Rx16 prevent wed_200_1_cairnes-wertnepy_2arnold

Youth, Performance-Enhancing
Drugs and ADHD Medication
Presenters:
• Jan Cairnes, BBA, CPP, Director of Prevention Services,
Hanley Center Foundation
• Ryan Wertepny, Prevention Coordinator, Hanley Center
Foundation
• David Arnold, Director, Alcohol Abuse Prevention Initiatives,
NASPA - Student Affairs Administrators in Higher Education
Prevention Track
Moderator: Nancy Hale, MA, President and CEO, Operation UNITE

Disclosures
David Arnold; Jan Cairnes, BBA, CPP; Ryan
Wertepny; and Nancy Hale, MA, have disclosed
no relevant, real, or apparent personal or
professional financial relationships with
proprietary entities that produce healthcare
goods and services.

Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

Learning Objectives
1. Describe the trends in misuse of
performance-enhancing drugs and ADHD
medication among young people.
2. Identify strategies for adolescents to achieve
their goals without performance-enhancing
drugs.
3. Outline plans for addressing ADHD misuse,
abuse and diversion among college students.

Ryan Wertepny
Ryan@HanleyCenterFoundation.org
561-841-1217
Jan Cairnes, CPP
Jan@HanleyCenterFoundation.org
561-841-1122
KIDS, DRUGS & SPORTS
Winning at
Any Cost

High School Athletes and
Drug Use Factors
 Media/Advertisements
 Body Image
 Role Models
 Peer Influences
 Impulsivity / Risk Taking
 Belief in high use
 Don’t believe in the unhealthy side effects
 Athletes believe they won’t be harmed

A Shift in Attitudes and
Perception of Harm
 Kids aged 12-17 estimate performance enhancing drugs are
being used by 29% of professional athletes.
 One in 5 males aged 18-25 said that taking PED’s is “the only
way to make it in professional sports”.
 An additional 24% said it “was critical to enhancing one’s
athletic performance”.

Performance Enhancing Drugs
 Also known as “PEDs”
 Substances used to improve activity or ability
 Often indicates illegal or unethical use of these
substances
 Substances include:
 Anabolic Steroids
 HGH
 Creatine
 Steroid Precursors
Dehydroepiandrosterone (DHEA)

Anabolic Steroids
 Synthetic substance related to the male hormone testosterone
 Used to treat hormone problems in men, delayed puberty, and muscle
loss from some diseases
 Athletes use to increase muscle and improve athletic performance
 Available as creams, pills and by injection

Anabolic Steroid
Potential Problems
 Shrunken testicles (males)
 Cancer (liver, prostate,
kidney)
 Heart disease
 Breast development (males)
 Uncontrolled aggression
 Depression
 Male pattern baldness
 Acne
 Liver disease
 High Blood Pressure
 Stunted Growth
 Masculinization – facial hair
deepened voice (females)

Human Growth Hormone (HGH)
 HGH (Somatotopin) is naturally produced in the pituitary
gland.
 Synthetic human growth hormone spurs growth in children
and adolescents
 Used in aiding with cancer treatment and hormonal
imbalance caused by premature birth

HGH Side Effects
 Hypertension
 Severe headaches
 Loss of vision
 Stunted growth
 Acromegaly
 High blood pressure &
heart failure
 Diabetes and tumors
 Crippling arthritis

Creatine
 Naturally occurring compound produced by
your body that helps your muscles release
energy
 Taken in high doses produces small gains
and short-term bursts of power
 Over-the-counter as powder or pills

Creatine Side Effects
 Stomach and muscle
cramps
 Weight gain
 Dehydration
 Kidney and liver damage
 High blood pressure

Dehydroepiandrosterone (DHEA)
 Hormone naturally produced by the
adrenal gland
 Leads to the production of androgens
and estrogens (male and female sex
hormones).
 DHEA can improve sex drive, build muscle,
and fight the effects of aging.

