Prevalence of pharmacotherapy for attention‐deficit/hyperactivity disorder and prescription stimulant misuse: A national study of US college students

Abstract

Background and aimsIncreasing rates of attention‐deficit/hyperactivity disorder (ADHD) pharmacotherapy may simultaneously benefit patients and increase the availability of stimulants for misuse. We measured the association between university‐level prevalence of ADHD medication treatment and prevalence of prescription stimulant misuse (PSM) among college students.Design, setting and participantsThis was an observational study using cross‐sectional data from the American College Health Association–National College Health Assessment III. Data included 395 participating universities between Fall 2019 and Fall 2022. Our sample included 224 469 undergraduates aged 18–25 years (65.2% cisgender female; 58.7% White).MeasurementsStudents self‐reported any life‐time clinical ADHD diagnosis, past‐year ADHD medication treatment and past‐3‐month PSM. We defined university‐level ADHD medication prevalence as the proportion of included students endorsing past‐year ADHD medication treatment. Secondary outcomes included life‐time PSM and moderate‐ to high‐risk alcohol and cannabis use. We also measured university‐level depression medication prevalence as a negative control exposure.FindingsAmong the included students, 9.6% reported a life‐time clinical ADHD diagnosis, 5.1% reported past‐year medication treatment and 2.4% reported past‐3‐month PSM. The prevalence of ADHD medication treatment varied among universities [mean = 5.3%, standard deviation (SD) = 2.8%]. In adjusted models, prevalence of PSM was 7% relatively greater for every 1% increase in university‐level medication prevalence [adjusted prevalence ratio (aPR) = 1.07; 95% confidence interval (CI) = 1.04–1.09]. Further, individuals with non‐medication‐treated ADHD were 40% more likely to report PSM than those without ADHD (aPR = 1.40; 95% CI = 1.25–1.56). There was no statistically significant difference in PSM among individuals with ADHD who did or did not receive medication (aPR = 0.90; 95% CI = 0.78–1.04). Results for secondary outcomes and the negative control partially supported the specificity of the findings.ConclusionsAmong university students in the United States, there appears to be a positive association between attending universities with a greater prevalence of attention deficit/hyperactivity disorder (ADHD) medication treatment and risk of prescription stimulant misuse (PSM). This study provides further support for the possibility that ADHD medication treatment prevalence is a risk factor for PSM.