Psychopharmacology and Psychiatry Updates ADHD Stimulants: Clinical Safeguards Against Misuse and Diversion
Mar 12, 2026
Oscar G. Bukstein, psychiatry professor and ADHD/substance-use expert, outlines clinical safeguards for stimulant prescribing. He explains why stimulants are Schedule II and how pharmacokinetics affect abuse risk. He reviews screening questions, red flags for misuse and diversion, and practical precautions like long-acting meds, monitoring, urine screens, and nonstimulant options.
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Graduate Student Borrowed Adderall To Finish Finals
- A 27-year-old grad student diagnosed with ADHD admits she borrowed a friend's Adderall in college to finish finals.
- This vignette frames the common scenario where past non-recreational misuse raises but does not determine current prescribing decisions.
Therapeutic Stimulants Mimic Cocaine Brain Effects
- Therapeutic stimulants share brain effects with cocaine, including striatal uptake and dopamine transporter interaction.
- Methylphenidate differs pharmacokinetically by slower clearance than cocaine, which may reduce rapid adaptation and abuse liability.
Screen Thoroughly For Substance Use History
- Screen for current or past substance use, history of stimulant/amphetamine abuse, and prior SUD treatment before prescribing stimulants.
- Ask about periods of abstinence and specific substances to stratify risk rather than assuming all past use is equal.