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Adderall: unprescribed and dangerous

How college kids self-medicate for success

Meredith Purcell

July 31, 2008 | 12:00 a.m. CST

As the sun set over Busch Stadium one summer evening, Christina struggled to keep her eyes open. She had started boozing before the first pitch, continued to drink throughout the game’s earlier innings and risked striking out at her goal to hit up Paddy O’s after the ninth. Attempting to fight off the fatigue that accumulates during a day of drinking, Christina washed down with a sip of beer the small blue pill that she had put in her purse that morning. Ten minutes later, she was wide-eyed and awake, ready to take on the downtown bar scene.
“I took an Adderall,” she says. “If you have some Addie, you can pop it and then be ready to party for five more hours.”
Christina is just one of many college students who have joined in on the trend of using Adderall without a prescription to aid studying, enhance partying or even lose weight. According to the National Household Survey on Drug Abuse published in 2006, illegal drug use among teens in the U.S. continues to decline, but the misuse of prescription and over-the-counter medication remains high. The survey said that teens are abusing these drugs because they falsely believe that they provide a medically safe high. In reality, these students are risking their health for a better grade, a longer night of partying or a smaller waist size.

Putting the “ADHD” into “Adderall”

Adderall, the brand name of amphetamine-dextroamphetamine, is a central nervous system stimulant that is most commonly used to treat attention-deficit hyperactivity disorder and narcolepsy. The pill affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. The theory is that children are hyperactive because they lack stimulation, explains Dr. Aneesh Tosh, an adolescent medicine pediatrician at the University Hospital. By giving a child a stimulant medication, the brain is preoccupied and he or she is able to concentrate.
According to the U.S. Drug Enforcement Administration, in Missouri, Adderall and Ritalin are among the most commonly abused “diverted pharmaceuticals” — drugs that users obtain illegally by means other than a prescription. A 2006 study on the illicit use of drugs found that college students chose Adderall over other stimulants such as Ritalin. Because the drug is legally prescribed to many in the college population, students who are not prescribed have an easy time obtaining the medication.
“People network to get Adderall,” Christina says. “If you know someone who’s got some, you ask them where to get it. I get mine from my sister and sorority sisters.”
The college senior swears that, even without a prescription, Adderall isn’t hard to find. “Even if I didn’t know the people who I get it from, I could easily ask other friends to get it for me from one of their friends,” she says. “It’s very easy.”
Part of the problem is that most students who are prescribed the drug don’t take the medicine on a daily basis and know that they can turn a profit by giving their extra pills to friends. “Most people don’t want to take it every day,” says Kevin, an MU student who is prescribed Adderall even though he believes he does not have ADHD. “They have a surplus of Adderall and want to make money and sell it.”
According to the National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Service Administration, 16.2 million Americans ages 12 and older had taken a prescription pain reliever, tranquilizer, stimulant or sedative for nonmedical purposes at least once in 2006.

Missourian guidelines for anonymous sources

Dear reader: Christina, Kevin and Jennifer are real people, but their last names are only known to the reporter, myself and the Missourian’s executive editor. The Missourian and its publications, including Vox, have a policy forbidding the use of anonymous sources unless the information they give us is essential to the story; printing their full names could result in harm to them; and the story is important to the health of the community. In my opinion, the information that Christina, Kevin and Jennifer gave is important to telling the story and meets those criteria.
– Rob Weir, Editorial Director

Important questions:

Before we publish a local story with anonymous sources, editors and reporters should ask these questions:

• Is the information absolutely essential?
Put another way: Could we still run the story without quoting the anonymous source?

• Could we convince the source to go on the record? Or could we get that information from an on-the-record source?

• Does the source believe that he or she will be harmed? That could mean either physical harm or the loss of livelihood, but it doesn’t mean simple embarrassment.

• Is the source hiding behind anonymity to take a cheap shot at an enemy?

• Is the story important enough to the health of our community to override the risk to the newspaper’s credibility? For example: A story about bad housing might be important enough, but a story about a quaint old house probably is not.

