barely know, may include a drug dealer)

• Stranger (someone you do not know by name, may include a drug dealer)

15. Have you ever used your prescription stimulant for purposes other than its prescribed use (for example, snorted or injected it to get “high,” rather than using it as prescribed for the treatment of ADHD)?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #21.)

16. Approximately how often or how many times have you engaged in this type of stimulant use (using a prescription stimulant for non-prescribed purposes)? If you can calculate or estimate the number of times you have used a prescription stimulant in this manner, please list the number in the blank space. (For example, if your use is daily for a year, estimate 365 times.)

• Once

• Twice

• Few Times (3–9 times) calculated # of times

• Several Times (10–20 times)

• Many Times (20–100 times)

• Too Many Times to Count (> 100 times)

17. How many different stimulants (prescription and non-prescription) do you typically use at one time for non-prescribed purposes (for example, to get “high”)?

• One

• Two

• Three

• Four

• More Than Four

18. In the following table indicate:

1. which prescription stimulants you have used for non-prescribed purposes (circle the drug name);

2. the cost to you to obtain these medications outside of your normal use of prescribed stimulants (fill in the amount you paid under the drug name); and

3. how you prepared them for use (place a check mark below the drug on the line indicating the method of preparation for use – choose your most common method per drug).

Use the blank column at the end to write in any prescription stimulant that you do not see listed already.

Short-acting/Immediate-release Stimulants:

Stimulant used:	Adderall	Ritalin	Focalin
Cost per pill:	$	$	$	$
Preparation for use:
Crush & inhale it
Crush & inject it
Soak overnight & inject it
Soak overnight & drink it
Microwave/melt & inject it
Microwave/melt & drink it
Microwave/melt & snort it
Other

Long-acting/Extended-release/Slow-acting Stimulants:

Stimulant used:	Adderall XR	Ritalin LA	Focalin XR	Concerta
Cost per pill:	$	$	$	$	$
Preparation for use:
Crush & inhale it
Crush & inject it
Soak overnight & inject it
Soak overnight & drink it
Microwave/melt & inject it
Microwave/melt & drink it
Microwave/melt & snort it
Freeze, crush & snort it
Other

19. Rank the order of importance of the four factors below in impacting your choice of a stimulant to use for non-prescribed purposes. Rank the items 1 through 4, assigning “1” to the most important factor and “4” to the least important factor to you.

___ How quickly you experience a “high” or other desired effect from the drug

___ How easy you can obtain or get the drug

___ How easy the drug is to use for the non-prescribed purpose (e.g., ease of preparation)

___ Cost of the drug

20. Have you ever taken a prescribed stimulant and cocaine at the same time to enhance the effect of either one?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and proceed with the next question.)

21. What is your current age? years old.

22. What is the highest level of education you have completed to date? (Check only one.)

• Currently in elementary, middle, or junior high school

• Currently in high school

• High School Graduate or GED

• Associate's Degree

• Bachelor's Degree

• Master's Degree

• Doctoral Degree (PhD, EdD, PharmD, etc.)

23. Have you obtained any of the following credentials as a result of specialized education beyond high school? (Check any that apply and fill in a description of the credential.)

• Licensure (e.g., RN, MD, DDS)

• Certification (e.g., Technician)

• Other

• N/A

24. Are you currently enrolled in a traditional college or university?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #26.)

25. How many years of college have you completed to date in your current program? Indicate the type of program in which you are currently enrolled. (Check only one in each column.)

• One Undergraduate (Bachelor's degree)

• Two Graduate (Master's degree)

• Three Post-Graduate (Doctoral degree)

• Four

• More than four

26. Are you currently enrolled in a trade/vocational/technical school?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #28.)

27. Approximately what percentage of your program have you finished? (Check only one.)

• ¼ of the way through

• ½ of the way through

• ¾'s of the way through currently in the last semester, quarter or session of classes

28. Are you currently enrolled in any other type of non-traditional educational program (certification program, for example)?

• Yes (If you answered “Yes,” check this box & describe the type of program, your area of study and how much of the program you have completed on the line below.)

• No (If you answered “No,” check this box and go to question #29.)

29. Are you currently employed?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #31.)

• N/A (<15 yrs. old, still in elementary, junior or high school, permanently disabled.)

30. What is your current occupational category? Select the best match and fill in your current job title. (See pages 13-14 for examples of occupations for each category.)

• Management, Business & Financial Operations

• Professional

• Service

• Sales

• Office & Administrative Support

• Farming, Fishing & Forestry

• Construction

• Installation, Maintenance & Repair

• Production

• Transportation & Material Moving

• Armed Forces

• Self-employed

• Job Title

31. How many jobs have you held in the last three years? (If self-employed, count your own business as one job.)

32. What is your current marital status?

• Single

• Married

• Divorced

• Widowed

• Separated

• Have a partner, living together, not married

33. Have you ever been divorced?

• Yes

• No

• N/A (Have never been married)

34. Have you ever smoked a tobacco or tobacco-like product? (For example, cigarettes, cigars, pipe tobacco, cannabis.)

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #39.)

35. At what age did you first start smoking? (Please check one of the following age ranges. If you remember the exact age, please also write it in the space provided. (For example, 11–17 years old; 14 years old.)