DHEA Side Effects
 Men
 Breast tenderness
 Frequent urination
 Aggression
 Testes size reduction
 Women
 Oily skin
 Increased unnatural hair
growth
 Deep voice
 Irregular periods
 Small breast size
 Increased genital size For both genders
 Acne, Itchiness
 Difficulty sleeping
 Headaches & nausea
 Mood changes

Supplement Industry
►$37 billion/year supplement industry
targets athletes
►Not regulated by the FDA
►Study on major retailers in NY showed,
4 out of 5 tested herbal supplements
didn’t contain the ingredients stated on
their label, and more than 1/3 of them
contained “contaminants”

Risk Behaviors with PEDs
Activity Total % Female Male
Did not eat breakfast
daily
61.9% 66.2% 57.6%
Did not eat breakfast
ever
13.7% 13.8% 13.5%
Were not physically
active daily
72.9% 82.3% 63.4%
Were not physically
active ever
15.2% 19.2% 11.2%
Skipped meals for 24
hours to lose weight
13% 18.7% 7.4%
Took diet pills for
weight loss
5% 6.6% 3.4%
Vomited or took
laxatives for weight
loss
4.4% 6.6% 2.2%

Why Risk it?
Nearly 8 million students participate in high school athletics, while just over 460,000 compete as a
NCAA athlete. That’s just 5.75% of students that move on the play at the collegiate level.

“Doping Rises Among High Schoolers,
but Few Districts Test”
 Use of HGH by American teens
doubled from 2012-2013.
 Steroid use also rose in that
period.
 Only 20% of high schools in the
U.S. have drug testing policies.
 Students are not typically tested
for PED’s.
 Florida’s Miami-Dade County
School District piloting program to
test student-athletes for steroids
and PED’s.

How does body image play a role in
PED use?

“Little did I know I have 22 inch guns and
disappearing birth mark on my right arm.”
–Andy Roddick
How does body image play a role in
PED use?

Favorable Attitudes in the
Media

1970
12” biceps
GI Joe
CHANGING IDEALS

Influencing children for decades
Slumber Party Barbie was
introduced in 1965 and came with a
bathroom scale permanently set at
110 lbs with a book entitled “How to
Lose Weight” with directions inside
stating simply “Don’t eat.”

Mr. Olympia Over the Years
Phil Heath
Mr. Olympia 2015

Ms. Olympia Over the Years
Rachael McLish
Miss Olympia 1980
Iris Kyle
Miss Olympia 2013

Drug Prevention & Health
Promotion Education
ATLAS - Athletes Training & Learning to Avoid Steroids
ATHENA - Athletes Targeting Healthy Exercise &
Nutritional Alternatives
 Drug Prevention
 Sports Nutrition
 Exercise Training

t
National Football League ATLAS & ATHENA Sites
2007-2014
More than 100 Schools
> 35,000 Student-athletes & > 750 Coaches

Resources:
 Supplement Information
 www.fda.gov
 PED Basic Information
 www.usada.gov
 www.mayoclinic.com
 High School & Youth Trends
 www.drugabuse.gov
 Teen Surveys
 http://teens.drugabuse.gov/drug-facts/
 “Better at any cost: The dangerous intersection of
young people steroids, and the internet.”
 http://media.digitalcitizensactionalliance.org/314A5A5A9
ABBBBC5E3BD824CF47C46EF4B9D3A76/a46c7adf-339a-
4403-bae2-a03777700b91.pdf

Resources Continued:
 “Testing High School Athletes for Doping Uncommon”
and “Survey finds shape increase in teen uses of HGH”
 www.usnews.com
 High School Athletes moving to College and
Professional Level
 www.NCAA.org
 Youth Risk Behavior Surveillance 2013
 www.cdc.gov
 “Steroid Use Among High School Athletes”
 http://globalsportsdevelopment.org/steroid-use-among-
high-school-athletes/

Help prevent the misuse, abuse and
diversion of ADHD prescription stimulants
among college students
M a r c h 3 0 , 2 0 1 6

DISCLOSURE STATEMENT
• David Arnold, BSW, Director, Alcohol Abuse Prevention
Initiatives, NASPA - Student Affairs Administrators in
Higher Education, has disclosed no relevant, real or
apparent personal or professional financial relationships
with proprietary entities that produce health care goods
and services.

