The Ritalin Riddle: Lack of Education Surrounds Student Stimulant Use

It is 10pm on a Wednesday night, and Ted* has a six-page paper for his Russian literature course due the next day. Ted, who suffers from a sleep disorder, is tired and worried that he won’t be able to focus properly on his paper. Caffeine never seems to do the trick for him, and he needs to get a good grade on this assignment.

Fortunately, his friend Chris*, who lives in the same dormitory one floor below, has a prescription for Adderall, a powerful prescription amphetamine used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) and narcolepsy. Chris offers to trade Ted 30mg in exchange for some of his Klonopin, a benzodiazepine similar to Xanax and Ativan. They make the deal, and Ted takes the pills. Fully awake and focused, Ted can now begin work on his paper.

Scenes like this are commonplace at Amherst and other college campuses where the widespread availability of prescription stimulants such as Adderall, Vyvanse, and Ritalin, fuels an underground drug trade among students seeking to manage overwhelming work-loads or self-medicate undiagnosed cases of ADHD and other disorders. Nevertheless, many students remain unaware of the potential health risks and legal consequences of illicit prescription drug use, and the College offers few educational materials about the drugs or resources to address addiction and other negative side-effects.

A Culture of Acceptance

A 2005 study by the Univ. of Maryland found that after alcohol and marijuana, Adderall is the mostly widely available drug on college campuses. This is the result of the decades-long trend of increasingly prescribing stimulants to adults and children with ADHD. The number of children on medication for ADHD has risen from 600,000 in 1990 all the way to 3.5 million in 2012. In 2011, adults between the ages of 20 and 39 received more than 14 million monthly prescriptions for stimulants. Sales of the drugs have more than quintupled since 2002.

With increased availability, comes increased illicit use. A 2012 study from Stetson Univ. found that 15 percent of American college students admitted to the non-medical use of prescription stimulants like Adderall and Vyvanse. A 2008 survey at the Univ. of Kentucky found an even higher figure: 34 percent of students claimed to have used ADHD medication illegally, while only four percent reported having a prescription.

The College is no exception to this trend. While official statistics about prescription stimulant use at the College are not available, an informal survey posted to the Facebook pages of each class found that 18 percent of the students surveyed reported using ADHD medication without a prescription at least once in the last six months. Less than eight percent of students said they had prescriptions. While these results aren’t statistically rigorous, they support claims made by students interviewed by members of the AC Voice staff about the widespread availability and usage of illicit prescription drugs.

Ted, who reported using study drugs two to three times a week, said that he has never had to pay for study drugs and added that he knew several people, even within his own dorm, who would supply him the drug for free. Chris, who has a prescription for Adderall, remarked that he freely gives out the drug to friends:

“I think it’s kind of fucked up to sell it—it only costs like $10 a bottle—but it’s fine to give it away. If friends ask me for it, I’ll give it to them and just expect something back in return later down the road. I don’t want to have that kind of dealer relationship with people.”

Even students who have never used stimulants commented on their ubiquity. Carmen*, a third-year Biology major, said that obtaining drugs like Adderall or Vyvanse is “incredibly easy,” citing a culture of acceptance around illicit usage of the drugs.

“This campus is inundated with more than enough people with wealthy parents who can get them loads of drugs to give out or sell to other students. There’s a huge difference between the legality of the drugs and how people perceive them morally, sort of like how people accept underage drinking,” Carmen said.

Undermedication and Overmedication

Since the easy availability of stimulants leads to a culture of acceptance, students may be deadened to the risks associated with abusing study drugs. However, the practice of distributing drugs can seriously afflict both members of the transaction.

Professor Julia McQuade, a professor of clinical psychology at the College, raised concerns about the undermedication of students with prescriptions, who give away their pills to friends or other buyers. When students who need medication don’t have enough, their educational experience suffers.

Tara*, a sophomore who has had a prescription for Adderall for several years, said that she often felt uncomfortable telling other students about her medication for this very reason. Tara said that she needs the medication in order to treat her ADHD, and she is worried that if others knew they would pressure her to share it with them.

“I don’t want people to bother me for it,” Tara said. “I don’t want to have to say ‘no’ to my friends.”

Additionally, non-medical use poses risks for individuals who lack education about proper dosage or potentially lethal drug interactions. Carl*, a junior who has used prescription stimulants in the past, said that he once had to call ACEMS after taking a large dose of Vyvanse in combination with his prescribed dose of Wellbutrin, an anti-depressant that can cause negative reactions when combined with amphetamines. Carl had received 75mg of Vyvanse from a friend, who told him to only take half. Since Carl had a lot of work, he figured he would be okay if he took the whole dose.

After working all night, Carl felt sick, so he took a Sudafed (which contains pseudoephredine, a mild stimulant) and went to class. After approximately half an hour, Carl felt his heart racing and had difficulty breathing.

“I can tell when it happened because my notes became illegible scribbles before stopping,” Carl said.

Carl went back to his room, still struggling to control his heart-rate and regain his breath. He remembers being very confused, and having distorted vision. Another resident of his dorm told him that his pupils were extremely dilated and that he was shaking uncontrollably.

“I was sitting in my room debating whether I could even make it to the health center–but felt sure that if I tried I wouldn’t have been able to make it,” Carl said.