• Do not recall or know

• 11–17 years old

• 18–25 years old years old (exact age)

• 26–34 years old

• 35 years or older

36. Do you currently smoke tobacco or other tobacco-like products? (For example, cigarettes, cigars, pipe tobacco, cannabis.)

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #39.)

37. Indicate which products you smoke. (Check all that apply.)

• Cigarettes

• Cigars

• Pipe tobacco

• Cannabis

38. Indicate under each product how often or how much you smoke that product.

Frequency	Cigarettes	Cigars	Pipe Tobacco	Cannabis
Number per day or # of times per day
Number per week or # of times per week
Number per month or # of times per mo.

39. Have you ever been issued a driver's license?

• Yes (If you answered “Yes,” check this box and proceed with the next question.)

• No (If you answered “No,” check this box and go to question #41.)

• N/A (Check this box if you are unable to apply for a license due to age or disability, for example, and go to question #41.)

40. Have you ever had your driver's license suspended or revoked?

• Yes

• No

41. Have you ever been charged with, arrested or convicted for an unlawful act?

• Yes

• No

Common Stimulant Medications Prescribed for ADHD

Trade Name	Generic Name
Adderall	amphetamine
Concerta	methylphenidate (long acting)
Cylert	pemoline
Dexedrine	dextroamphetamine
Dextrostat	dextroamphetamine
Focalin	dextroamphetamine
Metadate ER	methylphenidate (extended release)
Metadate CD	methylphenidate (extended release)
Methylin	methylphenidate
Methylin ER	methylphenidate (extended release)
Ritalin	methylphenidate
Ritalin SR	methylphenidate (extended release)
Ritalin LA	methylphenidate (long acting)

Stimulant Medications/Drugs Commonly Obtained and/or Used Illegally/Illicitly

Common Name	Alternative/Slang Names
amphetamine	Dexadrine, Fastin, Ionamin, Sanorex, Tenuate
Benzedrine
benzphetamine	Didrex s
Butyl Nitrite
Cocaine	Coke
Crack Cocaine	Crack, Crack Cocaine, Freebase Rocks, Rock
dextroamphetamine	Dexedrine, Dextrostat, Focalin
Ice	Meth, Crystal, Crank, Methamphetamine
methylphenidate	Metadate (ER, CD), Methylin (ER), Ritalin (SR, LA)
Phenmetrazine

Occupations (From the Occupational Outlook Handbook of the Bureau of Labor Statistics)

Management
Administrative Services mgr Advertising/PR/Sales mgrs. Computer/IT/IS managers Construction managers Education Administrators Eng./Science managers Farming/Ag. managers Food Service managers	Funeral Directors HR/training/labor rel. mgrs. Industrial Production mgrs. Lodging managers Medical/Health Svcs. Mgrs. Property managers Purchasing managers/buyers Accountants/Auditors	Appraisers/Assessors Budget analysts Claims adjusters/examiners Insurance underwriters Loan officers Management analysts Meeting/Convention planners Tax examiners/collectors
Professional
Computer occupations Mathematical occupations Architects/Surveyors Cartographers Engineers Drafters/Engineering Techs.	Life Scientists Physical Scientists Social Scientists Science technicians Community/Social Services Legal occupations	Education/training/library Art/Design occupations Entertainers/performers/sports Media/Communications Health Diagnosing/Treating Health technologist/technician

*Chart continued on next page.

Service
Healthcare support occup. Protective service occup.	Food preparation/serving Building/Grounds cleaning	Personal care occupations Personal service occupations
Sales
Advertising sales agents Cashiers Counter & rental clerks Demonstrators, models	Insurance sales agents Real estate brokers/agents Retail sales persons Sales engineers	Sales reps, wholesale/manuf. Sales worker supervisors Financial services agents Travel agents
Office & Administrative Support
Financial clerks Information/record clerks Office & administrative sups Secretaries/Admin. Assistant	Material recording, scheduling, dispatching, & distribution Office clerks	Communications equip. ops. Computer operators Data entry/info. processing Desktop publishers
Farming
Agricultural workers	Fishers/fishing vessel ops.	Forest/Conservation/Logging
Construction
Boilermakers Brick/block/stone masons Carpenters Carpet/tile/floor installers Cement/Concrete finishers Construction/Bldg. Inspector	Construction equip. operator Construction laborers Drywall/tile installers/tapers Electricians Elevator installers/repairers HazMat removal workers	Painters/Paperhangers Pipelayers/plumbers/pipefitters Plasterers/Stucco masons Roofers Sheet metal workers Iron/Metal workers
Installation, Maintenance & Repair
Electrical & electronic equipment mechanics, installers, and repairers	Vehicle & mobile equipment mechanics, installers, and repairers	Other installation, repair & maintenance – Heating & A/C, Home appliance, etc.
Production
Assemblers/fabricators Food processing Metal workers/plastic work Printing occupations	Textile, apparel, furnishings Woodworkers Plant & system operators Inspectors, testers, sorters	Jewelers, stone/metal worker Painting/coating workers Photographic process worker Semiconductor processors
Transportation
Air traffic controllers Aircraft pilots/flight eng. Material moving occupations	Busdrivers Taxi drivers, chauffeurs Truckdrivers	Driver/sales workers Rail transportation jobs Water transportation jobs
Armed Forces
Any occupation similar to those above, performed while enlisted in one of the branches of the armed forces (Army, Navy, Marine Corps, and Air Force)