The New All-Nighter

In middle school, I watched one kind-hearted teacher transform into an irritable disciplinarian whenever he “forgot his coffee.” Then and there I decided to avoid caffeine for as many years as I could, afraid to discover how this habit would affect my own personality and productivity. A few years later, I arrived at college to find a new and intense form of energy seeping through the ranks of my driven, stressed-out classmates. Now, Adderall is gaining popularity as the all-nighter drug of choice on college campuses. My opinion of caffeine has risen since this discovery - it still looks better on a resume than prescription pill abuse.

Researchers know that prescription painkillers like Oxycontin, Percocet, Vicodin, and Xanax have attracted adolescents as recreational drugs, but few studies have addressed the prevalence of prescription academic enhancers like Adderall or Ritalin. The annual Center for Disease Control (CDC) Risky Behavior report just included statistics about prescription drug use in high schools for the first time, and estimates that 20.2% of students have consumed some form of this medication without a doctor’s prescription. The percentage of students who have indulged without medical approval climbs from 15.1% of ninth graders to 25.8% of twelfth graders, which makes me wonder about, say, college students. Does this trend continue upward after students graduate from high school? No studies have answered this question. Prescription drug companies aren’t exactly funding research that might reduce (profitable) misuse of their products.

Adderall, a combination of amphetamine and dextroamphetamine, is now accessible and acceptable on many college campuses as a “study drug.” Doctors prescribe it to patients who suffer from Attention Deficit Hyperactivity Disorder (ADHD) and, occasionally, narcolepsy (although it was marketed as a diet pill in the 60’s). ADHD is one of the most common mental disorders in American children and adolescents, but it also affects 4.1% of adults in any given year. Fortunately for patients who struggle with ADHD, diagnosis and treatment have risen sharply in the last two decades as medical awareness of the disease has increased. Less fortunately (from a public health perspective, at least), the rising number of Adderall prescriptions coupled with the drug’s recent celebrity status has turned it into an accessible drug for students without attention deficits. Even though the standards that define ADHD have improved, misdiagnosis and over prescription happen –as some patients who hope to obtain a coveted drug from doctors have noticed.

One study in the Journal of Clinical Psychology revealed that, of 483 students with prescriptions for medication, 35.8% reported that they had diverted a drug to a peer at some point in life. Most of these diversions resulted from friendly peer-to-peer handouts rather than lucrative drug deals. These results offer some insight into the developing “study drug” culture. A culture forms when certain behaviors catch on, replicate themselves within a community, and start to define that community. Accordingly, students with prescriptions who distribute to friends without prescriptions create a norm and culture for prescription drug abuse. Social circles provide teenagers with communal support and behavioral guidance, so I probably don’t need to convince anyone that most adolescents accept, or outwardly fail to challenge, certain vaguely dangerous aspects of student culture.

I say “vaguely” because, really, who knows what Adderall does? I did not, but the all-caps lettering on the FDA information packet caught my eye: “MISUSE OF AMPHETAMINES MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EFFECTS.” No one mentioned that. I read on:

Risks associated with Adderall include:

•      Sudden death
•    Serious cardiovascular events
•     Cardiovascular Events: Palpitations, tachycardia, elevation of blood pressure, sudden death, myocardial infarction. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use.
•    Central Nervous System Events: Psychotic episodes at recommended doses, overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, depression, tremor, headache, exacerbation of motor and phonic tics and Tourette’s syndrome, seizures, stroke.
•    Gastrointestinal Events: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects.
•     Allergic Reactions: Urticaria, rash, hypersensitivity reactions including angioedema and anaphylaxis. Serious skin rashes, including Stevens Johnson Syndrome and toxic epidermal necrolysis have been reported.
•    Endocrine Events: Impotence, changes in libido.
•    Stroke in adults
•    Increase in short term blood pressure and heart rate
•    Emergence of new psychotic or manic symptoms in patients with no previous psychiatric history
•    New or worse bipolar illness
•    New or worse aggressive behavior or hostility
•    Long-term suppression of growth
•    Seizures
•    Visual disturbance (blurring of vision, etc.)
•    Temporary impairment of a patient’s ability to engage in potentially hazardous activities such as operating machinery or vehicles
•    Dependence. Tolerance, extreme psychological dependence, and severe social disability have occurred.
•    Oh yeah, you probably shouldn’t be pregnant while you’re taking this stuff

This list applies to people without pre-existing conditions; I only skimmed pages (there were a few) for users with coexistent risk factors. An additional list of side effects, about 24 in all, ended in this statement: “Fatal poisoning is usually preceded by convulsions and coma.” I’m not going into detail about any of the conditions on the risk list, but if you have questions I encourage you to look for answers on http://www.webmd.com/ or http://www.healthfinder.gov/.

I do not offer this information to scare everyone away from a drug that significantly improves the lives of some patients. Every body responds differently to every drug (that’s why science is so COOL!), and some patients experience no uncomfortable side effects with Adderall. Others do, but it is difficult to predict how your body will respond. I hope that this information helps you accurately assess the risks and benefits of your own actions, since every consumer deserves the chance to do that for herself. Since this particular form of pill abuse is a new phenomenon, few drug prevention programs mention it. Parents cannot pass down wisdom from bad Adderall experiences in the 70’s, and adolescents who accept the drug from friends probably do not rush off to read the warning label. Instead, students encounter information about prescription stimulants from advertisements that boast a medication’s ability to help children concentrate and succeed in school. The fact that a pharmacy distributed the product because a physician gave it the okay might contribute to a misleading security blanket. Remember that the pharmacy distributed that bottle with a warning label for a reason.

Articles keep informing me that students today endure a huge amount of pressure and stress, a sentiment that I appreciated for 48 hours of exam week. I find it ironic that the Adderall bottle discourages “anxious, tense, or agitated” people from taking the drug when its use on campus probably peaks during finals. For that two-week period, when I am anxious, tense, and agitated, the appeal of a magic all-nighter paper-writing pill does not elude me. However, some risks run deeper than the physiological ones that I mentioned above.

Adderall can lead to dependence. If a student without ADHD relies on it to complete assignments, staying up for 24 hours to write a paper due the next day, a few life strategies that should improve during college (I hope) become difficult to accomplish. These include concentration, healthy work habits, time management, and self-reliance. If college is the time to polish these skills, taking the prescription way out might make for a difficult transition into the working world. Stimulants disrupt sleep cycles, which are hugely, MAJORLY important to every student’s health, success, and wellbeing (but seriously, read this article http://www.aasmnet.org/Articles.aspx?id=659). In the end, I have to thank my middle school teacher for demonstrating the unappealing effects of caffeine reliance on a forty-year-old career man. I can’t imagine years of stimulant abuse turning out much better.

 (1) http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf

(2) http://www.healthbeatblog.com/2010/07/illicit-drugs-on-campus-are-increa...

(3) http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf