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Non-medical use of ADHD meds examined in Convention session

By Brian Hendrickson

Dr. Amelia Arria routinely encounters parents who downplay their children’s use of stimulant medications intended for treatment of Attention Deficit Hyperactivity Disorder.

Concerns of the drug use are often quickly shot down. Arria, the director of Maryland’s Center on Young Adult Health and Development, said parents will justify the behavior because it’s intended to gain a perceived academic performance boost, not to get high. The behavior wasn’t stigmatized among parents, Arria said. It was condoned.

 But in an hour-long presentation on nonmedical stimulant usage Thursday at the NCAA Convention, Arria and Jeffrey Anderson, Connecticut’s head physician and chair of the NCAA Committee on the Safeguards and Medical Aspects of Sports, explained why the use of stimulants – a substance class banned by the NCAA – is a serious concern among college students and athletes that can lead to more serious trouble. It also presents the NCAA with a complicated dilemma.

“On one hand, ADHD is a legitimate problem. Failure to recognize it and diagnose it often puts both academic and social hurdles in our student-athletes lives,” Anderson said. “On the other hand, this use of stimulant medication, it has abuse potential, no question about it.”

Arria said the use of stimulant medications did not appear to be a rampant problem, but data presented by both speakers indicated that it was a growing area of concern.

The NCAA’s most recent drug-use survey indicated that 4.3 percent of student-athletes reported using stimulant medications with a prescription. But 6.3 percent reported using those medications without a prescription, a possible sign of medications being given or sold by friends and peers. Anderson said that underground trade presents a pair of problems: Patients distributing their medications aren’t receiving proper medical treatment for their condition, while others are receiving treatment without medical supervision.

Stimulant use appears to become more prevalent the longer students are in college, Arria said. One study screened an entire freshman class of 1,253 students and followed them through to their post-college years. The study found that 63 percent of the students tried marijuana at least once during college, the most common drug used in the survey. Stimulants, however, ranked second with 30 percent of students using them by their senior year.

One concern Arria raised was that studies have shown that stimulant drug use is a gateway to use of other drugs and alcohol. Arria said her study found that of respondents who reported nonmedical use of stimulants, 93.5 percent also reported use of marijuana, 89.4 percent used tobacco products, and 100 percent used alcohol.

And the perception that stimulant use would lead to better grades – the justification parents gave Arria for dismissing their children’s usage – does not appear to be valid. She said data show stimulant drugs help patients diagnosed with ADHD to improve concentration. But nonmedical users appear to gain a minimal cognitive boost from the drugs.

Instead, Arria said students who used stimulants were significantly more likely to skip classes, which compromised their ability to get good grades. Arria said the average college student skips about 7 to 9 percent of their classes. But nonmedical stimulant drug users in her study skipped about 25 percent.

“Finals week is far less daunting when you’ve actually put in the time,” Anderson said, drawing a laugh from the crowd. “We are a nation of quick fixes. We want the easy thing. So you spend 14 weeks partying, and in the 15th week you’re like, ‘Man, I need something to help me get through this.’ ”

Anderson and Arria had several recommendations for addressing the problem.

One response has already started going into action. In 2009, CSMAS adopted a series of criteria for evaluating possible ADHD cases and examining the diagnosis and follow-up examinations. Those criteria help examine cases of stimulant usage among athletes to determine those that are legitimate and worthy of a medical exception, and those that are abusive.

A new NCAA reporting document sent out this month for medical exception cases will follow those criteria. It is currently an optional form but will become mandatory in 2012-13.

 Arria suggested freshman students should cut back on their course loads to prevent the overwhelming feeling that can lead to stimulant usage. She added that parents, clinicians and schools should work to correct misconceptions about the effects of stimulant use on academic performance and the potential harmful effects on a student’s health.

“When there is a high perception of harm,” Arria said, “they’re less likely to use.”