- Dec. 4, 2008
- 3 Comments
This story has been edited so a source was removed.
Alexis lay on the edge of her bed, staring vacantly at the floor, not wanting to get up. It had been three days since she last took Adderall, two days since she had even left her bedroom. She was trying for the fourth time to quit the prescription stimulant she had been using to motivate herself for three years.
“I went into a really dark place for a long time,” she said. “I was sleeping all the time, I couldn’t move.”
Alexis, who like the other illegal users of Adderall quoted in this story asked that her name not be used, is among a growing number of students at the University of Kansas who have used the amphetamine stimulant intended to treat attention-deficit hyperactivity disorder, or ADHD, and narcolepsy. Last year, Watkins Memorial Health Center filled 941 prescriptions for Adderall and similar stimulants, accounting for eight percent of its overall drug sales. That figure doesn’t include students who fill prescriptions in their hometowns or at off-campus pharmacies, including discount stores like Wal-Mart Inc., where a one-month supply of 20 milligrams costs $113 compared to $155 at Watkins.
Adderall is Food and Drug Administration-approved for the estimated four percent of adults in the United States who are diagnosed with ADHD, but for the college students who pop an Adderall without a prescription to get high, stay awake, lose weight or party harder, it’s a risky move that could lead to addiction or health issues.
The amphetamine cocktail increases energy, alertness and enhances concentration for three to five hours. Its reputation has caused Adderall to fall into the hands of people who want it rather than need it. What’s more, some medical professionals say Adderall may not be effective in treating ADHD in users older than 16.
Its scope and use
The medical community recognizes Adderall’s benefits in calming children who have ADHD, but its effectiveness at treating adults college age or older is debatable.
Elias Michaelis, distinguished professor and director of the pharmacology and toxicology department, said Adderall decreased hyperactivity only in users younger than 16.
“When you get past adolescence, it starts having more of a hyperactivity-inducing effect rather than calming, which is the opposite of why it was initially prescribed,” he said. “At that stage it turns into exactly what an amphetamine does.”
He said users who take Adderall into adulthood risked losing neurochemicals in their brains and exhibiting abnormal behaviors, such as abusing and becoming dependent on the drug.
One KU student who was prescribed Adderall in high school and continued taking it in to his college years with disastrous results was Thor Nystrom, a May graduate and former Kansan writer.
“Adderall is definitely a gateway drug,” he said. “When I got to college, that’s when I started drinking heavily for the first time while taking my Prozac with Adderall. It was just a horrible mix and it did a number on my head. That’s when I started to act erratically.”
Adderall is especially popular among college students. Sales have increased more than 3,000 percent since 2002 for Shire Pharmaceuticals, Adderall’s distributor. A study by the University of Wisconsin found that as many as one in five college students have taken Adderall or Ritalin, a similar stimulant, without a doctor’s prescription. If those numbers held true at the University, about 6,000 KU students would have used Adderall.
Cathy Thrasher, chief pharmacist at Watkins, said Watkins had more Adderall prescriptions than the average drug store because its clientele was between the ages of 18 and 25.
Myra Strother, staff physician at Watkins, said she treated between 100 and 150 students diagnosed with ADHD at any one time each semester.
Watkins requires patients to pass a battery of tests and psychiatric evaluations before receiving a diagnosis of ADHD and a prescription for Adderall. Patients must then see their doctor on a regular basis and prescriptions are non-refillable.
“Here we’re real picky,” Strother said. “We don’t want people taking it unless they really need it to function.”
While the process to obtain Adderall is closely managed, a black market of Adderall “pharming” thrives with prescribed users selling their pills to other students, even though it is a felony according to federal law.
Criminal penalties for first-time illegal possession of Adderall range from fines of up to $20,000 to a minimum sentence of five years’ imprisonment, but Capt. Schuyler Bailey of the KU Public Safety Office, said he knew of no arrests made in Lawrence for illegal possession.
What the experts say
Medical professionals disagree on whether Adderall is safe or even addictive. Nancy Hamilton, associate professor of psychology, said a substance was addictive only if a person developed the regular habit of using it and without it would experience negative symptoms and crave its high or its reinforcing properties. Even chocolate can fall into this category, she said.
“If you quit eating chocolate today, you wouldn’t necessarily experience negative reinforcement, but you really might miss the taste of chocolate,” Hamilton said.
She said the biggest point of disagreement was whether people trying to quit taking Adderall felt compelled to return because of withdrawal symptoms or because they simply enjoyed the high.