LEARNING OBJECTIVES
 Describe the trends in misuse of performance-enhancing drugs and
ADHD medication among young people.
 Identify strategies for adolescents to achieve their goals without
performance-enhancing drugs.
 Outline plans for addressing ADHD misuse, abuse and diversion
among college students.

AGENDA
 About the Coalition to Prevent ADHD Medication Misuse
(CPAMM)
 What we know about ADHD medication misuse, abuse
and diversion among college students
– Harris Poll National Survey
 Discussion and opportunities for collaboration

ABOUT THE COALITION TO
PREVENT ADHD MEDICATION
MISUSE

41
INTRODUCTION OF CPAMM
PARTNERS

ABOUT THE COALITION TO PREVENT
ADHD MEDICATION MISUSE
NASPA – Student Affairs Administrators in Higher Education
 Leading association for the advancement, health, and sustainability of the
student affairs profession.
 Recognize that higher education administrators, families, college students,
and physicians must collaborate to both support those with ADHD and
reduce the number of students who misuse stimulants.
 NASPA is collaborating with BACCHUS Initiatives of NASPA and the
University of Washington to conduct focus groups and quantitative research
among college students and administrators to try to gain a better
understanding of how the college environment affects the issue and what
kind of programmatic efforts and messages might be the most effective.

The BACCHUS Initiatives of NASPA
 Actively promote student and young adult-based, campus and community-
wide leadership on healthy and safe lifestyle decisions concerning alcohol
abuse, illegal drug use, and other high-risk behaviors.
 Collaborate with student leaders, leveraging peer-to-peer influence and
impact.
 Provide resources and trainings so peer educators can assist campus
efforts to prevent the misuse of ADHD prescription medication.
 Engage our collegiate peer educators to assist campus efforts to help
prevent the misuse of ADHD prescription medication by developing peer-led
trainings to promote healthy choices.

American Academy of Family Physicians (AAFP)
 Founded in 1947, the American Academy of Family Physicians
represents 120,900 physicians and medical students nationwide.
 Committed to ensure that medications prescribed by physicians are not
inappropriately diverted.
 Recognizes that there is growing concern about inappropriate use of
ADHD medications, and wants to educate physicians and the public
about the rising prevalence of the issue.
 Spearheading research to characterize current approaches to
prevention of misuse in primary care of ADHD medications in teens and
young adults.

Children and Adults with Attention-Deficit/Hyperactivity Disorder
(CHADD)
 Seeks to improve the lives of people affected by ADHD by providing
education, advocacy and support for individuals with ADHD.
 Interested in addressing the impact of ADHD medication misuse on
people with ADHD.
 Through the support of CPAMM’s educational programming and
research, CHADD continues to monitor for valuable insights
regarding why ADHD students decide to divert their medication.

The Jed Foundation
 Leading nonprofit that exists to promote emotional health and prevent
suicide among college and university students.
 Helping academic institutions create healthier campus communities and
prevent substance abuse and self-harm.
 Aims to address the issue of ADHD prescription stimulant medication
misuse among college students through existing programs.
 Through CPAMM, the foundation will continue inspiring national
dialogue on mental health, and helping academic institutions create
healthier campus communities and prevent substance abuse and self-
harm.

Shire
 Works to transform the lives of people around the world whose
health is impacted by rare and other specialized conditions by
providing innovative treatments.
 Has a responsibility to take a stand on misuse, abuse, and
diversion of ADHD medication.
 Concerned that when people who don’t need ADHD medicines
take them, they trivialize a real psychiatric disorder and take
medicines away from people who really need them.
 Committed to bringing significant leadership and financial
resources to CPAMM.

