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Aderrall, Concerta, and Ritalin, Oh My: The Truth About Study Drugs
September 20, 2006
As prescription stimulant abuse increases among college students so do concerns about what has caused this alarming trend, its potentially dangerous side effects, and what can be done to stop it.
At such a prestigious and competitive university like Vanderbilt, practically everyone has experienced the pressure to succeed. Whether it be academic, athletic, social, or familial, there is no denying the innumerable stresses faced daily by college students. Busy schedules, social “obligations”, and just plain procrastination exacerbate the problem until it reaches the breaking point: 9:19 PM Sunday night and you still have three Biology chapters to read, a five page research paper to write, and a four hour organic chemistry lab to prepare for by 9 AM Monday morning. You panic, only making matters worse, and look desperately for a solution. Your gaze wanders over to your roommate’s shelf and spots her prescription Adderall. Since it helps her study better and faster, it could help you too. And it’s prescribed by doctors all over the world, so it can’t be dangerous, right? Wrong.
Situations like this one occur everyday at college campuses all over the United States as many students turn to prescription stimulants to increase focus, avoid sleep, and in essence be more efficient with their time. In fact, recent studies have proven that non-medical use of prescription stimulants among high school and college students is on the rise. The 2003 National Survey on Drug Use and Health, NSDUH, defines non-medical use or abuse as the use of prescription drugs not prescribed for the respondent by a physician or used for the experience or feeling they caused. Many abusers ignorantly believe that because these medicines are prescribed by doctors, they can’t be dangerous. Others justify abusing them by claiming that since the medicine helped them study or perform better, they probably have ADD and should be taking them anyway. These false rationalizations only contribute to the national increase in their abuse. The truth is that non-medical use or abuse of prescription stimulants has many potentially dangerous side effects and more efforts should be made to educate people about the possible harms they can cause. Moreover, because many studies have indicated an increase in their abuse and that certain demographics are at a higher risk to abuse them, education about these drugs and more stringent controls on their distribution is essential in reversing the trend.
What Are Stimulants?
Commonly prescribed stimulants include Ritalin, Adderall, Concerta, and Dexedrine. They increase alertness, attention, and energy as well as raise blood pressure and increase heart rate and respiration. In the past they have been used as a treatment for asthma and other respiratory problems, obesity, and some neurological disorders. Today stimulants are prescribed mainly for the treatment of ADHD, or attention-deficit hyperactivity disorder, which is characterized by a constant pattern of unusually high levels of activity, impulsivity, and inattention that is more prominent or severe than is typical for a person at that stage in development. ADD, attention-deficit disorder, is treated with stimulants too since it is characterized by an inability to concentrate, poor self control, and a short attention span also. ADD and ADHD are usually diagnosed in children between the ages of 3 and 5 and most symptoms improve with age. It is estimated that children with the disorders carry them into adulthood only 50% of the time. The FDA approved stimulant treatment for these disorders in children over six years of age. Stimulants are the primary therapeutic treatments for these conditions and can have a response rate as high as 90%. Stimulants have also been approved to treat narcolepsy, which is a chronic neurological disorder which causes involuntary sleep episodes. (Challman 2000)
How Do Stimulants Work?
Dextroamphetamines (Dexedrine and Adderall) and methylphenidates (Ritalin and Concerta) work in the same ways because they have similar molecular structures. They are both central nervous system, CNS, stimulants. They affect the body in similar ways to caffeine and amphetamines like cocaine but are more potent than the former and less potent than the ladder. Scientists believe ADD and ADHD may be caused by an imbalance of two neurotransmitters in the brain, dopamine and norepinephrine, which play an important role in focusing and attention tasks. Higher levels of dopamine are speculated to reduce hyperactivity, and an increase in norepinephrine is thought to heighten the attention span. While the specific mechanism of how stimulants function has not been completely identified, they have chemical structures very similar to these key brain neurotransmitters; thus they enhance the effects of these important chemicals in the brain and help balance them. Stimulants’ physiological effects include an increase in blood pressure and heart rate, constriction of blood vessels, an increase in blood glucose levels, and the opening of the pathways of the respiratory system. Even when taking the correctly prescribed amount, adverse side effects can include dry mouth, nervousness, headache, insomnia, nausea, loss of appetite, irritability, anxiety, jitteriness, and even anorexia or tachycardia. However, the margin of safety is high for these medications when taking them as prescribed by a doctor. The potential for side effects increases linearly with dosage and is more likely at high levels, for example in doses larger than 2 mg/kg for methylphenidates (Klein-Schwartz 2002). http://www.nida.nih.gov/researchreports/prescription/prescription4.html
Why Do People Abuse Stimulants?