How it works
Adderall, a mixture of amphetamine salts, affects the central nervous system by increasing levels of dopamine in the brain. That enhances enjoyment and motivation during rewarding experiences such as eating or having sex. Without adequate dopamine, a person with ADHD can feel fatigued, depressed or unmotivated.
Strother said doctors could scientifically diagnose a person with ADHD by observing which parts of a person’s brain responded during certain activities by taking an X-ray, or PET scan, of the brain.
“If you look at a PET scan of someone doing math projects, a person with ADHD has an area that doesn’t light up,” Strother said.
She said stimulants such as Adderall make all areas of the brain “light up” more.
Strother disagreed with critics who say ADHD describes a behavioral problem rather than an illness.
“It’s not a made-up illness,” she said. “Stimulants have been used for 25 years now. It’s just too bad some people take advantage of it.”
Adderall, which can be swallowed, sniffed, smoked or injected, typically has a calming effect in people with ADHD, but poses major health risks and side effects for those without ADHD.
The amphetamines cause increased alertness, excitement and blood pressure. The release of dopamine induces a sense of euphoria that can last several hours, longer than the 15- to 30-minute high of cocaine. The increased brain activity can cause insomnia, anxiety, loss of appetite, agitation, increased body temperature, hallucinations, convulsions and, in extreme cases, even death.
The FDA blames Adderall use for 25 deaths in children and adults. The FDA also found 54 cases of serious cardiovascular problems, including heart attack, stroke, hypertension, palpitations and arrhythmia associated with the stimulant.
Alexis, daughter of a psychiatrist father and a psychologist mother, got a trial prescription of Adderall at age 15, when she complained of having difficulty focusing in school.
“I really liked how it felt,” she said. “It was something I’d never felt before in my life. My eyes were opened. I could understand things better. I had never read a book on my own before then, but I wanted to learn and read. I didn’t care about anything intellectually until I started taking Adderall.”
While she gained the concentration to read, it didn’t take long for Alexis to lose her sense of humor, her sex drive, her boyfriend and many friends. Everything she did became logical and void of emotion. There was no room left for relationships, she said of her life with Adderall.
“I would pick out things from my carpet,” she said, describing the intense focus that came from taking Adderall. “In my younger years, I’d done some hard drugs, and this stuff is more intense than any of those.”
Alexis recalls consuming an entire month’s prescription in a week, wondering how she would make it to the next month without Adderall.
“It was a real addiction,” she said. “I’d call my parents and tell them I got my purse stolen and my Adderall was in it just to get another prescription. I was lying to my parents.” She said she developed insomnia and hit bottom when she went seven days without sleeping.
When she stopped taking it, the five-foot-two-inch sophomore ballooned from 110 to 140 pounds in four months. Although she knew she was doing the right thing for her health, she couldn’t look at herself in the mirror.
“You’re doing something good by getting off, but then you see the negative effects on your body and it’s so depressing,” Alexis said.
It’s been two years since she gave up Adderall and Alexis still has trouble sleeping and experiences mild panic attacks. Despite that, she says she is finally headed in the right direction and will get married this summer.
Being in school is a frustrating reminder of what Adderall cost her.
“I am 23 years old and should have graduated a long time ago and I still have two more years left after this year,” she said. “It sucks, but I feel like I grew so much as a person just through dealing with that.”
Andrew gulped down his third Bud Light as strangers funneled through the front door of his apartment at a party. Despite a night of drinking, he was still alert, having popped an Adderall a friend slipped him earlier in the evening. He was in full swing, ready to continue partying, and downed another beer.
“Adderall is everywhere,” he said. “With a college crowd, it’s like socially acceptable cocaine.”
Andrew, 23, is from Arlington, Va., and dropped out of the University in 2007 to attend trucking school. During his KU years, Andrew took Adderall while drinking with friends because it enabled him to party harder and longer.
“I didn’t want to be the first to pass out,” he said.
When he was a student, Andrew procrastinated on writing papers until the night before they were due, because Adderall kept him awake and made him feel like he could run a marathon.
“For me, it was just a utility drug,” he said. “I just don’t see it becoming habit forming.”
Looking back on his college years, Andrew still thinks illegally taking prescription drugs is fine if the user is responsible. But, he admitted, “Few people are.”
As her thin fingers twisted her dark brown hair into a braid, Lindsay stood in her bathroom getting ready for work. She tied off the braid and removed the orange bottle of Adderall from the medicine cabinet. Plucking out a single pill, she tilted her head back and washed it down with a gulp of water.
