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Dr. Timothy Wilens on the Risks of Stimulant Misuse and Abuse

December 09, 2020

(Part 5 of 5)

Timothy Wilens, MD, discusses the risks associated with misuse and abuse of prescription stimulants. Dr. Wilens is Chief, Division of Child and Adolescent Psychiatry, and Co-Director, Center for Addiction Medicine, at Harvard Medical School, Boston, Massachusetts.

Read the transcript:

A lot of people say, "So what?" about stimulant misuse. “Why is that such a big deal?” I have to say, when I first started doing research in this area I said, "It's pretty benign." That's what I thought. In fact, the more you study it, the more you understand what is linked to stimulant misuse both short‑term and long‑term. It isn't so benign.

It has some ramifications that are noteworthy and helpful so that you can talk to your potential patients and the lay public about this, so we can help reduce these issues. Number one, there are data that show, we've demonstrated that in our studies, that stimulant misuse is associated with substance use disorders.

In fact, study after study, survey study, in‑depth studies, show that about half of kids who misuse stimulant medications also have a bona fide substance use disorder, much higher than the general population rate or population rate in that age group. There is something going on that's linking stimulant misuse with substance use disorders.

These are kids who are also having a lot more academic decline at that time. The other interesting component of that is if you look at kids even in high school who misuse stimulants and you ask the question, what happens when they're adults? We've done this.

Sean McCabe from University of Michigan, and myself, and a team looked at 15‑year follow‑ups of kids who had misused stimulants in high school and found that they were at higher risk for substance use disorders across their lifespan, that they had academic and occupational underperformance and underachievement, and that there were lasting effects to the age of 35.

Is it that the stimulant misuse led to that or is a marker? We don't know. There was clearly impact and things seen longitudinally associated with early misuse of stimulant medications.

The other thing we always worry about is medical complications and co‑occurring problems or comorbidities associated with stimulant misuse.

Dr. Steve Faraone and myself published something1 recently that looked at the poison control reports for misuse of this class of medications and found that there was significantly increased both medical morbidity as well as even mortality, death, associated with misuse of stimulants.

To no surprise, that risk increases with any misuse but really goes up dramatically with intranasal or intravenous misuse. As I said earlier, intranasal misuse occurs in up to 40 percent of kids who are misusing the immediate‑release preparations of stimulants.

It's not an uncommon phenomena and you see things such as more hospital stays, more difficulties with cardiac issues, even GI issues, pulmonary issues, and, unfortunately, higher rates of mortality.

What used to be thought of as, "Well, kids are just using a little bit of Ritalin here or there or Adderall," or whatever it was, is now body of work is telling us this is a more significant issue and something that we all need to work together as prescribers and practitioners to start to reduce the ultimate prevalence of this across all of our society, and in particular, in the areas such as college where we know these rates are higher.

More from Dr. Wilens:
Negative Outcomes Associated With Untreated ADHD
Improving Outcomes in ADHD Through Early Treatment
Strategies for Treating Patients With Both ADHD and SUD
Limiting the Misuse and Diversion of Prescription Stimulants


Faraone SV, Hess J, Wilens T. Prevalence and consequences of the nonmedical use of amphetamine among persons calling poison control centers. Journal of Attention Disorders. 2019;23(11):1219-1228.

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