This is evident from research by the Institute for Responsible Medication Use (IVM) and the Trimbos Institute. As part of the ‘Healthy Focus’ project, they investigated – commissioned by the Ministry of Health, Welfare and Sport (VWS) – the extent and motives behind the improper use of ADHD medication.
This mainly concerns methylphenidate, ( lis)dexamfetamine and modafinil. During the project, the IVM and Trimbos Institute also examined the role of healthcare providers and education and prevention professionals.
ADHD medication without a prescription
Four percent of students had used ADHD medication improperly at some point in the past year, meaning without a doctor’s prescription. This mainly concerns (bachelor’s) students between the ages of 22 and 25. This is evident from the recently published ‘Monitor of Mental Health and Substance Use among Higher Education Students’ by the Trimbos Institute, RIVM and GGD GHOR.
During the project, a number of in-depth analyses were also conducted on existing datasets. These showed that 5.5 to 22.5 percent of the young adults studied had taken ADHD medication without a doctor’s prescription at some point in their lives. Improper use of ADHD medication is highest among people who regularly go out.
Students who use ADHD medication improperly expect the drug to improve concentration even without a diagnosis of ADHD. They also expect to be able to focus for longer. Students mainly use it around assignment deadlines, exams and writing their thesis.
Palpitations, dependence and being unable to sleep
In the Netherlands, ADHD medication is only available on a doctor’s prescription. In addition, methylphenidate and dexamfetamine are listed under List I of the Opium Act. This means that unlawfully possessing or trading these substances is a criminal offence.
With improper use, there is also no careful assessment of the indication or supervision by a doctor. As a result, there is no monitoring for underlying conditions, such as cardiovascular disease or mental health disorders. Under these circumstances, using ADHD medication can be risky.
Side effects include insomnia, nausea, reduced appetite, palpitations and nervousness. During the project, the Trimbos Institute interviewed more than twenty students who used ADHD medication improperly. Some of them also experienced these side effects. Improper use can also lead to psychological dependence. Students then believe that they can no longer study without using ADHD medication.
Preventing stockpiling of medication
Students indicate that they often obtain ADHD medication from acquaintances, friends and family members who have been prescribed it by a doctor. Conversations with healthcare providers show that not all healthcare providers are familiar with this improper use. It is therefore important to raise awareness among these healthcare providers.
It is also essential to dispense ADHD medication carefully. This means not prescribing it when there is no indication, being careful with repeat prescriptions, keeping track of what the patient actually uses and preventing the patient from ‘stockpiling’ medication. For example, by ensuring that the patient does not leave part of the medication unused or request repeat prescriptions when the medication is no longer needed.
It is also important for healthcare providers to recognise improper use and make its risks open for discussion. Finally, staff in education and addiction care have a role to play in identifying and discussing this use among students.
Next steps
Based on the project’s findings, the project group was able to revise and develop a number of important information materials, such as the fact sheet ‘Improper use of ADHD medication’. In addition, the findings of this project provide insights for the further development of materials and interventions to reduce the improper use of ADHD medication. The project group will work on this in the follow-up phase.
Three tips for preventing the improper use of ADHD medication
Students: using ADHD medication without a prescription involves risks, both physical and mental. If you experience problems with concentration, discuss this with your GP, academic adviser or study career counsellor.
Healthcare providers: be aware that some students use ADHD medication improperly. Discuss actual use with your ADHD patients, make improper use of ADHD medication open for discussion, be careful when issuing prescriptions and repeat prescriptions, and provide information at the time of dispensing about the risks and consequences.
Education professionals: make the topic of concentrating and performing under pressure open for discussion, including any problems experienced in this regard. If you suspect that a student is experiencing problems, possibly in combination with improper use of ADHD medication, initiate a conversation.