OBJECTIVES: To measure the level of stimulant use and misuse among the US population and to determine the association between the use of prescription stimulants and non-medical use of other prescription drugs.

METHODS: The study was a retrospective cross-sectional analysis utilizing the 2015 National Survey on Drug Use and Health (NSDUH) dataset. Stimulant use was characterized as appropriate use, misuse, or no use. Stimulant misuse was defined by NSDUH as use in any way not directed by a doctor. The outcome variable included misuse of other prescription drugs such as sedatives, tranquilizers, and pain relievers. Sociodemographic characteristics and mental health status were used as control variables. A logistic regression model assessed the association between stimulant misuse and misuse of other prescription drugs, after adjusting for covariates. The model also included all possible interactions between stimulant use and other covariates.

RESULTS: The study sample was adjusted for sampling weights, clustering, and stratification of the data. The final weighted sample consisted of 261.19 million individuals. Nearly 5 million respondents (1.9%) reported stimulant misuse and 22.1 million (8.5%) reported appropriate use. Stimulant misusers were more likely to be 26-34 years old, male, Caucasian, with previous alcohol, tobacco, and marijuana use. Among respondents with a history of a Major Depressive Episode (MDE), both appropriate users (OR:2.19; p<0.001) and misusers of stimulants (OR:18.67; p<0.001) had significantly higher odds of misusing other prescription drugs when compared to individuals who did not use stimulants. Among those without MDE, stimulant misuse (OR:8.65; p<0.0001) and appropriate use (OR:1.35; p<0.0001) had lower, but significant odds of the outcome.

CONCLUSIONS: Patients who used prescription stimulants both appropriately and inappropriately had significantly higher odds of prescription drug misuse compared to stimulant nonusers. A better understanding of this relationship could assist interventions in better targeting patients at risk of prescription drug misuse.