OMB Control No: 0910-0847 Expiration Date: 12/31/2022
Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0910-0847. The time required to complete this screening document is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.
The question below is about stimulants. Some stimulants are used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), shift work disorder, sleep apnea, or narcolepsy. They are also known to aid with losing weight, staying awake, or studying. Some stimulants are available without a prescription or are made illegally (not by a drug company). We will be asking about both types of stimulants in this survey.
B1. Have you ever used the stimulant below? Select yes or no.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B2. What is your age in years?
Enter a whole number.
B3 . The list below shows events that may happen to someone during their life. Please choose any 5 events that have happened to you.
Event |
Variable Name |
Graduated high school |
|
Got married |
|
Had first child |
|
Had first relationship |
|
Started college |
|
Graduated college |
|
Got first job |
|
Moved out of parent’s house |
|
Bought own house |
|
Moved to another state/city |
|
Got divorced |
|
Death of a loved one |
|
Travelled abroad for the first time |
|
Left a job that was meaningful to me |
|
Got a pet |
|
Bought first car |
|
Add an event not listed |
|
Add an event not listed |
|
Add an event not listed |
|
Add an event not listed |
|
Add an event not listed |
Please be specific.
Please type in
Please type in
Please type in
Please type in
Please type in
B4. Please place the 5 major events you identified on the timeline below.
Drag and drop the flag on the timeline to answer the question.
B5. When you first used each of the stimulants below, what was your age in years?
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Used amphetamine made by a drug company |
|
Used atomoxetine |
|
Used methylphenidate |
|
Used modafinil |
|
Used amphetamine not made by a drug company |
|
Used cathinones |
|
Used cocaine powder |
|
Used crack cocaine |
|
Used MDMA |
|
Used methamphetamine |
B5.1. Have you ever injected the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.2. Have you ever shared a needle with another person while injecting the stimulant below? Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.3. Have you ever used the stimulant below at the same time as another drug? Please say no if you took a drug at the same time as another drug as directed by your healthcare provider.
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5a.3.1. What was the other drug you used at the same time as amphetamine made by a drug company? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.1. At what age did you first use [PIPE OET B5a.3.1] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.2. What was the other drug you used at the same time as atomoxetine? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.2. At what age did you first use [PIPE OET B6a.3.2] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.3. What was the other drug you used at the same time as methylphenidate? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.3. At what age did you first use [PIPE OET B6a.3..3] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.4. What was the other drug you used at the same time as modafinil? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.4. At what age did you first use [PIPE OET B6a.3..4] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.5. What was the other drug you used at the same time as amphetamine not made by a drug company? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.5. At what age did you first use [PIPE OET B6a.3..5] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.6. What was the other drug you used at the same time as cathinones? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.6. At what age did you first use [PIPE OET B6a.3..6] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.7. What was the other drug you used at the same time as cocaine powder? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.7. At what age did you first use [PIPE OET B6a.3..7] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.8. What was the other drug you used at the same time as crack cocaine? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.8. At what age did you first use [PIPE OET B6a.3..8] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.9. What was the other drug you used at the same time as MDMA? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.9. At what age did you first use [PIPE OET B6a.3..9] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5a.3.10. What was the other drug you used at the same time as methamphetamine? If you used more than one, list the one you have used most often.
Enter just one drug.
[Check box] I prefer not to answer
B6a.3.10. At what age did you first use [PIPE OET B6a.3..10] in a way not directed by your healthcare provider?
Drag and drop the flag on the timeline to answer the question.
B5.4. Have you ever snorted the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.5. Have you ever used the stimulant below to feel good or get high?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.6.
Have you ever
used
the
stimulant below to
improve professional or academic performance without being told to by
a healthcare professional?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.7. Have you ever purchased the stimulant below from the Internet without a prescription? Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.8. Have you ever purchased the stimulant below from a dealer?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug compnay such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.9. Have you ever received a prescription for yourself for the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
B5a.9.1. When you first received a prescription for yourself for amphetamine made by a drug company, for what medical condition or symptom did you receive the prescription?
