Medication Misuse Behaviors in School Settings Among Children and Adolescents: A Systematic Review.

Abstract

The inappropriate use of medication by students during their schooling period has been recognized as an emerging worldwide public health issue, especially regarding the prescription stimulant medications prescribed for attention-deficit/hyperactivity disorder. Some examples of such behaviors include non-medical use, excessive use, insufficient use, and misuse. Such behaviors emerge from an interplay of many different factors at the level of the individual, peers, and school environment. In this systematic review, we have synthesized data extracted from peer-reviewed scientific articles, book chapters, and systematic reviews published between 2000 and 2025, selected using databases like PubMed, Scopus, Web of Science, and Google Scholar. Thirty scientific papers met our inclusion criteria and underwent thematic analysis, along with evaluations of the quality and certainty of the evidence. Four key themes emerged from our analysis, namely: (1) prevalence and patterns of misuse (from 5% to 29%), (2) peer and environmental influence, (3) risk and protective factors, and (4) effectiveness of school-based interventions. Non-medical use of prescription stimulants is influenced by academic stress, peer pressure, and easy access to drugs, while protection is provided by school surveillance, adherence to policy, and education. Multicomponent interventions comprising policy enforcement, supervision, and peer approaches prove to be more effective than other types of interventions. Medication misuse among children and adolescents in schools can be addressed effectively only with comprehensive interventions taking into account individual, peer, and school-level factors. Further studies are needed in low- and middle-income countries, especially in Africa.