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Fast Times

The quiet epidemic of the college wonder drug — Adderall.

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Wiggle worm. Bouncy. Jumpy. Talkative. Impatient.

Lydia* has lived with these descriptions her whole life.

"Are you familiar with Tigger from Winnie the Pooh?" she asks. "That."

She's never liked to sit still. In conversations, she can barely wait for her turn to talk. Still, her grades in high school weren't bad, but maybe not as good as they could've been. When she went to college as an adult, she decided it was time to get some extra help.

"I thought, you know, I could go [to the clinic] and qualify and get me some damn Adderall," Lydia says. "I heard you could write the hell out of some papers and [it can] really get you through school — and you might even lose weight."

She jokes that weight loss was not her primary objective but that it would've been nice. She was tested and says her hyperactivity and impulsivity "were off the charts," but that she barely registered for attention deficiency. Still, the psychiatrist wrote her a prescription for Adderall and she got it filled.

She had tried Adderall once before.

"I remember I studied four chapters — it was this amazing rote memory thing — and I memorized the names of every chapter and made acronyms out of each subchapter," she said. "It was unreal. My brain was on fire!"

Lydia's is a story familiar to Americans in the decades since attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) became common diagnoses, as has the prescription of Adderall to treat them.

Early on, criticism of this treatment option came from those who believed that being hyper and unable to focus were just part of being a kid — normal behavior. The idea that doctors would give kids amphetamine — speed, of all things! — to help them simmer down seemed absurd. After all, Adderall is a Schedule II controlled substance, similar to opium, meth, and cocaine in the eyes of U.S. law.

But those worries have seemingly faded, as have the fears about prescribing Adderall to young people diagnosed with ADD and ADHD, now a routine practice.

In recent years, illegal use of the drug has spread quietly but widely, mainly to high school and college campuses where it is used by students to help them study — or, increasingly, to stay up all night and party.

Illegal sale or possession of Adderall can bring serious jail time, but that doesn't seem to be slowing down the traffic between student buyers or sellers, most of whom don't really consider the pills a dangerous drug. Supporting this view is the fact that cracking down on illicit Adderall trade does not seem to be a major focus for law enforcement.

A Brief History

Versions of amphetamines were given to WWII soldiers and pilots to keep them alert and to fight fatigue during combat. In 1960, a different formulation of what we now call Adderall was marketed as an appetite suppressant called Obetrol, according to the Food & Drug Administration (FDA).

In 1994, the drug was given the name Adderall, and the company that owned the brand took steps to get it approved and into the market. Adderall was approved in 1996 as a treatment for ADHD and narcolepsy, and the government removed its approval for use as a weight-loss drug.

Millennials have grown up with Adderall. A 17-year-old college student today was born after the drug was approved by the FDA in 1996. Many of those students were prescribed the drug as children. It was a normal constant in their lives and they brought it with them to college. Full-time college students, ages 18 to 22, are twice as likely as their peers who weren't full-time students to use Adderall non-medically, according to the 2009 National Survey on Drug Use and Health.

That study paints a picture of the typical recreational Adderall user. They are mostly white, mostly full-time college students. They drink alcohol — many of them are binge drinkers, and nearly half of them reported heavy alcohol use. Many who used Adderall recreationally also used marijuana, prescription pain relievers, cocaine, and hallucinogens.

GREG CRAVENS
  • Greg Cravens

But oddly, their view was that Adderall is legal and safe, not like those other illegal drugs. College students interviewed in 2007 told researchers from the National Institutes of Health that Adderall "is definitely not a drug." They feel their use of the drug is "physically harmless and morally acceptable."

And why wouldn't they think that? After all, a government-regulated and reputable company makes the drug. Even Hogwarts students were using memory-enhancing and stimulant potions to study for exams in the 2003 book Harry Potter and the Order of the Phoenix.

The "Smart Pill"

The New York Times has called Adderall "the smart pill" and "the competition drug." High Times magazine called it "America's favorite amphetamine." Others have called it the "good-grade drug," "college crack," and "the smart drug."

