A prospective examination of stimulant diversion and related risk factors for young adults with childhood- or adult-diagnosed ADHD

项目摘要 通过分享、出售或交易转移ADHD兴奋剂是这些药物的主要渠道， 附表二管制药物在成年早期达到滥用流行率的高峰（未使用 处方，过度使用处方药）。然而，对兴奋剂转移的理解和贡献 这些因素仅限于小规模横断面研究的推测。兴奋剂的使用率急剧增加 近年来，处方（从约4920万人到6280万人），主要是成年人，引起了人们的高度关注。国家- 关于这一重要专题的科学研究，排除了根据推断的变量开展预防工作的可能性。 因果影响。此外，虽然初级保健是ADHD最常见的治疗环境， 人口及其成年后的转用风险，包括在儿童期后进行诊断和治疗的情况， 是很难理解的。由于对这些趋势的关注以及相关的人身危险和法律的 结果，FDA最近建立了一个公共摘要，要求对滥用的潜在作用发表评论- 威慑刺激制剂。随附的审查指出，需要提供资料，说明 为他们的决策提供信息，包括定性滥用的纵向途径。拟议 一项前瞻性的研究检查了年轻人中的兴奋剂转移和假设的风险因素， 兴奋剂转移的高峰年龄：最初诊断和兴奋剂治疗在成年早期， 这些兴奋剂在青少年时期被儿科医生治疗，现在已经进入成年早期。的 合并样本将提供一个独特的机会，以检查ADHD的时间之间的关联 治疗、兴奋剂转移和假设的风险因素。N=357例接受兴奋剂治疗的青少年， 初级保健中的ADHD（U 01 DA 040213）和150名新招募的首次诊断和治疗的年轻人 在成年期，将进行研究（总n = 507）。三个年度评估将涵盖18-24岁， 在其最流行的年龄段进行兴奋剂转移的前瞻性研究。自我和父母报告 行为经济学任务将用于评估个人内部，态度行为和社会规范 风险因素和环境调节因素（父母和供应商因素）。这项研究的结果将有助于 NIDA 2016-2020战略计划的优先重点领域#3，“解决真实的世界复杂性”， 研究结果将适用于两个最大的，最不了解的部分治疗ADHD人群-那些 在初级保健中接受治疗，而那些年轻的成年人则被诊断。研究结果将提供至关重要的前瞻性 收集数据，为开展兴奋剂转移预防工作提供信息。

Project Summary Diversion of ADHD stimulants, by sharing, selling, or trading, is the primary conduit by which these Schedule II controlled drugs reach their peak prevalence of misuse in early adulthood (use without a prescription, overuse of prescribed medication). Yet, understanding of stimulant diversion and contributing factors is limited to speculation from small cross-sectional studies. Dramatically increased rates of stimulant prescribing in recent years (from ~49.2 to 62.8M people), mainly in adults, has heightened concern. The state- of-science on this important topic precludes development of prevention efforts based on variables with inferred causal influence. Additionally, although primary care is the most common treatment setting for ADHD, this population and its risk for diversion in adulthood, including when diagnosis and treatment occurs after childhood, is poorly understood. Due to concern about these trends and reports of associated physical dangers and legal consequences, the FDA recently established a public docket requesting comments on the potential role of abuse- deterrent stimulant formulations. The accompanying review stated a need for information on factors that would inform their decision-making, including characterization of longitudinal pathways to misuse. The proposed study prospectively examines stimulant diversion and hypothesized risk factors among young adults at peak age for stimulant diversion: those initially diagnosed and stimulant-treated in early adulthood, and those stimulant-treated as adolescents by pediatricians and aging now into early adulthood. The combined sample will provide a unique opportunity to examine associations between timing of ADHD treatment, stimulant diversion, and hypothesized risk factors. N=357 adolescents stimulant-treated for ADHD in primary care (U01 DA040213), and 150 newly recruited young adults first diagnosed and treated in adulthood, will be studied (total n = 507). Three annual assessments will span ages 18-24 to allow prospective study of stimulant diversion during the age period of its greatest prevalence. Self- and parent-report and behavioral economics tasks will be used to assess intrapersonal, attitudinal-behavioral, and social-normative risk factors and environmental moderators (parenting and provider factors). The results of this study will aide Priority Focus Area #3 of NIDA’s 2016-2020 Strategic Plan, “Addressing Real World Complexities” by generating findings that will apply to two of the largest, least understood segments of the treated ADHD population—those treated in primary care, and those young adult-diagnosed. Findings will provide crucially needed prospectively gathered data to inform the development of stimulant diversion prevention efforts.