JMIR Publications

ABSTRACT

Background:

The availability of central nervous system stimulants has risen in recent years, including increased dispensing of stimulants, parent-reported attention-deficit/hyperactivity disorder (ADHD) in children, and diagnosed ADHD during adulthood. Crucial components of prescription stimulant use during adulthood remain poorly understood in the context of drug use patterns in the general population. Understanding these patterns would bring public health and regulatory practices toward person-centric, precision public health.

Objective:

The objective of this study was to quantitatively delineate unique behavioral profiles of adults who currently non-medically use stimulants and opioids using a latent class analysis (LCA) and to contrast the differences in findings by drug class. We further evaluated if subgroups identified were associated with an increased Drug Abuse Screening Test (DAST-10) score, an indicator of overall problematic drug use.

Methods:

This study utilized a national, cross-sectional, online survey, using three survey launches from 2019 to 2020 (prior to the COVID-19 pandemic). Adults who reported non-medical use of prescription stimulants (n=2,083) or prescription opioids (n=6,127) in the last 12 months were analyzed. A weighted LCA was used to identify patterns of use; drug types, motivations, and behaviors were factors in the model, which characterized unique classes of behavior.

Results:

Five stimulant non-medical use classes were identified: Amphetamine Self-Medication (Prevalence: 25.6%), Network Sourced for Alertness (Prevalence: 19.0%), Non-Amphetamine Performance Use (Prevalence: 13.7%), Recreational Use (Prevalence: 23.9%), and Non-Discriminatory Behaviors (Prevalence: 17.9%). The drug non-medically used, acquisition though a friend or family member, and use to get high were strong differentiators between classes. The latter four classes had significantly higher DAST-10 scores than Amphetamine Self-Medication. Four opioid non-medical use classes were identified: Moderate Pain with Low Mental Health Burden (Prevalence: 21.9%), High Pain with Higher Mental Health Burden (Prevalence: 38.4%), Risky Behaviors Diverse Motivations (Prevalence: 20.8%), and Non-Discriminatory Behaviors (Prevalence: 18.9%); there was a progressive and significant increase in DAST-10 scores across classes. The potency of the opioid drug, pain history, routes of administration and psychoactive-effect behaviors were strong differentiators between classes.

Conclusions:

A more precise understanding in how behaviors tend to co-occur would improve efficacy and efficiency in developing interventions and supporting the overall health of those who use drugs, and it would improve communication and connection with those at risk for severe drug outcomes.