"Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug? Do you understand that?" Tom Cruise's now infamous rant on the Today Show has been the brunt of many jokes, but when it comes to Adderall and Ritalin, two prescription stimulants used to treat ADHD, Mr. Cruise may not be so far off.
Adderall and Ritalin have in fact become "street drugs" at America's colleges and universities, where prescription stimulants often replace coffee and CliffsNotes as the study aids for today's college students.
"It's very much like coffee, but it's a little bit more intense," says a Brown University student who has an Adderall prescription and who requested that her name be withheld. She reports regularly selling her medication to other students, most of whom wanted it to help them focus on their schoolwork.
"People wanted it so often. People would pay almost anything," she said. Her asking price was up to five dollars a pill. "I sold a lot more than I took, that's for sure," she said, "It was like a bartering thing, I had something people wanted and they had something I wanted."
Her experience is not uncommon. "In general, the illicit use of prescription drugs is second only to marijuana in terms of being the most common form of illicit drug use on college campuses," says Dr. Sean Esteban McCabe, interim director of the University of Michigan Substance Abuse Research Center. According to Dr. McCabe's recent survey, 6.9 percent of American college students have taken prescription stimulants illicitly, and up to 25 percent at certain elite universities with high academic pressures and admission standards. More than 50 college newspapers have already published articles describing Adderall abuse on campus.
Unlike many prescription drugs, which may work only for people with a medical condition, Adderall and Ritalin improve the focus of everyone. They work by enhancing Dopamine and Norepinephrine pathways that are involved in attention and are deficient in the brains of patients with ADHD. The drugs are identical in most ways and they're equally popular on campus.
"I heard about somebody who was selling it, and since it was easily accessible, I decided to try it," said a Vassar College student who preferred not to be named. "It helped me concentrate; it helped me motivate to spend a long time working on a project."
Because they are prescribed by physicians, medications like Adderall and Ritalin often seem safer than illicit drugs and may therefore be more attractive to students. "I don't think there's a cachet about doing Adderall the way there is about doing coke," the Vassar student said. "You don't need someone to do a line with you, and it's not social like marijuana."
Rather than taking the pill orally, some students attempt to increase the buzz by crushing it up and snorting it. The Vassar student reported that she knew people who "crushed it and snorted it and went all night together, taking breaks and hanging out."
Abuse of ADHD medication can also begin even earlier than college. Jeremy Wayne Swanson, a 21 year-old from Hudson, Wisconsin began abusing Ritalin in Junior High School. Jeremy is part of another group of prescription stimulant abusers -- those who obtain the drugs legally with a physician's prescription to treat their ADHD. "I started not to like the feeling I got taking it normally. I felt like a walking zombie," he said. "I would put it in my mouth, walk out of the nurse's office and then take it out of my mouth, walk into a bathroom, and snort it."
Jeremy also sold his medication, making up excuses as to why he needed frequent refills. "I was supposed to be doing 4 a day, but I was snorting about 10-15. People would come to me at all hours of the night and say 'just give me some, please, please, I'll give you anything'."
For Jeremy, Ritalin was a gateway drug that he believes opened the door to cocaine and methamphetamine addictions. After being caught at school with cocaine, Jeremy entered rehab and then a halfway house. He has been clean since 2003, and is now studying to become a drug counselor for others with drug addiction problems. When asked what he would say to students now abusing ADHD medications, Jeremy says he would "try to completely steer them away from it. You think of it as harmless, but it's really not."
Abuse of prescription drugs among teenagers, however, is on the rise nationwide. A new report by the National Center of Addiction and Substance Abuse at Columbia Universityfound that teenage abuse tripled between 1992 and 2003. "They're easily available," says Joseph A. Califano Jr., chairman of the center and former U.S. secretary of health, education, and welfare. "They're in every medicine cabinet in the country; they're in every town in the country."
