November 3, 2003

Adderall pervades University

Editor's Note:

Two students were granted anonymity to discuss their experience with Adderall. They are referred to in this story as Nikki and Chris.

It's late. Nikki has not slept for hours, and the caffeine pills she has been downing to help study for midterms are starting to take a toll on her body. She has a few options: pop a few more caffeine pills and let the jitters continue; go to sleep without finishing her essay; or try a friend's "miracle" drug that will not only keep her awake and help her concentrate, but will also have no nervous effect on her body. It's not such a concern to Nikki that this "miracle" drug has much the same chemical effect on the brain as cocaine does.

This drug is safer—it's prescription, after all.

At least this seems to be the consensus among stressed-out students like Nikki. She uses the prescription drug Adderall, often misspelled as Aderol, to combat sleepiness—a pesky inconvenience during exam periods. Nikki, a second-year in the College, recently stayed awake for nearly four days straight in order to study, popping a pill or two every day.

Though diagnosed with mild ADD in the past, Nikki was never prescribed a drug and only recently started buying Adderall for $2 a pill from a friend with a prescription.

Prescription drug abuse is not a new issue. From the publicity given to Courtney Love's abuse of Oxycontin (a prescription depressant) to the couple recently sentenced to life in prison for burglarizing pharmacies, the illicit use of medicine has long percolated through the news as a societal ill. It is often vilified in the media, spotlighted as a source of entertainment for society's irresponsible or attributed solely to dangerous criminals.

University students have a different reason for abusing prescriptions of Adderall. It is not used to party or escape from reality, but, increasingly, by students like Nikki—to help concentrate and study.

Adderall is a relatively new drug, most commonly used to treat Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). It is classified as a stimulant; this class of drugs generally increases attention, enhances brain activity and raises blood pressure and heart rate. They also increase the amount of the neurotransmitter dopamine in the brain, according to the National Institute on Drug Abuse (NIDA).

Adderall's release of dopamine elicits a feeling of euphoria that is similar to the feeling that can be obtained from illegal drugs like cocaine. Overdosing can lead to extremely high body temperatures, paranoia, heart failure, seizures, and irregular heartbeat, according to NIDA.

It is for this reason that doctors like Tom Kramer, director of the Student Counseling Center at the University, fear the addictive quality of Adderall and similar prescription drugs. "Adderall is a more pleasurable drug than caffeine; it's much more euphoric and certainly more addictive," Kramer said.

Chris is a second-year in the College who has used Adderall twice. He opted for the pill instead of caffeine because, rather than make him very nervous, "Adderall gave me the ability to actually focus," he said. "I know that it's highly addictive, but everything in moderation. If [Adderall] is what I need to get me to focus, that's what I'll do."

Since the FDA approved Adderall, the availability of Adderall and similar drugs has been on the rise. Consequently, so has the drug's use for non-medicinal purposes. There is no biological way to test for ADHD—only a guideline created by the American Psychiatric Association that includes a checklist of symptoms: "does not pay close attention to details," "talks excessively," and "fidgets," according to the U.S. Food and Drug Administration Consumer.

Prescriptions for amphetamines-which also include the popular drug Ritalin-have increased from 1.3 million to around 6 million since 1996.

A 1999 National Household Survey on Drug Abuse reported that two percent of the population over the age of 11 has abused prescription drugs. About 900,000 of these cases involved stimulant abuse. The same survey showed that the largest increase in non-prescribed users occurred in 12- to 17-year-olds and 18- to 25-year-olds.

Whether consumed illicitly or in the form of a prescription, drugs have gone in and out of fashion for years. Sarah Van Orman, medical director of the Student Care Center at the University, frames discussion of Adderall in this context. She said that drug use "is not more of a problem than it was ten years ago. There are trends and it's something that's always there."

Van Orman said that the University's health community is paying more attention to Adderall abuse, in part because it is now more available than Ritalin.

Ritalin is now prescribed less frequently because, though it is fast-acting, relief comes in a small burst and then quickly decreases. Adderall, conversely, is formulated to act more gradually, having a slower onset and dissipation. Because of this, it is less addictive than Ritalin, according to Van Orman.

Chris and Nikki do not think of themselves as drug abusers, because they use Adderall only as a means to study, not for recreation.

So if the side effects are relatively minimal-at least in the short term—and the potential for helping stay awake and attentive is great, what is stopping more students from taking Adderall?

Staff psychiatrist at the Student Counseling Center and specialist in child and adolescent psychiatry Jacqueline Pardo, responded to this by citing the concept of diminishing return. She said that people who take Adderall without a prescription will "get a high but then someone will have to take more and more of the drug to get back up."

Some students equate using Adderrall with cheating. "It is one thing to do [Adderall] for recreational purposes, but using drugs to gain an advantage over other people is fraudulent," said first-year in the College Gabriel Mares. "Performance-enhancing drugs are not acceptable in athletics; they shouldn't be acceptable in academics either."

Students taking the drug feel that the workaholic environment justifies their actions:"People have always had crazy amounts of work and [taking Adderall] is a good way to get things done," Chris said.

To Ian Hawkins, a third-year in the College, it is acceptable to derive benefit from a drug—as long as it is for the sake of studying. "To say [taking Adderall] is unfair is to say that learning is a competition," Hawkins said. "But learning is for the sake of a better impact on the world."

Van Orman said that most students abuse the drug not to gain an academic edge but rather because they believe themselves to have ADHD. Chris, for his part, said that he does not think he has ADHD. Nikki was diagnosed with ADHD in the past but never given a prescription for medication.

Faculty members don't seem aware that Adderall abuse is a problem among the students. Susan Art, dean of students in the College said she had only heard of users with prescriptions taking too much of the drug, not necessarily using it for recreational purposes. Art referred to a low prescription drug abuse report rate in a recent University drug survey of undergraduate and graduate students. She was unsure whether that Adderall abuse was on the rise.

One female first-year said she saw a few friends using Adderall to combat hangovers "on a Sunday morning when you have to get all your work done." However, she estimated these users to be a "small population of people."

A recent study in Journal of Child and Adolescent Psychopharmacology showed that the stimulant class of prescription drugs does not directly predispose users to other substance abuse. However, NIDA published a paper in 1999 that showed that people with ADD and ADHD are more at risk for becoming abusers of drugs and alcohol. The NIDA paper demonstrated that the increased risk for drug and alcohol was not due to the disorder itself; rather, they showed a causal link between Adderall abuse and later drug and alcohol abuse. Prescription stimulants are a gateway to other illegal stimulants, like cocaine and methamphetamine.

The connection between prescription Adderall and illicit stimulants remains murky. Another study conducted by NIDA showed that giving cocaine abusers prescription stimulants like Adderall reduced their cocaine dependence. Similarly, the Drug Enforcement Administration found that humans and animals had nearly identical reactions to amphetamine (Adderall), methylphenidate (Ritalin), and cocaine when taken in similar doses, according to a DEA report.