Talk to college students off the record and they say Adderall is everywhere on college campuses, especially during exam time. Late-night cram sessions, once driven by will-power and coffee, are now often fueled by Adderall in what is commonly called an "Adderall-nighter."

How widespread is the use of Adderall? It's difficult to measure, because, unless it's prescribed, its use and sale is illegal. The on-campus Adderall trade comes with an understandable code of silence. So, researchers went to the place where millennials often say unfiltered things in public that they think in private: social media.

Researchers from Brigham Young University monitored Twitter messages for the word "Adderall" from November 2011 to May 2012. They found 213,633 such tweets from 132,099 unique users. Adderall tweets peaked around exam times. Adderal tweet volumes were highest in college towns in the Northeast and the South.

Most of the tweets were casual, sarcastic, and joking, the researchers said. Examples included: "Adderall stockpile for finals." "Adderall, Coffee, Red Bull. Epic focus. Or a heart attack." "Does anyone have adderall? #desperate."

"I think the question is, does it really make you smarter?" asks Casey Laizure, a professor in the Department of Clinical Pharmacy at the University of Tennessee Health Science Center (UTHSC) in Memphis. "Probably not, but what it does do is give you the capability to study for a longer length of time and that certainly makes you smarter, and [Adderall] is clearly effective at doing that. So, you can see why there's an incentive for academics and students to use it."

Adderall increases dopamine levels in the brain, Laizure says. Cocaine does the same thing, but cocaine does it very quickly, which creates euphoria. Adderall increases dopamine levels slowly and for a sustained period of time, which "increases your ability to do a repetitive task and maintain your concentration," Laizure says.

The discovery of this effect happened by accident: To get more accurate cranial scans, doctors would replace a patient's cerebral spinal fluid with air. The procedure gave patients terrible headaches, so doctors gave them amphetamines to help regenerate the spinal fluid more quickly, which got rid of the headaches faster. One doctor noticed that doing so also increased the attention spans of some of his young patients who had behavioral problems.

The Party Drug

GREG CRAVENS
  • Greg Cravens

Published research on the extent of Adderall use on college campuses for academic purposes is still mostly anecdotal, so it's no surprise that even less is known or has been published about the recreational use of Adderall.

But anecdotes abound about students (and others) using Adderall to help them stay alert while drinking and partying. The drug erases the downer effects of alcohol, such as lethargy and loss of coordination, so a person can drink longer and harder.

"That's a good way to kill yourself," Laizure says. "It gets rid of the signal that tells you to stop drinking, so it encourages you to drink at this more toxic level. And that's associated with increased instances of death from alcohol intoxication."

No government study outlines this widespread phenomenon. Drug companies and the FDA simply suggest not to mix alcohol and Adderall. They say to tell a doctor about alcohol use before taking the drug.

The nature of Adderall helps keep its use under the radar. It's not stoners in a corner sharing a smoky joint or a bubbling bong. It doesn't have the frat-bro bravado of funneling beers or doing keg stands. There's no tell-tale red-eyes, no slurred speech, no hangover. It's a white-collar drug with minimal street trade.

As common as Adderall seems to be on campus, it is all but invisible to the general public. Adderall use is veiled by its lack of a stigma, by its casual acceptance and its clandestine transfer from those who have prescriptions to those who don't. But universities have had to respond.

"You don't see people showing up at our door saying they're addicted to it," says Robert Maichrowicz, associate director of The Counseling Center, an on-campus treatment center at the University of Memphis. "Not in the way somebody who is, say, struggling with marijuana or alcohol comes to us."

But Maichrowicz knows Adderall is on his campus, legally and illegally. In fact, students can be prescribed the drug at The Counseling Center. Testing for the diagnosis is rigorous; the test itself costs $200, and students must be tested every three years to renew their prescription. Maichrowicz says these controls help to weed out those seeking Adderall for recreation, study focus, or profit.

Iverson Bell is a Memphis psychiatrist and an assistant professor of psychiatry at UTHSC. He works with the school's University Health Services clinic for students and employees. He says a careful, two-step diagnosis procedure precedes any prescription for Adderall or any other drug associated with attention deficiency on his campus.

