The Potential for Misuse and Abuse of Medications in ADHD: A Review

@article{Clemow2014ThePF,
  title={The Potential for Misuse and Abuse of Medications in ADHD: A Review},
  author={David B Clemow and Daniel J. Walker},
  journal={Postgraduate Medicine},
  year={2014},
  volume={126},
  pages={64 - 81}
}
Abstract This article reviews the literature concerning attention-deficit/hyperactivity disorder (ADHD) medication misuse, abuse, dependence, diversion, and malingering. The review covers nonmedical use (NMU) of both stimulant (methylphenidate and amphetamine) and nonstimulant (α-adrenergic agonists and atomoxetine) prescription medications, and provides a discussion on the relevance for ADHD treatment today. The neural basis for ADHD medication mechanisms of action (increased norepinephrine… 
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TLDR
Methylphenidate-induced regional elevations in brain dopamine appear to be integral to both efficacy in attention-deficit/hyperactivity disorder and potential for abuse, raising potential concerns for drug safety and prescription drug diversion costs associated with nonmedical use.
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A robust pipeline of stimulants and nonstimulants in development are found, formulated to optimize onset and duration of effect, alter the time of administration, obviate the need to swallow whole capsules or tablets and to deter abuse.
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Carefully applied guideline-based diagnostics to clarify the potential presence of ADHD as well as a responsible prescription practice in a well-defined therapeutic setting with reliable monitoring of medication intake and regular consultations are essential conditions for a safe and proficient MPH treatment of ADHD in patients with SUD.
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TLDR
Factors involved in prescribing and medication use in individuals diagnosed with ADHD are reviewed, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications.
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It is important for clinicians to have some understanding of this issue as they consider prescribing stimulants for their pediatric patients with ADHD, because of its potential link with substance abuse.
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Modifications to routes of administration that may alter PK properties of stimulant-based medication for treating ADHD are reviewed, which are of clinical interest because they may pose safety hazards and affect efficacy.
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TLDR
Treatment with MPH requires adequate medical indication and supervision, not only for its potential cardiovascular side effects and exacerbation of psychiatric disorders, but also due to the risk of illicit use and intoxication.
A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities
TLDR
In the studies identified and assessed in this review, atomoxetine did not appear to exacerbate any of the comorbid conditions and could, therefore, be an important therapy choice for the treatment of ADHD in the presence ofComorbid disorders.
Treatment Resistance in Attention-Deficit/Hyperactivity Disorder
TLDR
In this chapter, the authors discuss both established and novel pharmacological treatment and neuromodulation in treatment-resistant ADHD.
ADHD Prescription Medications and Their Effect on Athletic Performance: A Systematic Review and Meta-analysis
TLDR
Dopaminergic/noradrenergic agonist medications appear to have a positive effect on athletic performance, as well as effects on physiological parameters.
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