A recent survey conducted by Harris Poll on behalf of the newly-formed Coalition to Prevent Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Misuse (CPAMM) finds that college students' perceptions and attitudes towards the misuse, abuse and diversion of ADHD prescription stimulants are complex. The findings paint a portrait of students who recognize the risks of misuse, but understand why some students may choose to misuse, given the academic pressures in today's college environment. CPAMM intends to use the findings to inform and develop educational campaigns to help prevent nonmedical use of ADHD prescription stimulants. The survey was conducted online between May 15 and June 11, 2014 among 2,056 US college students (full-time, 91%, part-time, 9%), defined as adults aged 18 to 24 enrolled and seeking a degree at a 4-year college or university and attending at least some in-person classes.1
Attitudes and perceptions about misuse, abuse and diversion
Based on the survey, college students consider taking ADHD prescription stimulant medications that were not prescribed to them to be unethical (75%), a form of cheating (when used for schoolwork)(59%), extremely/very harmful (73%) and a "big deal" (80%) if someone who doesn't have ADHD uses prescription stimulants, with 65% likening the misuse of ADHD prescription stimulants to do schoolwork to athletes who use performance-enhancing drugs. However, almost one in four students (24%) do believe it is okay for someone who doesn't have ADHD to use prescription stimulants for schoolwork, and 48% believe that students who misuse are just doing what they have to do to keep up with the pressures of college. In addition, 42% of students incorrectly believe that using ADHD prescription stimulants not prescribed to them is no more harmful than an energy drink or a strong cup of coffee.
Further, the majority of students believe the main drivers to start misusing ADHD prescription stimulants are a desire to get good grades (70%) and pressure to succeed (68%). Overall, 64% of students declare that they would "do anything to get an A," and 29% admit they will do whatever it takes to succeed academically even if it requires breaking the rules.
"The survey shines a light on the stress permeating the lives of students on today's college campuses.
We want to communicate as a Coalition that there are better, healthier ways to cope," says John MacPhee, Executive Director and CEO of The Jed Foundation, a CPAMM partner. Another perception of note is that 75% of students believe at least some of their peers have used ADHD prescription stimulants not prescribed to them. Reported rates of actual nonmedical use vary, but a 2013 survey at one large public university indicated that 9.3 percent of college students reported nonmedical use of prescription stimulant medication in the past year.2
"The misconception that 'everybody is doing it' and that misusing will somehow guarantee better grades is something that CPAMM hopes to challenge by creating peer-to-peer interventions for use by college students," says Ann Quinn-Zobeck, Senior Director of the BACCHUS Initiatives of NASPA, a CPAMM partner.
Groups that are more at risk to misuse
Two groups that stand out are members of Greek organizations (fraternities and sororities) and athletes (members of varsity, junior varsity, intramural and/or club teams). These groups are significantly more likely than their respective counterparts to say they are at least somewhat likely to use ADHD prescription stimulants in a way that is different from a doctor's instructions (Greeks, 40%, non-Greeks, 23%, athletes, 36%, non-athletes, 21%). They are also more likely to believe that using ADHD prescription stimulants without a prescription can help students get better grades even if they don't have ADHD - 52% of Greeks (versus 42% of non-Greeks) and 50% of athletes (versus 41% of non-athletes).
Where do college students believe their peers are getting ADHD prescription stimulants?
The survey reveals that 71% of students believe it is easy to obtain ADHD prescription stimulants without a prescription: 87% of students believe friends who have a prescription are the primary source for those who misuse, and about one in two (48%) also think an avenue to obtain them is pretending to have ADHD and getting a prescription from a health care professional. Of the 8% of students diagnosed with ADHD in the survey, more than a quarter (27%) feel it is acceptable for students with ADHD to share their prescription with a friend. Additionally, 46% of students who are diagnosed with ADHD and have a prescription stimulant feel at least a little pressure to share or sell their medication.3
"We recognize the role that students with ADHD may play, and are committed as a Coalition to instilling a greater sense of responsibility in students appropriately diagnosed with ADHD to not divert their supply and to help them feel empowered to say no when peers approach them for their medication," says Ruth Hughes, Ph.D., Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a CPAMM partner.
Dr. Julie Wood, Vice President for Health of the Public and Interprofessional Activities, American Academy of Family Physicians (AAFP), a CPAMM partner, agrees: "For students appropriately diagnosed with ADHD, the medicines may help. However, it is important for students with ADHD to recognize that distributing their medication to others is illegal and could be harmful, and for physicians to recognize their role in helping ensure this recognition."
Students' perception of university policies
Despite recognition of the consequences of misuse, and a belief by two in five students (40%) that misuse is a problem at their school, nearly three in five students (57%) believe that the administration and the professors at their school are unaware of the misuse of ADHD prescription stimulants on campus. Moreover, almost three in five college students (58%) feel that their school does not make it clear that they do not approve of ADHD prescription stimulant medication misuse.
"Many colleges and universities have a policy against ADHD prescription stimulant misuse, abuse and diversion, however as an association that represents more than 14,000 higher education professionals, it is imperative that we increase awareness of the seriousness of the issue for college administrators," says Kevin Kruger, Ph.D., President of NASPA, Student Affairs Administrators in Higher Education, a CPAMM partner.
Next steps for the Coalition to Prevent ADHD Medication Misuse (CPAMM)
"As the first national survey to evaluate the mindset of students surrounding ADHD prescription medication misuse, we find this research to be very insightful and informative," says Gwen Fisher, Senior Director of Corporate Communications, Shire, a CPAMM partner. "As a Coalition, we strive to be a trusted source of information. Understanding the attitudes, motivation, perceptions and misperceptions of college students around the issue is crucial to helping prevent nonmedical use - the primary mission of CPAMM. The data actually points to additional areas for further exploration."
Throughout 2014-2015, CPAMM plans to survey medical professionals to identify primary-care based strategies to help reduce ADHD medication misuse, abuse and diversion. In addition, the Coalition will conduct focus groups among college students and administrators to try to gain a better understanding of how the college environment affects the issue and what kind of programmatic efforts might be most effective. Also, the Coalition will evaluate potential partnerships with other organizations, associations and programs that reach college students. Ultimately, CPAMM intends todevelop peer-to-peer interventions for use by college students to help prevent the nonmedical use of ADHD stimulant medications. For more information regarding CPAMM or the "College Students and the Misuse, Abuse and Diversion of ADHD Prescription Stimulant Medications" survey, visit CPAMM.org. Join the conversation online using #CPAMMorg.