ADD/ADHD Articles

Potential for Stimulant Abuse in Drug-Users

By Jay D. Tarnow, M.D.

A frequent concern about stimulant medication is the potential for abuse. It must be noted that the incidence of substance abuse is greatly elevated in those with untreated ADHD, so treating the illness is likely to diminish rather than increase the rate of abuse. However, if a patient is an active substance abuser, stimulants are not the best choice of treatments for ADHD. We need to be concerned about diversion of the stimulants, i.e., the drugs being resold. We also must take into account the mentality of substance abusers, which says that if one pill is good, then more is better. And, most obviously, using stimulants to get "high" is another concern.

Still another problem with an active substance abuser is that it is difficult to know whether a medication given for ADHD is having the desired effect because of the presence of other mindaltering drugs.

Past I.V. or skinpopping drug abusers also require special care when prescribed stimulants. The physician should always evaluate these issues before starting any medication and be vigilant thereafter.

ADHD stimulant medication is taken orally. To produce a "high," stimulant medication needs to reach the brain very quickly. Oral use interferes with that, so abusers will break up medicines into powders and snort it or dissolve it, and then inject. Long-acting preparations make it very difficult or impossible to do that, so these formulations would be preferable when a risk of abuse is present.

Likelihood of drug abuse is diminished when ADHD is treated

Patients without active or a history of stimulant abuse are not likely to develop drug problems as a result of the prescribed stimulants for ADHD. Indeed, it is the untreated ADHD patient who is at heightened risk for becoming a substance abuser. Most of the long-term research shows that the use of medications which effectively treat ADHD decrease the risk of developing an abuse problem over time.