Please select one
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)_
Narcolepsy
Shift work sleep disorder
Another medical condition or symptom
B5a.9.2. When you first received a prescription for yourself for atomoxetine, for what medical condition or symptom did you receive the prescription?
Please select one
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)_
Narcolepsy
Shift work sleep disorder
Another medical condition or symptom
B5a.9.3. When you first received a prescription for yourself for methylphenidate, for what medical condition or symptom did you receive the prescription?
Please select one
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)_
Narcolepsy
Shift work sleep disorder
Another medical condition or symptom
B5a.9.4. When you first received a prescription for yourself for modafinil, for what medical condition or symptom did you receive the prescription?
Please select one
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)_
Narcolepsy
Shift work sleep disorder
Another medical condition or symptom
B5.10. Have you ever given away or sold the drugs from your prescription for the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
B5.11. Have you ever received the stimulant below from a friend or family member?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.12. Have you ever tampered with the prescription stimulant below before using it? Tampering could include crushing, chewing, heating, dissolving, or changing the drug in a way not directed by a healthcare professional.
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
B5.13. Have you ever smoked the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.14. Have you ever used the stimulant below to improve athletic performance without being told to by a healthcare professional?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.15. Have you ever used the stimulant below to lose weight?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.16. Have you ever used the stimulant below as a replacement for another drug?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B5.17. Have you ever swallowed the stimulant below?
Select yes or no for each.
Yes
No
Stimulants |
Variable Name |
Amphetamine made by a drug company such as Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics |
|
Atomoxetine such as Strattera® or other generics |
|
Methylphenidate such as Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics |
|
Modafinil such as Nuvigil®, Provigil®, or other generics |
|
Amphetamine not made by a drug company (Bennies, Black Beauties, Crosses, Hearts, LA Turnaround, Speed, Truck Drivers, Uppers) |
|
Cathinones (mephedrone, bath salts) |
|
Cocaine Powder (Blow, Bump, Coke, Charlie, Flake, Snow, Toot) |
|
Crack Cocaine (Candy, Crack, Charlie, Rock) |
|
MDMA (Ecstasy, Molly, Adam, Clarity, Eve, Lover’s Speed, Peace, Uppers) |
|
Methamphetamine (Crank, Chalk, Crystal, Fire, Glass, Go Fast, Ice, Meth, Speed, Crystal Meth) |
B6.1. The following refers to your use of amphetamine made by a drug company (Adderall®, Adderall XR®, Adzenys ER™, Adzenys XR-ODT™, Desoxyn®, Dexedrine®, Dyanavel® XR, Evekeo®, Evekeo® ODT™, Mydayis®, Vyvanse®, or other generics). Please place the events on the timeline below according to the first time you did each one.
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received a prescription for yourself |
|
Gave away or sold the drugs from your prescription |
|
Received from a friend or family member |
|
Tampered with |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.2. The following refers to your use of atomoxetine (Strattera® or other generics). Please place the events on the timeline below according to the first time you did each one.
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received a prescription for yourself |
|
Gave away or sold the drugs from your prescription |
|
Received from a friend or family member |
|
Tampered with |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.3. The following refers to your use of methylphenidate (Adhansia XR®, Aptensio XR®, Concerta®, Cotempla XR-ODT™, Daytrana®, Focalin®, Focalin XR®, Metadate CD®, Metadate® ER, Methylin™ ER, Quillichew ER™, Quillivant XR®, Ritalin®, Ritalin LA®, Ritalin SR®, or other generics). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received a prescription for yourself |
|
Gave away or the sold the drugs from your prescription |
|
Received from a friend or family member |
|
Tampered with |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.4. The following refers to your use of modafinil (Nuvigil®, Provigil®, or other generics). Please place the events on the timeline below according to the first time you did each one.