He decided to call ACEMS, and a few minutes later a policeman burst into his room with a tank of oxygen and assisted his into the ACEMS car. He was then taken to the health center until the episode ended.

Such reactions might not be common, but they are a growing trend nationwide. In 2005, for example, controlled prescription drug-related visits (including prescription stimulants like Adderall or Vyvanse) increased three and a half times more than heroin-related visits and four times more than cocaine-related visits.

Additionally, stimulants are highly addictive because they lead to “feelings of exhilaration, increased energy, mental alertness” according to the National Institute on Drug Abuse. As students begin to take the drug regularly, they require larger quantities to receive the same results. Even in cases where a legitimate disorder may be present, lack of oversight and a permissive culture surrounding abuse of the drug can set people on a path to addiction. Stimulants can also cause increased heart rate, increased blood pressure, reduced appetite, weight loss, irritability, insomnia, and psychosis. In severe cases, abuse of stimulants has caused individuals to commit suicide.

Without proper medical supervision, casual use can quickly lead down the road to addiction.

Although Chris had tried Adderall and other stimulants a few times in high school, when he arrived at the College he began to turn to stimulants more frequently to cope with all of his work. At first, he only used stimulants when he was swamped with work or needed to stay up late; he had a friend with a Vyvanse prescription who would give him pills whenever he needed them. But then he started taking them more frequently, at least three times a week, but only, he said, to do work.

At the beginning of his sophomore year, he went to a psychiatrist to receive his own prescription. Despite a legitimate prescription to treat his diagnosed disorder, Chris’s use of the drug was still driven by a binging mentality.

“I wouldn’t take it every day—maybe three times a week, four times a week, when I had to produce work.” Chris said. “That started to become abusive and unhealthy. I would do a lot and stay up all night, which messed up my sleep cycle and my appetite and everything. I lost a lot of weight and was really anxious.”

At that point, Chris said, his usage started to become recreational as well, as he pursued a “palpable high.” What had started as a simple way of getting the energy and motivation he needed to finish his work ending up becoming a problem, hampering his well-being and affecting his relationships with other people—contributing, he said, to the demise of his relationship with his boyfriend.

A Lack of Education

Although Chris says that with the benefit of a semester-long break while abroad and a new prescription from his psychiatrist his usage has now become therapeutic and beneficial, his story demonstrates the danger of the lack of education about the effects and risks of prescription stimulants. Anxiety, weight loss, and the weakening of his interpersonal relationships were all side-effects Chris faced without proper psychiatric education or warnings prior to his prescription. Essentially, Chris’s relationship with the drug began without any psychiatric preparation. This experience mirrors the experiences of both those who take study drugs occasionally to complete vast quantities of work and those who self-diagnose an attention-deficit disorder and self-medicate with drugs purchased from a friend.

Despite these risks, the College has been slow to do much in the way of education or preventative campaigns. The College’s Health Education webpage lacks any mention of prescription stimulants, focusing almost exclusively on alcohol. Under the section titled, “Clear Signs of an Alcohol/Drug Problem,” it lists generalities such as “impaired job or class performance” that might not be present with a prescription stimulant addiction. It also fails to list sleep-deprivation or insomnia, two major side effects of stimulant use. During orientation, first-years receive a battery of presentations on health issues surrounding sexual practices and alcohol, including a mandatory workshop on alcohol given by the Student Health Educators (SHEs) in each first-year dorm. In contrast, there are no workshops currently being offered on controlled prescription drugs or prescription drug abuse.

While Amherst does have a task force assigned to addressing drug abuse problems, it seems to fall short in bringing awareness to the study drug problem. According to the AAS, the Alcohol and Other Drugs (AOD) Task Force “will examine the way alcohol and drugs function in our campus culture and brainstorming ideas for improving the health and safety of campus social life.” However, C, a student on the task force, reported that alcohol and party policy dominate the discourse of the meetings. A similar emphasis on alcohol (and lack of information about drugs) can be seen in the “Coming to College: Suggestions for Parents and Guardians” letter written by the AOD Task Force. While it outlines parameters for discussing alcohol usage, sexual intercourse, and smoking, it does not once mention prescription drug use.

Denise McGoldrick, Assistant Dean of Students and Director of Health Education—who leads both the SHEs and the AOD Task Force—declined to respond to a request for comment on this article, saying “I am afraid I have nothing useful to add.”

However, a student on the task force, who wished to remain anonymous while discussing the Task Force’s proceedings, said that the Task Force had considered the issue of prescription stimulant abuse during one of its meetings, but failed to take any action because some members, including Dean McGoldrick, didn’t want to be perceived as condoning off-label drug use. Dean McGoldrick did not respond to requests for comment on these allegations.

Prescription stimulants can allow students with ADHD and other cognitive impairments to function in the high-stress environment of Amherst College. Even for individuals without any medical need for the drugs, they can help make an overwhelming schedule manageable or make up for lost sleep after a night spent in Frost. But without adequate education and medical supervision, these ubiquitous drugs carry grave risks: overdose, addiction, and even death. Any college or university that ignores these dangers does so at its own peril.

*Names changed with permission to protect the privacy of sources.