By Ross Barkan
After the second dose, Pierce’s ears begin to ring. His teeth are chattering, his joints are trembling, and his vision is warping. Objects fall away, shrouded in an imaginary distance. Later on, he will not want to eat. He won’t sleep.
Pierce will continually torture his body. For the thrill? No. To relax? No, again. Pierce is one of millions, a student fighting for the upper crust of academia. He is either smart, a cheater or stupid, depending on who you talk to. Pierce uses Adderall without a prescription.
The senior political science major at Stony Brook University takes multiple doses of Adderall, a brand-name stimulant of mixed amphetamine salts usually prescribed to children and adults who have been diagnosed with attention-deficit hyperactivity disorder (ADHD), to help him study for exams. When taking Adderall, Pierce can consume copious amounts of information at an above-average rate, making what was once a classic college chore a cakewalk. His focus surges, his fatigue decreases and his cognition appears to reach new heights.
“Adderall is very effective for me since I am quick to fall asleep when digging through a large amount of material for an exam or paper,” Pierce said. “It keeps me awake, simple as that. I have the concentration to do work. I am just plagued with a lack of sleep from my classes. Adderall helps with that problem.”
The appeal of Adderall for any college student is obvious. Now more than ever, the pressure to succeed can be overwhelming. A difficult economic climate has made education all the more important, especially for students seeking admittance to graduate school. A team led by Sean Esteban McCabe, a professor at the University of Michigan’s Substance Abuse Research Center, reported in 2005 that in the previous year, 4.1 percent of American undergraduates had taken prescription stimulants for off-label use. At one school, the figure was 25 percent. Another study in the Journal of American College Health pegged the number as high as 34 percent.
Pierce wants to be admitted into a top-ranked law school and believes the benefits of Adderall outweigh the side effects. Does he worry that he is doing long-term damage to his body?
“Absolutely,” he said. “It’s not something I enjoy doing at all. In fact, I hate it. I hate the feeling, the effects, all of it. I just am completely and utterly dedicated to my academic goals. Any damage that I get from pursuing that is collateral damage at most.”
Acquiring Adderall on campus is not a difficult task. Unlike marijuana, cocaine or MDMA (a psychoactive drug known more commonly as “ecstasy”), Adderall is perfectly legal, a Food and Drug Administration (FDA)-approved drug that is not usually searched for by police. Adderall has no scent and users on Adderall without a prescription are inconspicuous to the untrained eye. There is no slurred speech, bloodshot eyes, or loss of motor control. Only the loss of focus.
It is illegal to sell or use Adderall without a prescription.
Pierce describes “opportunist” dealers of the drug who look to price gouge desperate students but acknowledges that most people who have Adderall, usually students who are legally prescribed the drug, are more than willing to part with a few pills for several dollars. One female student described a friend with an ADHD diagnosis who regularly deals away most of his medication. Another male student told of one student who, because he was improperly diagnosed with ADHD, now holds a large supply of Adderall that he gives away for free.
The Science of Adderall
“The problem with taking it [Adderall] without diagnosis is that you don’t know if you are vulnerable to addiction,” said Dr. Joanna Fowler, a senior scientist at the Brookhaven National Laboratory who specializes in organic synthesis and neurochemistry. “Don’t experiment.” Fowler, like many other professionals, worries about the addictive habits that frequent Adderall use can engender.
Adderall is an amphetamine, a central nervous system stimulant. It affects the chemicals and nerves in the brain that contribute to hyperactivity. People diagnosed with ADHD and narcolepsy are prescribed Adderall with increasing doses, beginning at one capsule a week. As time passes, the dosage is usually increased.
According to the FDA, the least amount of amphetamine feasible should be prescribed to minimize the possibility of an overdose. Adverse side effects to people taking the prescribed dosage include overstimulation, restlessness, dizziness, insomnia, depression, headache, seizures and stroke. Blood pressure can also be elevated.
On top of this laundry list of possible side effects are the dangers that come with overdosage. Pierce and his fellow users walk a very dangerous line when they begin to use beyond the recommended dosage, especially when they have not been recommended an original dosage.