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received a prescription for yourself |
|
Gave away or sold the drugs from your prescription |
|
Received from a friend or family member |
|
Tampered with |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.5. The following refers to your use of amphetamine not made by a drug company (bennies, black beauties, crosses, hearts, la turnaround, speed, truck drivers, uppers). Please place the events on the timeline below according to the first time you did each one.
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.6. The following refers to your use of cathinones (mephredone, bath salts). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.7. The following refers to your use of cocaine powder (blow, bump, coke, charlie, flake, snow, toot). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.8. The following refers to your use of crack cocaine (candy, crack, charlie, rock). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.9. The following refers to your use of MDMA (ecstasy, molly, adam, clarity, eve, lover’s speed, peace, uppers). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
B6.10. The following refers to your use of methamphetamine (crank, chalk, crystal, fire, glass, go fast, ice, meth, speed, crystal meth). Please place the events on the timeline below according to the first time you did each one
Drag and drop the flag on the timeline to answer the question. If you do not remember, please provide your best estimate.
Stimulants |
Variable Name |
Injected |
|
Shared a needle |
|
Used at the same time as another drug |
|
Snorted |
|
Used to feel good or get high |
|
Used to improve professional or academic performance |
|
Purchased from the Internet without a prescription |
|
Purchased from a dealer |
|
Received from a friend or family member |
|
Smoked |
|
Used to improve athletic performance |
|
Used to lose weight |
|
Used as a replacement for another drug |
|
Swallowed |
C1. Complete each question below. Instructional Text: Drag the slider to answer the question.
No Risk
Slight Risk
Moderate Risk
Great Risk
Scrolling Text |
Variable Name |
How much do people risk harming themselves physically and in other ways when they use a prescription stimulant as directed by a healthcare professional? |
|
How much do people risk harming themselves physically and in other ways when they use someone else’s prescription stimulant once a month? |
|
How much do people risk harming themselves physically and in other ways when they inject a prescription stimulant once a month? |
|
How much do people risk harming themselves physically and in other ways when they use cocaine once a month? |
|
How much do people risk harming themselves physically and in other ways when they use methamphetamine once a month? |
|
How much do people risk harming themselves physically and in other ways when they use a prescription stimulant more often than directed by a healthcare professional? |
|
How much do people risk harming themselves physically and in other ways when they use a prescription stimulant at a higher dose than directed by a healthcare professional? |
|
How much do people risk harming themselves physically and in other ways when they use a prescription stimulant at different times than directed by a healthcare professional? |
|
D1. Have you ever been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) by a healthcare professional? Select yes or no.
Yes
No
D2. When you were first diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) by a healthcare professional, what was your age in years?
Enter a whole number.
D3. Have you ever been diagnosed with narcolepsy by a healthcare professional? Select yes or no.
Yes
No
D4. When you were first diagnosed with narcolepsy by a healthcare professional, what was your age in years?
Enter a whole number.
D5. Have you ever been diagnosed with shift work sleep disorder by a healthcare professional? Select yes or no.
Yes
No
D6. When you were first diagnosed with shift work sleep disorder by a healthcare professional, what was your age in years?
Enter a whole number.
D7. Have you ever been diagnosed with sleep apnea by a healthcare professional? Select yes or no.
Yes
No
D8. When you were first diagnosed with sleep apnea by a healthcare professional, what was your age in years?
Enter a whole number.
E.1 Please describe just one more way in which you have used stimulants.
[Text Box] Please be specific.
[Check box] I prefer not to answer
E2. Should we trust your answers to this survey? Select yes or no.
Yes
No
E3. We know some of these questions are difficult to answer and we appreciate your honesty. If you ever think about hurting yourself, are worried about a friend or loved one, or would like emotional support, please call this free and confidential service for support and information about self-harm: National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting 741741.
Press "Continue" to finish the survey.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Mizrachi, Ila |
| File Modified | 0000-00-00 |
| File Created | 2022-06-06 |