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、出售或交易来转移ADHD兴奋剂的注意力，是这些 附表二管制药物的滥用在成年初期达到顶峰(未使用 处方、过量使用处方药物)。然而，对兴奋剂转移和贡献的理解 这些因素仅限于来自小型横断面研究的推测。兴奋剂使用率大幅上升 近年来(从4920万人到6280万人)开处方，主要是在成年人中，已经引起了高度关注。国家-- 在这一重要主题上的科学性阻碍了基于变量的预防努力的发展 因果影响。此外，尽管初级保健是ADHD最常见的治疗环境，但这 人口及其成年后被转移的风险，包括在儿童之后进行诊断和治疗的风险， 人们对此知之甚少。由于对这些趋势的担忧，以及有关相关人身危险和法律法规的报道 后果，FDA最近建立了一个公开的纪要，要求对滥用的潜在作用发表意见- 具有威慑性的兴奋剂配方。随附的审查指出，需要关于下列因素的信息： 为他们的决策提供信息，包括描述滥用的纵向路径。建议数 这项研究前瞻性地检查了年轻人中的兴奋剂转移和假想的危险因素 兴奋剂转移的高峰期：那些在成年期早期被诊断并接受兴奋剂治疗的人，以及 那些儿科医生像青少年一样服用兴奋剂的人，现在已经进入成年早期。这个 联合样本将提供一个独特的机会来检查ADHD的发病时间与 治疗、兴奋剂转移和假想的危险因素。N=357名青少年接受兴奋剂治疗 初级保健中的ADHD(U01 DA040213)，以及150名新招募的年轻人首次诊断和治疗 成年后，将被研究(总数n=507)。三次年度评估将跨越18-24岁，以允许 兴奋剂高发年龄段兴奋剂转移的前瞻性研究。自我报告和家长报告 行为经济学任务将被用来评估个人、态度行为和社会规范 风险因素和环境调节因素(养育和提供者因素)。这项研究的结果将有助于 NIDA 2016-2020年战略计划的重点领域#3，“解决现实世界的复杂性”，通过 这一发现将适用于ADHD治疗人群中规模最大、了解最少的两个部分--即 在初级保健中接受治疗的人，以及那些被诊断为年轻人的人。调查结果将提供未来迫切需要的 收集数据，为兴奋剂转用预防工作的发展提供信息。

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.