The problem is likely to get worse. "As more and more kids are diagnosed with ADHD, not only children but also young adults, there are going to be more of these drugs available for college students to get a hold of," says Dr. William Frankenberger, director of the Human Development Center at University of Wisconsin-Eau Claire.
Many students believe these drugs help them focus on their studies, but there is doubt as to their actual academic advantages. "People are better able to pay attention for prolonged periods without getting tired and fatigued. That is true for everyone," says Dr. Frankenberger. But this does not necessarily indicate improved performance, he warns.
As stimulants, Adderall and Ritalin may interfere with normal sleep. Students often feel like they're better prepared, but don't do as well. This is also true for patients who are prescribed the medications by physicians, and there is some indication that children on ADHD medications may actually fall further behind, says Dr. Frankenberger, perhaps due to sleep interference.
So what is the harm of using Adderall and Ritalin? If it helps everyone focus, at least in the short term, then why not make it over-the-counter?
Amphetamines are highly addictive and easily abused. "The longer you take them," says Dr. Frankenberger, "the more problems are associated with your use, and the higher dose you take, the more prominent the side effects become."
Adderall and Ritalin are serious prescription drugs with real risks and side effects including nausea, loss of appetite, insomnia, and anxiety. The drug information sheets also include a long list of negative drug interactions. If a person is taking a drug with possible chemical interactions, there could be serious consequences.
Adderall XR, the extended release version of Adderall popular on the college scene, has already been banned in Canada because of possible links to cardiac arrhythmias in children. The FDA looked at the same evidence as Canada, but kept Adderall XR on the market. Doctors take extensive medical histories before prescribing Adderall, and patients with possible cardiac complications are not prescribed the drug. This is something that students taking it without a prescription are unlikely to know.
Dr. Bruce Wright, Director of Health and Wellness Services at Washington State University, also warns of possible long-term effects. "The brain has its own kind of intrinsic reward system, so when something happens to us we feel good," he says. "The parts of the brain that are responsible for that are the same parts of the brain that drugs like Adderall impact. With prolonged or frequent medication the brain's own capacity to do that decreases."
Perhaps of more immediate concern to parents is the indication that Adderall abuse is often accompanied by other drug and alcohol abuse. Based on his survey, Dr. McCabe believes that prescription stimulant abuse "tends to be part of a larger cluster of problem behaviors among college students, including higher rates of other drug use and driving under the influence." Students who had used a prescription stimulant non-medically in the past year were ten times more likely to report marijuana use, twenty times more likely to report cocaine use, and five times more likely to report driving after binge drinking.
Shire Pharmaceuticals, the makers of Adderall, have several programs geared towards educating physicians, patients, parents, and college students about the risks associated with Adderall. Matt Cabrey, a spokesperson for Shire, says that the company has been focusing on educating physicians who prescribe ADHD medications, the patients themselves, and the parents of those patients. In addition, Shire recently initiated an education program designed specifically to reach college students.
Mr. Califano says that the primary role of the pharmaceutical industry should be to cut direct-to-consumer advertising. He also emphasizes the importance of a public health campaign. "The responsibility is for the public health officials," he says. "We've gotten through with smoking, now we need that kind of campaign for prescription drugs."
At WSU, Health and Wellness Services has developed tight protocols to carefully monitor and limit the prescription of Adderall and Ritalin. "You can't just come in and list the symptoms and get on Adderall," says Dr. Wright. Dr. McCabe believes that "the first step is that colleges in the US can become more aware. It may be that schools are able to provide programs to address some of the underlying motives and students won't feel compelled to use them in that way."
So is Tom Cruise right? Are Adderall and Ritalin really "street drugs?" For some, yes. But, says Dr. Wright, "everything that can be abused is available on the street." What does not fit in Mr. Cruise's anti-medication diatribe is the fact that Adderall and Ritalin are important and effective medications for patients suffering from ADHD. Concern with the abuse and over-prescription of stimulant medications must be balanced with the sometimes life-changing successes that these drugs have for the people who actually need them.
By Jenny A. Gold