People who are not diagnosed with ADD or ADHD may take stimulants for their ability to suppress appetite, cause wakefulness, increase focus and attentiveness, and even cause euphoria when taken in large amounts. Indeed, Dr. Stephen Hinshaw of the University of California-Berkeley agrees that anyone, ADHD affected or not, will experience a performance boost when taking a stimulant (Smith 2006). However, because they are a Schedule 2 drug, they are approved for medical use but also have the highest potential for abuse. To achieve boosts in attention, most people take stimulants orally while those who strive to attain the euphoric high caused by large levels of dopamine crush the tablets and either snort the powder or dissolve it in water and inject it intravenously, a very dangerous practice. (Klein-Schwartz 2002)
What Are Some Effects/Risks of Prescription Stimulant Abuse?
Any time stimulants are abused, some dangerous and serious side effects are possible. Short term effects can include dangerously high body temperature, loss of appetite/anorexia, inability to sleep, feelings of hostility, distorted thinking, paranoia, irregular heartbeat, hallucinations, seizures, heart failure, and even death. People who continue to abuse prescription stimulants may develop many severe problems including severe weight loss or malnutrition, mental illness/psychotic episodes, depression, periods or delirium or panic, heart disease, exhaustion, decreased immune system function, tolerance and addiction.
How Serious Is This Problem?
Many studies have been conducted within the past few years to research the national prevalence, trends, and characteristics of prescription stimulant abusers.
Research Report: Non-Medical Use of Prescription Stimulants Among US College Students: Prevalence and Correlates from a National Survey
This widely acclaimed and referenced research study was conducted through the University of Michigan. The report listed many pertinent facts as background for the study. It stated that prescription stimulant use is highest in the United States. It also cited recent national increases in these prescription rates and other studies which concluded that non-medical use of prescription stimulants continues to grow among young adults, especially college students, in the United States. The purpose was to investigate the prevalence rates and correlates of the non-medical use of prescription stimulants including Adderall, Ritalin, and Dexadrine in US college students. The design was a 20 page self-administered mail survey to a representative sample of 10, 904 randomly selected college students from 119 four year colleges across the country. The study found that 6.9% of college students reported life-time non-medical use of prescription stimulants, 4.1% reported non-medical use in the past year and 2.1% reported past month use. Past year and past month non-medical use was highest among college students who were male, white, members of fraternities and sororities, had lower grade point averages, and attended more selective colleges in the Northeastern part of the country. It also found that non-medical use of prescription stimulants was highly correlated to other substance use and risky behaviors. Some limitations of this study include the fact that they only focused on three types of stimulants and that the study included only four year colleges and thus may not be representative of the national college population. The nature of such an extensive self report survey should also be taken into account when examining the results. (McCabe 2004)
Research Report: Characteristics of Methylphenidate Misuse in a University Student Sample
This study sought to research the patterns of prescription stimulant abuse among college students and the characteristics of the abusers. The method involved 50 individuals who reported non-medical use of MPH, or methylphenidate, and 50 control subjects. All participants came from the same university. Data was obtained during confidential face to face interviews. The study found that those who misused the drug MPH were at a higher risk to misuse other substances, such as alcohol, marijuana, and cocaine. It also found that of those who abused MPH, 70% said they used it for recreation or to get high while only 30% used it to enhance their academic performance. Finally, it reported that most of those who abused MPH obtained it from a friend or acquaintance with a prescription. The small sample size of participants was the greatest and most obvious limitation to this study, as well as the fact that only one university was sampled. (Barrett 2005)
Research clearly indicates that prescription stimulant abuse is a growing problem among college students in our country. From a medical perspective, there is also no denying the likelihood for severe and dangerous consequences when these types of drugs are abused. But despite their potential for abuse, they still remain a safe and highly effective treatment for the majority of people suffering from ADD and ADHD. Therefore, it is essential to balance the medical necessity for these drugs with their risk for non-medical abuse. Since the Barrett Darredeau study concluded that the participants received the MPH from prescribed users, increased efforts should be made in limiting their diversion. Also, education about the risk factors associated with abuse of these drugs should be increased so students are aware of the danger involved when using them non-medically. Finally, there needs to be more research done to better understand individual motivations for non-medical use so better preventative efforts can be implemented.
Barrett, Sean P., Darredeau, Christine, Bordy, Lana E., Pihl, Robert O. (2005). Characteristics of Methylphenidate Misuse in a University Student Sample [electronic version]. Canadian Journal of Psychiatry. Jul 2005; 50, 8. 457-461
Challman, Thomas D., Lipsky, James J. (2000). Methylphenidate: Its Pharmacology and Uses [electronic version]. Mayo Clinic Proceding. Jul 2005, 75, 7. 711-721
Klein-Schwartz, Wendy. (2002). Abuse and Toxicity of Methylphenidate [electronic version]. Current Opinion in Pediatrics. April 2002. 14, 2. 219-223
McCabe, Sean E., Knight, John R., Teter, Christian J., Wechsler, Henry. (2004). Non-medical Use of Prescription Stimulants among US College Students [electronic version]. Addiction. 99, 96-105
Smith, Kelsie (2006). Dangers of Stimulant Abuse. The University Daily Kansan. Feb 2006. http://www.kansan.com/stories/2006/feb/02/drugs/
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