 Created to help prevent ADHD medication misuse and become a
trusted source of information on the issue of ADHD prescription
stimulant medication misuse, abuse and diversion
 Diverse membership representing key constituencies
 Initial focus on college students
 Advancing its mission by conducting research, and engaging and
educating various groups affected by the issue

 Announced its formation and launched a website in August 2014
 Learning more about the issue through research conducted among
physicians, college students and administrators with:
– National market research fielded among college students
– AAFP physician research
– NASPA focus groups and quantitative research with students and
administrators
 Hosted the first National Summit on the issue of ADHD prescription
stimulant misuse, abuse and diversion among college students
 Launched an educational campaign, reaching physicians and
college administrators

WHAT WE KNOW ABOUT ADHD
MEDICATION MISUSE

THE ISSUE IS PERSISTANT
5.8%
7.0%
6.6%
7.4%
7.0%
10.2%
9.0%
9.8%
9.0%
10.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
2009 2010 2011 2012 2013
NMU among young adults (not enrolled in
college)
NMU among college students
Percentwhoreportedpast-yearNMU
Sample = National sample 1,950 respondents
one to four years beyond high school.
Question text: On how many occasions (if any)
have you taken Adderall on your own–that is,
without a doctor telling you to take it.
Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2014). Monitoring the Future national survey results on drug use,
1975–2013: Volume 2, College students and adults ages 19–55. Ann Arbor: Institute for Social Research, The University of Michigan.
 Approximately 10% of college students have used Adderall non-
medically in the past year
 The rate of NMU is consistently higher among college students than
among young adults not in college

Will efforts to halt prescription drug
abuse affect students?
THE ISSUE IS PERSISTANT

MISUSE HAS NO STIGMA
• In the mind of the misuser, ADHD medications are:
– federally controlled substances, therefore they have legitimacy
and are not considered “street drugs”
– made in safe factories
– prescribed by physicians
– taken by peers with ADHD to great affect
– easy to obtain and share due to lack of college enforcement
– taken for all “the right reasons,” e.g., to get better grades
– pervasive, “everyone is doing it.”
Source: Use of Prescription Drugs for Academic Performance Enhancement in College Aged Students Study, “Adderall is Definitely Not a Drug”: Justifications for the Illegal Use of ADHD Stimulants study,
53

WHAT WE KNOW ABOUT ADHD
MEDICATION MISUSE –
HARRIS POLL SURVEY

RESEARCH OBJECTIVES
 Measure college students’ awareness of ADHD prescription medication and
its misuse
 Gauge college students’ perceptions of ADHD prescription medication
misuse
 Assess college students’ potential motivations for misusing ADHD
prescription medication
 Evaluate how different segments of the college student population vary in
their views on ADHD prescription medication misuse
 Results of this research are intended for public release and to inform the
actions of CPAMM and our supporters
– For the purpose of this survey, misuse refers to any time the medicine is used in a
way that is different from the doctor’s instructions and could include people who do
not have a prescription for the medication but obtain it and use it, and people who
have a prescription but do not use it as directed by their health care provider.

RESEARCH METHOD
 Online survey conducted May 15 – June 11, 2014
 Survey length = approx. 20 minutes
 n=2,056 U.S. college students, including 164 diagnosed with ADHD
– 18-24 years old, enrolled and seeking a degree at a 4-year college or
university and attending at least some in-person classes between
January – June 2014
– Sample included full-time (91%) and part-time (9%) students, living in
a range of housing situations (e.g., on-campus, off-campus, with
parents, etc.)
 Data weighted where necessary by age, gender, race/ethnicity, region and
propensity to be online to bring them in line with their actual proportions in
the population
 Statistical significance testing was conducted at the 95% level of
confidence

