Opinion

Authors: Dr Rachel Sutherland (NDARC), Associate Professor Amy Peacock (NDARC), Associate Professor Caroline Salom (Institute for Social Science Research, The University of Queensland), Dr Jodie Grigg (NDRI), Associate Professor Raimondo Bruno (School of Psychological Sciences, University of Tasmania)

Each year, the National Drug and Alcohol Research Centre at UNSW Sydney surveys hundreds of people who regularly use drugs in Australia to understand trends in substance use around the country.

Today, we’ve released the 2024 report, which canvassed 740 people from Australian capital cities who regularly use ecstasy or other illicit stimulants.

While the focus of this research is largely on illegal drugs and markets, we also monitor trends in the use of pharmaceutical stimulants, such as ADHD drugs, without a prescription.

This year, 54% of the people we spoke to had used pharmaceutical stimulants in the previous six months when it was not prescribed to them. This was the highest percentage we’ve seen since we started asking people about this type of drug use in 2007.

What are pharmaceutical stimulants?

Pharmaceutical stimulants include the drug methylphenidate (brand names Concerta and Ritalin), as well as dexamphetamine and lisdexamfetamine (Vyvanse).

These medicines are commonly prescribed to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy, a chronic neurological disorder that causes excessive sleepiness and sudden bouts of sleep during the day.

These medications work in different ways depending on the type. But they treat ADHD by increasing the levels of important chemicals (neurotransmitters) in the brain, including dopamine and noradrenaline.

However, as with many pharmaceutical substances, people also use these stimulants when they’re not prescribed them. There are a range of reasons someone might choose to use these medicines without a prescription.

Studies of university students have shown these substances are often used to increase alertness, concentration and memory. Studies among broader populations have shown they may also be used to experiment, or to get high.

Worldwide, including in Australia, there have been notable increases in the prescribing of ADHD medications in recent years, likely due to increasing identification and diagnosis of ADHD. As prescriptions increase, there is increased potential for these substances to be diverted to illicit drug markets.

What we found

Non-prescribed use of pharmaceutical stimulants has tripled since monitoring began, from 17% of those surveyed in 2007 to 54% in 2024. It has been similarly high in recent years (52% in 2022 and 47% in 2023).

Frequency of use has remained relatively low. Respondents have typically reported using non-prescribed pharmaceutical stimulants monthly or less frequently.

In this survey, participants most commonly reported using dexamphetamine, followed by methylphenidate and lisdexamfetamine. Most (79%) reported it was “easy” or “very easy” to obtain these substances, similar to 2022 and 2023.

Of course, given our research looks at people who regularly use drugs, the use of pharmaceutical stimulants without a prescription doesn’t reflect use in the general population.

In the 2022–23 National Drug Strategy Household Survey, a general population survey of Australians aged 14 years and older, 2.1% of the population (equating to roughly 400,000 people) reported having used pharmaceutical stimulants for non‑medical purposes in the previous year. This was similar to the percentage of people reporting ecstasy use.

What are the risks?

Pharmaceutical stimulants are considered to have a relatively safe toxicity profile. However, as with all stimulants, these substances increase activity of the sympathetic nervous system, which controls various functions in the body during times of stress. This in turn increases heart rate, blood pressure and breathing rate.

These changes can cause acute cardiac events (such as arrhythmias, or irregular heartbeat) and, with repeated use of high doses, chronic changes in the heart’s functioning.

Recent Australian studies have documented an increase in poisonings involving these substances, although a notable proportion of these appear to be intentional poisoning. Of poisonings that only involved pharmaceutical stimulants, the drugs were mostly taken orally, with a median dose more than ten times a typical prescribed dose. The most common symptoms were hypertension (high blood pressure), tachycardia (increased heart rate) and agitation.

In our survey, those who had used pharmaceutical stimulants most commonly swallowed them in tablet form and generally took a dose slightly higher than what’s typically prescribed.

However, about one in four reported snorting as a route of administration. This can result in physical harms such as damage to the sinuses, and can heighten potential risks from the drug because it may take effect more quickly in the body.

Some pharmaceutical stimulants are “long-acting”, released into the body over a day. So there may also be a risk of premature re-dosing if people unknowingly use these formulations more than once a day. That is, if people don’t experience the desired effects within the expected time frame, they may take another dose, which can increase the risk of adverse effects.

Finally, non-prescribed pharmaceutical stimulants may have adverse effects when taken alongside other drugs. This can include a “masking effect” (for example, the stimulant may mask the signs of alcohol intoxication).

So, what should we do?

Pharmaceutical stimulants are an important medicine to treat ADHD and narcolepsy, and when used as prescribed are relatively safe. However, there are additional risks when people use these substances without a prescription.

Harm reduction campaigns highlighting these risks, including differences across formulations, may be useful. Continual monitoring, alongside more in-depth investigation of associated harms, is also crucial.

This article is republished from The Conversation under a Creative Commons license. Read the original article.