Larry A. Kroutil

The nonmedical use of prescription ADHD medications: results from a national Internet panel

BackgroundEmerging evidence suggests that nonmedical use (NMU) of prescription attention deficit/hyperactivity disorder (ADHD) medications is rising, but many previous investigations have used clinical or regionally based samples or limited their investigations to stimulants rather than to medications specifically used to treat ADHD. Using an Internet-based epidemiological survey, this paper advances understanding of the prevalence and correlates of NMU of medications used to treat ADHD, sources of diverted medications, motivations for use, and consumption patterns.MethodsThe study used a self-administered Internet survey of civilian, noninstitutionalized adults (N = 4,297) aged 18 to 49 in the United States. National-level estimates were created using propensity scoring methods and weighting procedures using data from three nationally representative probability surveys: a random-digit dialed telephone survey, the current U.S. Census, and the National Survey on Drug Use and Health (NSDUH).ResultsPast-year prevalence of NMU of ADHD medications was approximately 2%, with 4.3% reported among those aged 18 to 25 and 1.3% among those aged 26 to 49. Most respondents reporting NMU used on multiple occasions. Receipt of medications for ADHD was a significant correlate of past-year NMU, though most nonmedical users never had a prescription. Among persons who had never been prescribed medication to treat ADHD, friends or family members were the most common source. Productivity was the most frequently endorsed reason for NMU. Alcohol was the substance most commonly used in combination with ADHD drugs.ConclusionBecause most prescription ADHD medications currently are highly regulated, policy options for supply-side reduction of nonmedical use may include identifying those medications with lower abuse liability for inclusion on insurance formularies. Patient and physician education programs also may be useful tools to heighten awareness of intentional and unintentional diversion of ADHD medications for nonmedical purposes.

Trends in alcohol, illicit drug, and cigarette use among U.S. Military personnel: 1980-1992

This paper examines trends in alcohol use, illicit drug use, and cigarette use in the U.S. military. Data are drawn from five worldwide surveys (conducted in 1980, 1982, 1985, 1988, and 1992) of active-duty personnel. All surveys used similar methods and common measures of alcohol, illicit drug, and cigarette use. Findings indicate steady and notable reductions in overall alcohol consumption, illicit drug use, and cigarette use. They show less decrease in heavy alcohol use, however, and the apparent decline from 1980 to 1992 is largely a function of demographic changes in the military. In 1992, during the 30 days before the survey, about 1 in 3 personnel smoked, about 1 in 7 were heavy drinkers, and about 3 in 100 used illicit drugs; rates were higher among certain demographic subgroups. Further reductions in smoking and heavy drinking remain the major substance use challenges for the U.S. military in the 1990s.

Medication Costs to Private Insurers of Diversion of Medications for Attention-Deficit Hyperactivity Disorder

AbstractBackground: The diversion of prescription stimulants for misuse, particularly those used in the treatment of attention-deficit hyperactivity disorder (ADHD), is potentially a significant problem for public health and for healthcare funding and delivery. Most prior research on the diversion of prescription stimulants for misuse, particularly those used in the treatment of ADHD, has focused on the ‘end users’ of diverted medications rather than the suppliers. Furthermore, little is known about the direct costs of diversion for third-party insurance payers in the US.n Objectives: The objectives of this study were to estimate the prevalence in the US of people whose private insurance paid costs for ADHD prescriptions that they gave or sold to another person (diversion), and to estimate medication costs of diversion to private insurers.n Methods: Estimates are from a cross-sectional survey of respondents from two Internet survey panels targeting individuals aged 18–49 years in the civilian, noninstitutionalized US population, principally for those who filled prescriptions for ADHD medications in the past 30 days that were covered by private health insurance. Analysis weights were post-stratified to control totals from the Current Population Survey and National Health Interview Survey. Weighted prevalence rates and standard errors for diversion are reported, as are the costs of diverted pills using drug prices reported in the 2008 Thomson Reuters RED BOOK™. Sensitivity analyses were conducted that varied the cost assumptions for medications.n Results: Among individuals aged 18–49 years whose private insurance paid some costs for ADHD medications in the past 30 days, 16.6% diverted medications from these prescriptions. Men aged 18–49 years for whom private insurance paid some costs of ADHD drugs in the past 30 days were more than twice as likely as their female counterparts to divert medications from these prescriptions (22.5% vs 9.1%; p= 0.03). After a pro-rated co-payment share was subtracted, the estimated value of diverted medications in a 30-day period was

Evaluating Services Demonstration Programs: A Multistage Approach.

US8.0 million. Lower- and upper-bound estimates were

1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel.

US6.9 million to

1992 Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel

US17 million, for a range of

Cigarette smoking in the U.S. military: findings from the 1992 Worldwide Survey.

US83 million to

Drug use and pregnancy

US204 million annually. Overall, diversion accounted for about 3.6% of the total costs that private insurers paid for ADHD medications (range: 3.5–4.5%). The percentages varied by medication category, although relative differences were sensitive to inclusion of a pro-rated co-payment. A higher percentage of the costs of extended-release (XR) medications was lost to diversion compared with that for immediate-release (IR) medications.n Conclusions: Costs of ADHD medications paid for by private insurers that were lost to diversion were small relative to the total estimated medication costs and relative to total estimated healthcare costs for treating ADHD. Nevertheless, there may be significant cost savings for insurers if diversion can be reduced, particularly for XR medications. These findings represent a first step to informing policies to reduce diversion both in the interest of public health and for direct and indirect cost savings to insurers.

Methodological Considerations in Estimating Adolescent Substance Use

Abstract This paper describes the rationale for and an example of a multistage approach to evaluating services demonstration programs that takes account of the important design limitations often found in such programs. These limitations may include one or more of the following: (a) the lack of control or comparison groups — i.e., there is no requirement for experimental or quasi-experimental design; (b) the lack of a common intervention — i.e., the demonstrations involve multiple projects, each of which is implementing a different intervention; and (c) the lack of common data collection structure across projects. We view the evaluation of services demonstration programs as one step in the broader process through which new interventions are conceived, tested, and ultimately disseminated. We describe an approach to the evaluation of services demonstrations that provides an empirical basis for identifying those projects that appear “promising” (i.e., appear to be fulfilling the demonstrations objectives), and then describes a subset of promising projects in detail. Findings from such an evaluation can provide the basis for moving into the next phase, in which the effectiveness of one or more promising models is tested experimentally. As an example of how this approach can be applied, we describe the design of the National Evaluation of Models for Linking Drug Abuse Treatment and Primary Care, the evaluation of a federally-funded services demonstration that was aimed at examining alternative strategies for improving the linkage between the drug abuse treatment and primary care systems.