The drug is likely over-prescribed in general and on college campuses as well, Bell says. But he's not aware of a big problem at UTHSC, which trains older, post-undergraduate professionals for careers in medicine, dentistry, pharmacy, and nursing. Patients can fool the system, he says, but it is "very hard," especially at a medical school.

Most Adderall abuse at UTHSC would more likely be for academic purposes, Bell says, not for a high or all-night drinking.

"I've been in practice since 1981, and I don't think I've seen too many people who have been abusing it like that," Bell says. "Sometimes pills will get stolen by relatives, but in general the people who come to us aren't so much the ones we're afraid of using it [illegally]. It's the people out on the street who are buying it, maybe from our students or somebody else."

Adderall and Law Enforcement

Adderall is listed as a Schedule II drug, according to the Controlled Substances Act passed by Congress in 1970. The law categorizes drugs by their potential for abuse, accepted medical uses, and whether they could lead to physical or psychological dependence.

Adderall is not rated as dangerous as Schedule I drugs, which include heroin, MDMA, mescaline, LSD, peyote, and others.

Carrying more than half of a gram of Adderall illegally is a Class B felony in Tennessee and comes with a maximum sentence of eight to 12 years and a fine up to $100,000. An illegal Adderall possession conviction on less than half of a gram is a Class C felony, and comes with a three- to six-year sentence and a fine up to $100,000.

But the drug isn't on the law-enforcement radar like cocaine, marijuana, meth, and other Schedule I and II drugs. The Drug Enforcement Agency reported about 30,500 drug-related arrests in 2012 and claimed the seizure of thousands of pounds of cocaine, heroin, marijuana, and methamphetamine. But there were no reports specifically for Adderall.

The Federal Bureau of Investigation's reported arrests for synthetic or manufactured drugs (like Adderall) made up only a small slice of the overall drug arrest rate in 2012. Marijuana, cocaine, and heroin arrests dominated the list. In the South, for example, only six percent of all drug possession arrests included synthetic or manufactured drugs. In Tennessee, Adderall charges often come linked with bigger drug busts, where police usually aren't specifically looking for the drug. Many times these busts also lead to charges of TennCare fraud as people are charged with selling Adderall pills they got through Medicaid.

Illana Tate, public information officer with the Tennessee Bureau of Investigation (TBI), says she polled TBI offices across the state and found that non-medical Adderall use just isn't a big issue for them.

"There may be pockets of areas that we don't know about, due to local agencies not reporting those types of cases to us," Tate says. "I acknowledge that Adderall abuse is a problem for some areas, but clearly it is not being abused at a level to gain utilization of TBI resources."

The Dangers

Adderall use can be dangerous. It's a primary reason UTHSC and U of M officials said they are so rigorous in their diagnoses before prescribing the drug. In 2007, the FDA ordered drug makers to notify patients about some adverse cardiovascular and psychiatric events associated with ADHD drugs such as Adderall. Some patients with heart defects died while taking stimulants for the disorders. Other patients on ADHD medications reported hearing voices, paranoia, or becoming manic.

UTHSC's Laizure says there's still a lot of unknowns when it comes to Adderall. Science does not yet know exactly how it works. Also, the long-term consequences aren't yet known, simply because patients haven't been on the drug long enough. But Laizure does have a warning for anyone taking Adderall: "You can't take something that has that potent of an effect on the human brain and expect there not to be any consequences down the road."

Lydia says she doesn't take Adderall anymore. Even for the three years she had a legitimate prescription, she only took it off and on, not the way it was prescribed. She'd write those long school papers, but the drug made her feel anxious and she never wanted to take it recreationally. She was tempted to sell it, she says, but didn't, because she didn't "want to be a news story."

But she clearly remembers and jokes about having long conversations with her friends, long enough that everyone knew to avoid her when she was taking Adderall.

"And, boy, do you clean the house!" she says. "It's great for that. Baseboards? Come on. I don't clean baseboards, but Adderall does."

*Not her real name

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