OBJECTIVE To review all literature on the nonmedical use (NMU) and diversion of prescription stimulants to better understand the characteristics, risk factors, and outcomes of NMU and to review risk-reduction strategies. METHOD We systematically searched PubMed, PsycINFO, and SCOPUS from inception to May 2018 for studies containing empirical data about NMU and diversion of prescription stimulants. Additional references identified by the authors were also assessed for inclusion. RESULTS A total of 111 studies met inclusion criteria. NMU and diversion of stimulants are highly prevalent; self-reported rates among population samples range from 2.1% to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to describe NMU, and most studies have examined college students. Although most NMU is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or minor, medical effects; however, adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes. Although academic and occupational performance enhancement are the most commonly cited motivations, there is little evidence that academic performance is improved by NMU in individuals without attention-deficit/hyperactivity disorder. CONCLUSION NMU of stimulants is a significant public health problem, especially in college students, but variations in the terms used to describe NMU and inconsistencies in the available data limit a better understanding of this problem. Further research is needed to develop methods to detect NMU, identify individuals at greatest risk, study routes of administration, and devise educational and other interventions to help reduce occurrence of NMU. Colleges should consider including NMU in academic integrity policies.

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系统评价：处方兴奋剂的非医学使用：风险因素，结果和降低风险的策略。

目的回顾所有关于非医学用途（NMU）和处方兴奋剂转移的文献，以更好地了解NMU的特征，危险因素和结局，并审查降低风险的策略。方法从开始到2018年5月，我们系统地搜索PubMed，PsycINFO和SCOPUS，以获取包含NMU和处方兴奋剂转移的经验数据的研究。作者确定的其他参考文献也进行了评估。结果共有111项研究符合纳入标准。NMU和兴奋剂的转移非常普遍。人群样本中自我报告的比率分别为2.1％至58.7％和0.7％至80.0％。各种各样的术语用于描述NMU，并且大多数研究都对大学生进行了研究。尽管大多数NMU是口服的，但非口服NMU也会出现。NMU的大多数与无或轻微的医学影响有关；但是，某些人会发生包括死亡在内的不良医学后果，尤其是在通过非口服途径给药时。尽管提高学术和职业绩效是最常被提及的动机，但很少有证据表明，在没有注意力缺陷/多动症的个体中，NMU可以提高学业成绩。结论兴奋剂的NMU是一个重大的公共卫生问题，尤其是在大学生中，但用于描述NMU的术语的变化以及可用数据的不一致限制了对该问题的更好理解。需要进行进一步的研究以开发出检测NMU，识别风险最大的个体，研究给药途径，并设计教育和其他干预措施以帮助减少NMU的发生。高校应考虑将NMU纳入学术诚信政策中。