More on anonymous sources:

Anonymity threatens a newspaper’s credibility. The Missourian’s contract with its readers is bound by that credibility.

That’s why using anonymous sources should clear the highest barriers.

All anonymous quotes and citations in local copy must be cleared by Tom Warhover, the executive editor, unless prevented by time factors. Reporters must reveal the source to their assigning editor and executive editor.

Wire copy: There is a similar problem here, but there is less control. Cultural and physical situations across the globe could suggest more latitude. The culture of anonymity in Washington, D.C., might not. In any case, questions 1 and 3 can and should be asked of every wire story, and the news editor in charge should be consulted before running the story.

You probably can imagine dozens of exceptions or circumstances of nuance. The point is not to create law so much as to compel conversation about when the use of unnamed sources is appropriate.

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Study buddy

One of the reasons Adderall has found popularity on college campuses is its apparent ability to help students cram for tests. The drug has replaced more traditional methods of staying awake such as NoDoz and black coffee. “I am totally dependent on it academically,” Kevin says. “I could probably get by without it, but school would be much harder. I’d have to study more nights in advance and actually go to class.”
Kevin’s academic routine revolves around cram sessions fueled by the brightly colored pills, which he playfully refers to as skittles.
“I usually only go to about 10 percent of my classes, and then I take an Adderall,” he says. “I either take it really late at night and study until the test (the next morning), or I’ll take it really early in the morning before a test and teach myself everything in about 12 hours or so.”
Christina believes the drug gives her an edge over those who prefer to study without the aid of substances. “People who don’t take it during exam weeks and stuff are at a disadvantage,” she says. “Everyone that is sitting around Ellis is on Adderall, reading twice as much as people who don’t take it. And, they can study longer.”
Jennifer, an MU student who was prescribed the drug despite never being tested for ADHD, saw her grade-point average rise after adding the pill into her study routine. “First semester, I was not on it, and I got a 2.8,” the senior says. “Second semester, I got on it, and now I have a 3.3.”
The demand for Adderall is particularly high during exam time. “During finals week, I definitely make about 50 bucks from giving it away,” Jennifer says. She estimates that she has sold it to 50 of her friends who don’t have prescriptions.
But the drug isn’t a perfect fix for studying. “People are under the false perception that these drugs will help them focus, study and stay awake,” Tosh says. “Yes, these things can happen, but usually the side effects outweigh the benefits. I would never condone their use for these reasons. These stimulant medications should really be used to treat ADHD and ADHD alone.”

Unprescribed trouble

There’s a side effect most students who aren’t prescribed Adderall don’t consider when popping these pills to cram: They are breaking MU rules. MU spokesman Christian Basi says that because Adderall is a controlled substance, it is considered an illicit substance when in the possession of an unprescribed user. MU’s Standard of Conduct states that the university prohibits the unlawful possession, use, distribution and sale of alcohol and illicit drugs by students. Violating the code can result in consequences as serious as expulsion.
Of course, prescription drug abuse is punishable in more places than campus. The criminal penalties for these violations can range from fines up to $20,000 to time behind bars. Selling the drugs at a school can make matters worse for the defendant. As stated by the DEA, any person who distributes, possesses with intent to distribute or manufactures a controlled substance in, on or within 1,000 feet of a university is subject to twice the maximum punishment authorized and at least twice any term of supervised release authorized.
Donell Young, coordinator of MU’s Office of Judicial Services, says students have been caught with illicit drugs in the past. “It isn’t reported too often,” he says. “Last year, we had the most cases, so it could potentially be on the rise.”
Young also says that many of the cases involving nonmedical use of stimulant medications go unreported. The main way violators have been caught is when the medication is discovered on them while they are being apprehended for another offense, such as a minor in possession of alcohol.