“When we look at the brains of addicted people, we find differences in the reward system of the brain,” said Fowler. “The reward system is disrupted and is what keeps us functioning to enjoy [things like] food and music. Stimulant drugs are much stronger. They hijack your reward system.”
Foreseen…and Unforeseen Effects
“I’ll get very emotional after using Adderall,” said Roberta, a senior anthropology major. “A few hours later, like four to five, I start thinking about a lot of stuff. I usually get sad. I might start to cry.”
Roberta, like many other college students, uses Adderall to stay up all night and study for exams. She has been using since last semester and can’t imagine studying without the drug.
“Everyone I knows uses Adderall,” she said. “All of my friends, a lot of people.”
She said she doesn’t worry too much about side effects and, unlike Pierce, never considered the long-term harm she could do to her body. The federal government has classified Adderall under the same category as opium, morphene, and cocaine, all drugs with the potential for abuse. In recent years, Adderall and other ADHD medications have been linked to the deaths of 25 people.
“I never did the research,” Roberta said.
A Quick History
Between the 1940s and 1970s, amphetamines were used to treat obesity, fatigue and depression. The addictive properties of amphetamines were not yet known. In World War II, pilots used stimulants to stay awake. Baseball players popped amphetamines – known colloquially as “greenies” – to increase their alertness throughout a long and grueling season.
Amphetamines resurfaced in the 1990s. More children were diagnosed with ADHD and Adderall, introduced in 1996, was approved to treat the disorder. According to the National Center on Addiction and Substance Abuse report, between 1992 and 2002 the number of prescriptions for ADHD medications in the U.S. skyrocketed 369 percent to 23.4 million per year. In 2005, this number swelled to 31.8 million.
Health Canada suspended all sales of Adderall in Canada for a brief period in 2005 after 20 sudden deaths from use were reported. The ban was eventually lifted. Britain’s National Institute for Health and Clinical Excellence urged physicians not to prescribe Adderall to children younger than five and to strongly consider other approaches to behavior modification before prescribing Adderall to children five and older.
In 2006, the FDA nearly gave Adderall a black box warning (a warning meaning medical tests show that the drug carries significant risk and life-threatening adverse affects). Though FDA safety advisors voted 8 to 7 to approve the black box warning, the FDA’s pediatric advisory committee would not agree to the precaution.
Alan D. DeSantis, Elizabeth M. Webb, and Seth M. Noar published a 2008 study on the illicit use of prescription ADHD medications like Adderall in the Journal of American College Health. To stem the tide of illegal Adderall use, they proposed several solutions. One would be to target the sellers of Adderall who tend to be only a small percentage of the student population, students actually diagnosed with ADHD. They suggest a monthly allotment of 20 pills per student to prevent a surplus. Most prescribed Aderall users, they found, only use their medication on heavy workdays.
They also suggest education. As Roberta’s comments show, many college students are uneducated about the side effects of repeated and non-prescribed Adderall use. Mass communication and educational campaigns have successfully deterred drug use, perhaps most famously with Nancy Reagan’s anti-drug crusade in the 1980s.
Ellen Driscoll, the Substance Abuse Counselor at Stony Brook’s Center for Prevention and Outreach, also views education as the best mode of prevention.
“We don’t want students to be casual about Adderall use and view it as a study drug,” said Driscoll. “We do our best to spread the word through education and outreach programs. Students need to know about the side effects.”
The researchers believe that highly stressful finals week fosters additional use. They suggest creating more manageable finals schedules that limit the amount of exams to one a day and extending the exam period over a longer time span. Lessening time constraints might shrink the burden and stress on the students. When stress drops, usage drops.
The difficulty in prevention, though, lies in Adderall’s effectiveness. Perceived as a miracle drug, Adderall is a quick and easy way to finish mountains of schoolwork. If a student believes it helps him pass a test or write a paper, long-term damage will be sacrificed for short-term success.
Abusers of Adderall aren’t criminals, the mentally ill or any of the usual suspects. They are students, many of them high achievers, many of them who are willing to do anything it takes to climb closer to that elusive 4.0.
“It’s not the average loser druggie that uses Adderall,” Pierce said. “It’s the straight-A, good son. Adderall is the drug of society’s most productive members.”
Additional Reporting by Samuel Katz