Soon, the thumping bass from her stereo seemed to grow louder and her heartbeat quickened. As she looked in the mirror, she saw her body swaying to the music. Suddenly, her palms felt sweaty and her mouth, uncomfortably dry. The Adderall was kicking in.
“It was like everything was building up to more focus, energy and excitement,” she said.
Lindsay started taking Adderall illegally two years ago because she was working 12-hour shifts at a nightclub three times a week. Women she worked with at the club took it to provide the energy for long shifts of dancing on tables and entertaining customers.
She didn’t think popping one pill for extra energy would ever get out of hand. But soon, what was once a convenient way for Lindsay to stay awake on the job until 4 a.m. began controlling her.
“I wanted to quit before I ever got a prescription,” Lindsay said. “It had taken over my life. I was seriously a slave to Adderall.”
When she began taking Adderall more frequently, she decided to try to get a prescription from her doctor by faking ADHD.
“I drank two Red Lines,” she said about the high caffeine drink. “I totally acted it out. My doctor started prescribing it.”
When she realized she was hooked, in a moment of strength she flushed her entire prescription down the toilet. But then she gained 10 pounds in two weeks and depression set in. She returned to the doctor for a refill.
“They didn’t really care if you upped your prescription,” she said. “That’s a $160 doctor visit. It’s like by signing that piece of paper, they’re saying, ‘Here’s your drug. Have fun ruining your life.’”
Not long after she refilled her prescription, Lindsay began searching Google for rehab centers and made appointments with psychiatrists. But she couldn’t gather the courage to check into rehab and skipped every appointment. At her lowest weight, the five-foot three-inch junior, whose normal weight is 125, weighed 110 pounds. Being on the drug suppressed her appetite, making it easy to skip meals.
“I didn’t start taking it because I wanted to lose weight, but it put that desire in me in a weird sort of a way,” she said. “I just couldn’t stop and I wanted to. With everything in my heart I wanted to.”
Although Lindsay no longer takes Adderall, she said she still struggles with the effects of her abuse. She said she no longer reads style or fitness magazines because of their unrealistic expectations for women. Seeing friends in her classes who take Adderall is difficult for her because it reminds her of her slender self.
“It breaks my heart because I know what it does to you,” she said. “It totally took me into some of the lowest places that human beings who struggle with those feelings can go.”
A year ago, Lindsay was riding back to Lawrence with her brother after spending Christmas Day with her family, when she admitted to him that she was still taking Adderall.
“I started bawling, saying, ‘I’m taking it again. I don’t want to take it. I want to give my life to Christ,’” she said. “I got home that night, flushed it down the toilet, and that’s that.”
Lindsay began attending a local church and seeing a psychiatrist on a regular basis. She said she hasn’t returned to Adderall since.
Liz has a love-hate relationship with Adderall. She loves the high, but hates the addiction.
“The more you take, the more your body gets used to it, the more you get addicted,” she said. “It’s something that I can’t imagine not having right now.”
Three years after Liz was prescribed Adderall in high school, the Overland Park freshman regularly takes more than her prescribed dosage — simply because she likes how it makes her feel.
“I absolutely for no reason need Adderall,” she said. “I can focus and do it on my own, it’s a mind thing. I just want the drugs.”
Liz said when she takes Adderall she can do anything except stay in the same place or sit still. She craves a constant flow of new information or a change of scenery when she’s on the stimulant.
She likes to mix it with heavy drinking and other painkillers and prescription drugs. At 3:30 p.m. on a recent Friday, she’s still recovering from last night’s activities.
“I mix Adderall, Xanax and Hydrocodone and I drink all the time,” she said. “I black out all the time.”
Linda Keeler, psychologist for Counseling and Psychological Services, said mixing an “upper” like Adderall with a “downer” like alcohol can severely damage the liver, which filters both substances, and the brain, which responds to chemicals.
“Telling the brain to both relax and be aware can cause neurological problems and long term damage,” Keeler said.
Liz, who has abused Adderall for three years, said the damage had already been done.
“I just really started relying on it,” Liz said. “I started snorting it, started selling them to get money. I took them and wouldn’t eat or sleep — I would go crazy.”
She blames her current abusive addiction on the legal prescription she got as a teenager to treat her ADHD.
“No one under 18 should be taking Adderall,” she said, her voice shaking as she spoke. “I don’t think I should’ve. I don’t think today I would even have this — this thing to deal with. But here I am still taking it and I don’t want to be without it. That’s awful.”
— Edited by Elizabeth Cattell