Boozin’ with a boost

Other students find pleasure in taking an Adderall before they head out to the bars. “It keeps you awake,” Jennifer says. “It keeps you partying harder. You’re more lively and aware of everything that’s happening. I know some people that take it right before dinner time, so they don’t eat dinner in order to get more drunk.”
Christina believes Adderall affects her drinking habits. “I feel like I always drink more on Adderall just because I get so hyped up,” she says. “I definitely drink twice as much. I pretty much always black out when I go out and take an Adderall.”
Most people are not aware of the harmful side effects that come with an Adderall-and-alcohol cocktail. “Mixing Adderall and alcohol can add additional side effects that are not good,” Tosh says. “That combination lowers anyone’s seizure threshold and therefore increases the likelihood of seizures. People who are using Adderall plus alcohol are really more than doubling their risks of serious side effects. It is very dangerous behavior.”

Nosy Adderall abusers

Although the drug is more commonly taken orally, some people prefer to crush the pills and snort them. “My high school friends snort it all the time,” Jennifer says. “The regular Adderall is blue, and you see people that go out and have some blue on their nose. It’s like, ‘What have you been doing? Snorting Adderall?’ The faster it goes into your body, the faster it will take effect.”
But, as most people might imagine, snorting the drug is even more harmful than popping it orally. “Usually, medications are released slowly through the (gastrointestinal) track,” Tosh says. “But when it is snorted, it goes directly into the bloodstream. Therefore, a stimulant medication that is supposed to slowly release into your body is now being directly released, and there are quick variations of heart rate and blood pressure. The likelihood of having problems with these medications increases significantly.”
The most common side effects that nonprescribed users face when abusing Adderall relate to the heart. “Cardiac side effects, irregular heart rhythm, fast heart rate and even death are major concerns when people abuse stimulant medications,” Tosh says. “At safe doses for medically indicated conditions such as ADHD, these drugs can be safe. However, when students are abusing stimulant medications like Adderall, they are usually taking dosages much higher than we would normally prescribe.”

Over-prescription problems

Beyond the problem of people taking unprescribed Adderall, some people worry physicians and psychiatrists overprescribe the medication. Jennifer, who began taking the drug a year ago, was given the medication without being tested for ADHD. “I don’t really need it,” she says. “My doctor definitely didn’t go through tests to give it to me. My sister took it, and I was like, ‘Yeah, I really like it, and I need to improve my grades,’ so he prescribed me 20 milligrams.”
According to the DEA, one of the primary methods of obtaining the drug is doctor shopping, in which a patient goes to multiple doctors and feigns ADHD symptoms to get a prescription.
Despite worry that the drug is overprescribed, Tosh stresses the importance of stimulant medications to those with ADHD. “There has been some concern in the medical community that these medications are overprescribed, usually in the context of a poor diagnosis,” he says. “However, when ADHD is diagnosed properly, these patients do need to get treated. Treating ADHD improves that person’s quality of life.”
Tosh says that to properly diagnose ADHD, the doctor must get important background information from the patient’s instructors and family. This makes it harder for that patient to fake symptoms. Normally, a person is diagnosed with ADHD in elementary school. Late-onset ADHD does exist, but these patients still tend to exhibit symptoms of attention deficit or hyperactivity earlier in life.
“If the ADHD symptoms just come out of the blue, we tend to be a little more skeptical and ask more questions,” Tosh says. “Traditionally, there are questionnaires that we give to family members and teachers to answer that kind of give us a 360-degree view of how the person does or interacts on a daily basis, not just when they are seeing a physician.”
Tosh believes the best way to battle Adderall abuse is to keep close tabs on those who are prescribed the drug. “Normally we give a patient one month at a time and keep track of when their last prescription was prescribed,” he says. “If it has only been 10 days since their last refill and they are asking for more, then we are a little more skeptical as to why they need a refill so soon.”

A temporary lifestyle

Christina admits to taking Adderall without a prescription at least three times a week and worries about the harm she might be doing to her body. “I get concerned about the effects it has on my heart,” she says. “It’s like smoking cigarettes: You know it’s not good for you, but you don’t really think about it.” Besides, Christina swears that she will stop using Adderall after she leaves college. “I think that this is only a temporary thing for sure,” she says. “College is so hectic. Random sleep cycles ... a lot of partying. Once I am in a 9-to-5 life, I’m not going to be wanting to stay out until 2 a.m. It is like smoking weed or something. It’s a temporary lifestyle.”

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