KEY TAKEAWAYS
 A majority of college students are familiar with ADHD prescription
stimulant misuse and agree that it is unethical to take ADHD
prescription stimulants that were not prescribed
– However, approximately 4 in 10 agree that using ADHD prescription
stimulants without a prescription is no more harmful than an energy
drink or strong cup of coffee
 College students believe it’s easy for non-ADHD students to obtain
ADHD prescription stimulants
– Most cite friends with prescriptions as a likely source, and almost half
believe college students who misuse get them from a health care
professional by pretending to have ADHD
 College students are busy and feel stressed – and ADHD
prescription stimulant misuse is seen by many as a way to keep up
Source: 2014 online survey of college students conducted by Harris Poll on behalf of CPAMM

KEY TAKEAWAYS
 Nearly three in ten college students can be considered to be at-risk for
misuse – either because they say they are likely to misuse ADHD
prescription stimulants or because they reported having misused any
prescription medication in the past year
 A majority of college students believe that preventing misuse is not a
priority at their school and that administration and professors are not
aware of misuse on campus
 College students diagnosed with ADHD are less likely to view others
their age using ADHD prescription stimulants not their own as harmful
and more likely to say it is acceptable for a college student with ADHD
to share or even sell ADHD prescription stimulants
– Nearly half of ADHD college students with a prescription feel pressure to
share or sell their ADHD prescription stimulant medication

INSIGHTS AND IMPLICATIONS
 College students consider misuse to be harmful and unethical
– Leverage this belief through the power of positive peer-to-peer influence by
developing programs, tools, and tactics that aim to affect attitudes toward
misuse and ultimately the behavior of those who misuse or would consider
misusing
 Almost half of students equate the harmfulness of misuse to that of an
energy drink or strong cup of coffee – and three-quarters believe that at
least some students have misused
– Identify peer-to-peer tactics to address the social norming of the issue
– Communicate to physicians their role in conveying the significant medical
and legal consequences of misuse, abuse and diversion of ADHD stimulant
medication
 Most believe friends with prescriptions are a likely source for misusers,
and half believe students who misuse get ADHD prescription stimulants
from a healthcare professional by pretending to have ADHD
– Provide resources, tools, and tactics to physicians in order to leverage their
power as a key influencer to both the prescribed and to potential misusers

 College students are busy and feel stressed – and ADHD
prescription stimulant misuse is seen by many as a way to keep up
– Encourage college administrators, teachers, and other key influencers (e.g.,
parents) to address the stress of day-to-day college pressures by helping
students adopt healthy, lifelong coping skills
– Communicate to students that using ADHD prescription stimulants does not
guarantee better grades, nor is it a long-term solution for dealing with
academic stress
 A majority of students report that preventing misuse is not a priority
at their school and that the administration and professors are not
aware of misuse on campus
– Communicate to college administrators the significance of making their
stance on the issue known. Provide resources to administrators on how to
effectively communicate their position to students and staff, including
examples of policy initiatives

 Students diagnosed with ADHD are less likely to view misuse as
harmful and more likely to say it is acceptable to share or even sell
ADHD prescription stimulants
– Reach ADHD students to better inform their perception of the issue,
including ethical, legal, and medical consequences of misuse, abuse, and
diversion.
– Instill a greater sense of responsibility in ADHD students to not divert their
supply
 Nearly half of ADHD students with a prescription feel pressure to share
or sell their medication
– Provide support to ADHD students to help them feel empowered to say no
when peers approach them for their medication

DISCUSSION/OPPORTUNITIES
FOR COLLABORATION

WHAT CAN YOU DO?
 Go to CPAMM.org/collegeadmin to learn more about the issue and what
leaders on your campus can do
 Share the facts about misuse and raise awareness by talking to campus
and student leaders about the issue
 Join the Friends of CPAMM email list to learn more about new peer-to-peer
programming and other important initiatives in 2016
 Contact CPAMM to discuss other opportunities to collaborate

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