Last week, the Journal of Clinical Psychiatry published an important study on the growing number of young adults taking Adderall without a prescription. Focusing on trends between 2006 and 2011 in three sets of national data, the authors of the study found that while prescription rates for the drug had stabilized among adolescents, the opposite was true among 18-to-25-year-olds. In this age group, Adderall misuse had risen 67 percent and emergency room visits tied to the drug had increased 156 percent.
“The growing problem is among young adults,” explains Ramin Mojtabai, a professor at Johns Hopkins University’s School of Public Health and co-author of the study. “In college, especially, these drugs are used as study-aid medication to help students stay up all night and cram. Our sense is that a sizable proportion of those who use them believe these medications make them smarter and more capable of studying. We need to educate this group that there could be serious adverse effects from taking these drugs and we don’t know much at all about their long-term health effects.”
Adderall misuse typically occurs when prescriptions are shared; online pharmacies with lax requirements and poor safety regulations are another source of the problem. In 2009, the New Yorker referenced surveys calculating that 6.9 percent of students in U.S. universities had used prescription stimulants to try to overcome academic performance anxieties or being bested by their peers, with the greatest frequency at highly competitive schools. Four years earlier, a team led by a professor at the University of Michigan’s Substance Abuse Research Center “reported that in the previous year 4.1 percent of American undergraduates had taken prescription stimulants for off-label use.” A third study, dating from 2002 and tied to a single college, found that 35 percent of the students had used prescription stimulants nonmedically the previous year.
Writing for the magazine in 2009, Margaret Talbot investigated what was then seen as “the underground world of ‘neuroenhancing’ drugs.” She cited prominent bioethicists at Stanford, Harvard, and Penn arguing that concerns about misuse were largely misplaced and overstated. "Cognitive enhancement has much to offer individuals and society,” Henry Greely, Barbara Sahakian, and other leading figures argued in Nature, “and a proper societal response will involve making enhancements available while managing their risks.” Talbot's piece also referenced the British Medical Association arguing in one upbeat 2007 discussion paper, “Boosting Your Brainpower”: “Universal access to enhancing interventions would bring up the base-line of cognitive ability, which is generally seen to be a good thing.”
Much depends of course on how the issue is framed. If it's viewed solely as one of “enhancement,” then with the attractiveness of that word and what it conjures, what’s not to like? With dependency and other adverse medical issues stripped out, neuroenhancement seems to offer only upside. When adverse medical effects are factored in—as they must be, given their frequency—it seems appropriate to ask whether chemically-raised expectations about academic performance could be said to be a real or lasting improvement.
“Managing the risks” of amphetamine stimulants has in any case proven far from easy. As the latest study from Johns Hopkins underscores, misuse of Adderall among 18-to-25-year-olds is intensifying, with troubling implications not just medically, but also academically, since the studies cited by Talbot point to a growing perception that Adderall misuse among college students is unexceptional, even routine and necessary. “Amphetamines have a high potential for abuse,” the FDA warns of Adderall, Ritalin, and related stimulants such as Provigil, and can lead to dependence. Other side effects include nervousness, irritability, sleeplessness, loss of appetite, volatile behavior, extreme fatigue, cardiac arrhythmia, and what Lester Grinspoon and Peter Hedblom in 1975 dubbed “punding”: a “drug-induced compulsion for repetitive, sometimes elaborate but essentially useless busywork.”
Dr. Mojtabai at Johns Hopkins says that from a public health perspective, drugs such as Adderall should be monitored in the same way prescription painkillers have begun to be monitored, with prescriptions entered into a database to prevent the receipt of multiple medications from an array of physicians. The problem of availability via online pharmacies nonetheless remains.
Equally pressing, he recommends the use of informational campaigns for young adults explaining the many adverse effects associated with the drug. “Many of these college students think stimulants like Adderall are harmless study aids,” he says. “But there can be serious health risks and they need to be more aware.”
British Medical Association (2007). “Boosting Your Brainpower: Ethical Aspects of Cognitive Enhancements: A Discussion Paper.” London: BMA.
Chatterjee, A. (2009). “A Medical View of Potential Adverse Effects.” Nature 457, Jan. 29: 532-33.
Chen, L.-Y., R. M. Crum, E. C. Strain, G. C. Alexander, C. Kaufmann, and R. Mojtabai (2016). “Prescriptions, Nonmedical Use, and Emergency Department Visits Involving Prescription Stimulants.” J Clin Psychiatry 10.4088/JCP.14m09291.
Greely, H., B. Sahakian, J. Harris, R. C. Kessler, M. Gazzaniga, P. Campbell, and M. J. Farah (2008). “Towards Responsible Use of Cognitive-Enhancing Drugs by the Healthy.” Nature 456, Dec. 11: 702-705. doi:10.1038/456702a.
Grinspoon, L., and P. Hedblom (1975). The Speed Culture. Cambridge: Harvard UP.
Lane, C. (2009). "Using Meds for 'Neuro-Enhancement.'" Psychology Today, Apr. 25.
McCabe, S. E., J. R. Knight, C. J. Teter, and H. Wechsler (2005). “Non-Medical Use of Prescription Stimulants among U.S. College Students: Prevalence and Correlates from a National Survey.” Addiction 99.
Nixey, C. (2010). “Are ‘Smart Drugs’ Safe for Students? Students Are Increasingly Taking Neuroenhancing Drugs to Fight Fatigue and Help Them Concentrate. But How Safe Are They — And Is It Cheating?” The Guardian, Apr. 6.
Talbot, M. (2009). “Brain Gain: The Underground World of “Neuroenhancing” Drugs.” The New Yorker, Apr. 27: 32-43.