Evelyn Pringle February 24, 2006
Dubbed "Kiddie Coke," Adderall is being abused by increasing numbers of high school and college students all across America. It's difficult to quantify the extent of the abuse among students due the availability of the drug through legal prescriptions and on the internet.
Adderall is an amphetamine, a class of stimulant drugs that were widely abused when prescribed as diet pills until they were banned for that use more than 2 decades ago. However, according to clinical social worker, Catherine Wood: "The mother's little helpers of the 1960's and 1970's are all available now on the Internet."
Adderall maker, Shire Pharmaceuticals, cannot claim ignorance about the obvious rise in profits resulting from the sale of one of its top selling drugs on the internet to people without a valid prescription. And therefore, in addition to enjoying the black market profits in plain sight, Shire must be held accountable for any and all harm done to customers who unwittingly purchase Adderall online.
As for legal prescribing of ADHD drugs, in the last 10 years, the number of preschoolers taking the drugs has tripled and the number of school-age children has multiplied by 20, according to the November 20, 2004 edition of Learning. Of the more than 2 million children prescribed ADHD drugs, Adderall users represent about a quarter of the market.
More and more high school students are using the drug illegally. A 2004 University of Michigan study on non-medical use of amphetamines in schools nationwide, found 4.9% of 8th graders had used amphetamines in the previous year, 8.5% of 10th graders had used the drug, and with 12th graders, one in 10 seniors admitted to non-medical use of amphetamines.
Another 2005 report from the Partnership for a Drug Free America, based on a survey of more than 7,300 teenagers, also found one in 10 teenagers, or 2.3 million young people, had tried prescription stimulants without a doctor's order, and 29% of those surveyed said they had close friends who have abused prescription stimulants.
The use of ADHD drugs by college students is on the rise. Beyond the legitimate prescription of such medications lies new territory marked by illegitimate and inappropriate uses of stimulants, "practices that are often not even covert," according to Dr Richard Kadison, chief of mental health at the University Health Services, Harvard University, in the September 15, 2005, New England Journal of Medicine.
"Increasing numbers of students, and sometimes their families," Dr Kadison says, "request medication to provide an "edge," even if the students have no clinically significant impairment of functioning."
Many college students report what they call "pharming": using stimulants for recreation, to work more efficiently, and to lessen the need for sleep. A July 2005, Student Drug Research Survey of University of Maryland students found Adderall was the third-easiest drug to get at the University after alcohol and marijuana.
Because stimulants have been widely prescribed to children for decades, college students think Adderall is safe and know the symptoms to describe to get a doctor to write a prescription. The challenge for physicians, Dr Kadison says, is to determine which patients have a legitimate need for medication, particularly given recent warnings about the safety of some of these drugs.
The widespread tolerance of Adderall use resembles the blind eye too many parents cast on teenage drinking prior to the 1990s. And since it is primarily considered a study drug by many students, even students who are anti-drug have divided opinions about Adderall use. Typically, "Dealers" have valid prescriptions for the drug and sell their unused pills to friends for little or no profit.
But the fact remains, under federal law it is illegal to possess a Schedule II drug, such as Adderall, without a prescription and yet ironically, college students are using Adderall illegally in hope of doing better on law school admission tests.
Shortly before taking the Law School Admission Test at the University of Colorado, Carrie, a college senior, downed an Adderall with her breakfast of eggs and toast. "I'm nervous because I'm taking a test that will determine the rest of my life," she said in an interview with the Wall Street Journal, on November 8, 2004.
Carrie had no prescription for the drug but had bought 10 pills for $2 each from a friend's roommate. She took practice tests with and without pills, she told the WSJ, before deciding that Adderall would help improve her score.
Another pre-law student, Chul Yim, a graduate of the University of Nevada, who has a job in Washington, on Capitol Hill, told the WSJ, he's wrestling with whether to use a stimulant before he takes the Law School Admission Test.
"I really can't fail," Chul says, "because it's not just me that's failing. I fail for my parents and my entire family. Even if it bumps my score up an extra point, it's worth it."
These pre-law students obviously have no knowledge of the possible legal consequences they could face for using Adderall illegally. Serious criminal laws apply to the use of the drug and if caught, their plans for a career as an attorney would be history.
An article titled, "Students buy Adderall from students with prescriptions despite physical, legal and ethical consequences," in Grinnel College's Scarlet & Black Newsletter, Volume 122, Number 15, Feb 10, 2006, lists the criminal laws and penalties that apply as:
(1) Classified by the DEA as a Substance II, the same legal category as cocaine and heroin. For first time possession of between five and 49 grams, the minimum federal sentence is five years.
(2) If death or serious injury occur, the minimum sentence is 20 years.
(3) Individual first time offenders can be fined up to two million dollars.
(4) If a first-time offender possesses more than 49 grams, the minimum sentence is ten years and the maximum is life imprisonment.
In addition, the health risks associated with Adderall can be lethal. Concerned about the risk of sudden death or serious injury associated with stimulants used to treat ADHD, on February 10, 2006 the FDA's Drug Safety and Risk Management advisory committee said the drugs should carry the most serious type of warning label.
The proposed "black box" statements would inform doctors, patients and parents of the uncertainty regarding the risk the drugs may pose to the cardiovascular system. The label for Adderall has included the warning since 2004.
An FDA review of its own databases found reports of 25 deaths in children and adults between 1999 and 2003, and 54 cases of serious cardiovascular problems, including heart attack, stroke, hypertension, palpitations and arrhythmia.
The FDA said it has tallied an additional 26 deaths between 1969 and 2003 in patients on the drugs involving death by suicide, intentional overdose, drowning, heat stroke and from underlying disease.
The rate of possible underreporting is unknown. The adverse reactions system of reporting is voluntary and said to only represent between 1 and 10% of actual adverse events.
"Does the FDA get 10 percent of cases, 20 percent? Nobody knows," said Kate Gelperin, a medical officer in the FDA's Office of Drug Safety. Any link to the drugs "is really only a rough estimate," she told the panel.
The FDA may also undertake short-term studies into the effect of the drugs on blood pressure, heart rate and the heart muscle itself, said Dr. Peter Gross, chairman of the advisory committee.
The unsolicited recommendation was a surprise and caught the FDA off guard. The agency is not required to follow the advice of the panel but it generally does.
When asked why the committee approved a recommendation they had not been asked to consider, Dr Gross said: "No. 1, because of the seriousness of the side effects - the sudden deaths. No. 2, there is a sense maybe the diagnosis of ADHD is being applied where it shouldn't be applied," according to the Associated Press on February 10, 2006.