Non-Medical Use of Prescription Stimulants and Illicit Use of Stimulants for Cognitive Enhancement in Pupils and Students in Germany

Abstract

Introduction: The aim of this study was to assess for the first time the prevalence and factors associated with stimulant use exclusively for cognitive enhancement among pupils and university students in Germany.

Methods: A sample of 1 035 pupils (vocational and grammar schools) in small and big cities and 512 university students of 3 Departments (Medicine, Pharmacy, Economics) completed a questionnaire regarding knowledge and use of stimulants for cognitive enhancement and factors associated with their use.

Results: Lifetime prevalence for use of prescription stimulants (methylphenidate, amphetamines) for cognitive enhancement in pupils was 1.55% and in students 0.78%. Last-year and last-month prevalence rates were significantly lower. 2.42% of pupils and 2.93% of students reported lifetime illicit use of stimulants (amphetamines, cocaine, ecstasy) for cognitive enhancement with lower last-year and last-month rates. Prevalence was higher in male pupils, pupils from vocational schools and pupils with bad marks.

Discussion: The illicit use of stimulants for cognitive enhancement is significantly higher than non-medical use of prescription stimulants among pupils and students. Stimulant use is determined by gender, school type, and school marks. The potential risks associated with stimulant use require early awareness and intervention strategies.

References

• 1 Babcock Q, Byrne T. Student perceptions of methylphenidate abuse at a public liberal arts college.  J Am Coll Health. 2000;  49 143-145
• 2 Bright GM. Abuse of medications employed for the treatment of ADHD: results from a large-scale community survey.  Medscape J Med. 2008;  10 111
• 3 Cakic V. Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology.  J Med Ethics. 2009;  35 611-615
• 4 Cashin JR, Presley CA, Meilman PW. Alcohol use in the Greek system: follow the leader?.  J Stud Alcohol. 1998;  59 63-70
• 5 Farah MJ. Emerging ethical issues in neuroscience.  Nat Neurosci. 2002;  5 1123-1129
• 6 Farah MJ, Illes J, Cook-Deegan R. et al . Neurocognitive enhancement: what can we do and what should we do?.  Nat Rev Neurosci. 2004;  5 421-425
• 7 Franke AG, Lieb K. Missbrauch von Psychopharmaka zum Hirndoping. CME-Artikel.  InFo Neurologie & Psychiatrie. 2009;  11 42-51
• 8 Franke AG, Lieb K. Pharmacological neuroenhancement and brain doping: Chances and risks.  Bundesgesundheitsblatt. (in press)
• 9 Giles J. Alertness drug arouses fears about ‘lifestyle’ misuse.  Nature. 2005;  436 1076
• 10 Greely H, Sahakian B, Harris J. et al . Towards responsible use of cognitive-enhancing drugs by the healthy.  Nature. 2008;  456 702-705
• 11 Hall KM, Irwin MM, Bowman KA. et al . Illicit use of prescribed stimulant medication among college students.  J Am Coll Health. 2005;  53 167-174
• 12 Hechtman L, Greenfield B. Long-term use of stimulants in children with attention deficit hyperactivity disorder: safety, efficacy, and long-term outcome.  Paediatr Drugs. 2003;  5 787-794
• 13 Kaloyanides KB, McCabe SE, Cranford JA. et al . Prevalence of illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students: relationship with age at initiation of prescription stimulants.  Pharmacotherapy. 2007;  27 666-674
• 14 Killgore WD, Kahn-Greene ET, Grugle NL. et al . Sustaining executive functions during sleep deprivation: A comparison of caffeine, dextroamphetamine, and modafinil.  Sleep. 2009;  32 205-216
• 15 Killgore WD, Rupp TL, Grugle NL. et al . Effects of dextroamphetamine, caffeine and modafinil on psychomotor vigilance test performance after 44 h of continuous wakefulness.  J Sleep Res. 2008;  17 309-321
• 16 Maher B. Poll results: look who's doping.  Nature. 2008;  452 674-675
• 17 McCabe SE, Knight JR, Teter CJ. et al . Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey.  Addiction. 2005;  100 96-106
• 18 McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use and diversion of prescription stimulant medication.  J Psychoactive Drugs. 2006;  38 43-56
• 19 McCabe SE, Teter CJ, Boyd CJ. The use, misuse and diversion of prescription stimulants among middle and high school students.  Subst Use Misuse. 2004;  39 1095-1116
• 20 Mitler MM, Harsh J, Hirshkowitz M. et al . Long-term efficacy and safety of modafinil (PROVIGIL^®) for the treatment of excessive daytime sleepiness associated with narcolepsy.  Sleep Med. 2000;  1 231-243
• 21 Poulin C. From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: connecting the dots.  Addiction. 2007;  102 740-751
• 22 Racine E, Forlini C. Expectations regarding cognitive enhancement create substantial challenges.  J Med Ethics. 2009;  35 469-470
• 23 Strote J, Lee JE, Wechsler H. Increasing MDMA use among college students: results of a national survey.  J Adolesc Health. 2002;  30 64-72
• 24 Deutsche Hauptstelle für Suchtfragen e.V. Jahrbuch Sucht 2009 . 2009;  Neuland Verlag, Geesthacht
• 25 Teter CJ, McCabe SE, Boyd CJ. et al . Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors.  Pharmacotherapy. 2003;  23 609-617
• 26 Teter CJ, McCabe SE, Cranford JA. et al . Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample.  J Am Coll Health. 2005;  53 253-262
• 27 Teter CJ, McCabe SE, LaGrange K. et al . Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration.  Pharmacotherapy. 2006;  26 1501-1510
• 28 Upadhyaya HP, Rose K, Wang W. et al . Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults.  J Child Adolesc Psychopharmacol. 2005;  15 799-809
• 29 Wesensten NJ, Killgore WD, Balkin TJ. Performance and alertness effects of caffeine, dextroamphetamine, and modafinil during sleep deprivation.  J Sleep Res. 2005;  14 255-266
• 30 Wilens TE, Adler LA, Adams J. et al . Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.  J Am Acad Child Adolesc Psychiatry. 2008;  47 21-31
• 31 Wilens TE, Gignac M, Swezey A. et al . Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications.  J Am Acad Child Adolesc Psychiatry. 2006;  45 408-414
• 32 Wu LT, Schlenger WE. Psychostimulant dependence in a community sample.  Subst Use Misuse. 2003;  38 221-248

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