Substance transitions are broadly captured by polysubstance use or substitutions, i.e., when one substance is not available, another is used ( 54, 55). Initial route of administration can also affect subsequent ROA choices and overall pattern of drug use ( 58, 59). An opioid route of administration (ROA) transition (e.g., swallowing intact tablets then transitioning to crushing the tablet and snorting or injecting) is thought to occur when individuals develop tolerance to effects of a substance and desire stronger effects, more rapid onset of effects, or a more economical way of achieving them ( 42, 43, 57). This class transition has been related to age, availability/supply, drug quality, and surrounding environments ( 52– 56). For example, an opioid class transition is the precursory use of prescription opioids before the use of heroin ( 48– 51). However, there is an analogous framework to be found in the study of opioid use pathways and transitions ( 42– 47). The transition from oral to non-oral NMU of prescription stimulants is not yet well-documented.
While the physical and psychiatric risks as well as mortality associated with prescription stimulant NMU have been considered ( 29– 34), less is known about non-oral prescription stimulant NMU, which can include adverse physical outcomes, such as toxicity or tissue damage ( 35– 40), and adverse mental health outcomes, such as anxiety or depression ( 41) or even psychosis ( 33). Non-oral NMU of prescription stimulants-use that involves alternate routes of administration including intranasal or intravenous routes-has been reported in adolescents ( 18– 21), college students ( 22– 25), and adults ( 26– 28). These medications lead to regional elevations in brain dopamine ( 8– 10) rendering them as potential candidates for non-medical use (NMU) and diversion ( 8, 11– 17). Medications containing amphetamines (e.g., Adderall, Vyvanse) or methylphenidate (e.g., Ritalin, Concerta, Focalin) are considered the most widely prescribed stimulants in the United States ( 5, 6), and are regarded as the most efficacious drugs in the management of ADHD symptomatology ( 7). Prescription stimulant non-medical use (NMU) is a persistent, national dilemma ( 1– 4). Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention. In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways.Ĭonclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting ( n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use ( n = 14, 6%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Methods: Adults ( n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. Objective: Prescription stimulant non-medical use (NMU) is a national predicament.
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