By Ian Dillingham, Daily Staff Reporter
Published March 11, 2013
Editor's note: For the purposes of the article, some student names have been changed or omitted.
“It’s not so much peer pressure as peer acceptance.”
“Because it’s so accepted among a lot of people,” Kinesiology freshman Andrew said. “You don’t see any harm in doing it.”
Within the increasingly competitive college environment, where students are being pushed to achieve socially, academically and professionally, academic “performance enhancers” are being widely abused. Across the nation, students turn to these stimulants in an attempt to gain a mental edge.
Prescribed in various forms like Adderall and Ritalin to treat conditions like Attention Deficit Hyperactivity Disorder, amphetamines and methylphenidates are the most common ‘study aids’ abused on campuses.
For about $5 per pill — $10 during finals week — students buy these drugs from dorm mates, study partners and even family members.
Like many of his fellow students, Andrew said he often struggles to keep up when he has multiple projects and exams to worry about each week. When these projects start to stack up, Andrew takes Adderall to help him get through a long day in the UGLi.
Despite serious legal consequences for taking Adderall — or any similar medication — without a prescription, Andrew feels the risk is worth it.
“I find so far that it’s extremely beneficial,” Andrew said. “Some people feel like there’s a negative connotation around Adderall just because its not an open, legal drug … If I could only do one drug the rest of my collegiate career, it would most likely be Adderall because I feel that the academic upside to it is so significant that it can only help.”
Since coming to the University he has taken the drug five or six times while studying.
“It’s pretty common during finals season,” Andrew said. “It doesn’t necessarily improve your work, it just makes you focus more. It doesn’t make you smarter, you can just get your work done faster.”
When he feels the need to “really get work done,” he buys Adderall from a friend who is prescribed the drug for ADHD. It has a positive effect on his work, making him act “normally” but with high productivity levels.
“It’s impossible to detect,” he said. “If I’m sitting next to you in the library and we’re both doing work, but I’m doing my work a little bit faster and a little less distracted, nobody will be able to notice.”
Andrew said he didn’t feel pressured into taking Adderall, but the prevalence of the drug on campus dissuaded his worries.
“It’s not like people are pressuring you to do it, you just don’t see any downside to doing it,” he said.
“I think it is a dangerous problem.”
Robert Ernst, medical director at University Health Services said UHS prescribes stimulant medications to help students with ADHD and Attention Deficit Disorder. For these students, stimulants are extremely beneficial, because they increase alertness, focus and energy.
However, given the well-known potential for abuse — especially on college campuses — UHS does not diagnose students with ADHD or ADD. Instead, they rely on the diagnoses and treatment plans developed by outside physicians. Students can only obtain a prescription from UHS with a confirmed diagnosis from their own physician and a history of successful treatment with stimulants.
While some physicians with more experience feel comfortable diagnosing ADHD with only a patient history, others rely on surveys or questionnaires developed to help physicians diagnose the disease.
“Increasingly, (physicians) are believing that students can give the right answers on a survey to make it sound like ADHD,” Ernst said. “It was because of situations like that we decided we didn’t feel comfortable making that diagnosis based upon this survey.”
For students diagnosed outside the University, Ernst said UHS still takes precautions when distributing these medications.
“This is as controversial as it gets on college campuses, and many colleges’ health services have a ‘just say no’ approach to this,” Ernst said. “We don’t look at it as our role to make the diagnosis and initiate treatment, but welcome the opportunity to establish continuity relationships with students who have an established diagnosis and are already stable on a regiment.”
Even for students who demonstrate a legitimate need for medication, a monthly prescription is required to obtain more pills.
Stimulants are classified as Schedule II drugs in the U.S. under the Controlled Substances Act. The U.S. Drug Enforcement Administration heavily regulates these drugs based on their potential for abuse.
“Any time you have a Schedule II controlled substance, you are going to have a lot of (legal precautions),” Gwedolyn Chivers, director of the UHS Pharmacy, said.
In recent years, some physicians have started diagnosing students with ADHD and Attention Deficit Disorder once they get to college, despite the fact that these disorders should manifest by the age of seven in most patients. This inconsistency “confounds” many college health service clinicians, Ernst said.
“We feel uncomfortable making the diagnosis, because it’s just not the general notion that people present as adults, although that’s increasingly becoming the situation — adding to our concern that these are being used to divert the drugs or used for competitive advantage instead of for an established diagnosis,” Ernst said.
Students taking Adderall without a prescription — or who take the medicine as a performance enhancer, instead of treatment for a condition — risk a range of mild to serious side effects, including disrupting sleep, affecting appetite — two more common side affects — and heart palpitation.
“I’ve seen students come in and present with cardiac arrhythmia and disclose, after a couple of follow up questions, that they had borrowed a couple Adderall tablets from a friend,” Ernst said.
Controversy arose in February when Richard Fee, a student at Greensboro College in North Carolina, died after becoming addicted to Adderall and other medications, which were repeatedly prescribed despite protests from Fee’s parents that he did not have ADHD. According to The New York Times, Fee’s addiction may have contributed to his suicide, though “few people who misuse stimulants devolve into psychotic or suicidal addicts.”
Some students feel it’s safe to take another person’s prescription, since their friend with the prescription does not experience any side affects. Ernst said every patient responds differently, so students are putting themselves at great risk by taking these drugs.
Andrew said he felt “no significant alteration” in his physical well-being on Adderall. While on the drug, he said he sometimes forgets to eat or drink, so he keeps a water bottle and snack nearby, just in case.
One of the most severe symptoms of the drug — which is intended to keep the body focused — was that Andrew found it difficult to sleep after taking the drug. In contrast, once the drug wore off, Andrew experienced a “crash” — he counteracts with a cup of coffee.
The UHS physicians are aware that many students prescribed these medications do not take them on a consistent basis, creating the potential for a surplus.
When students come in asking for the maximum quantity of pills, Ernst said he and other physicians will often become suspicious and enter into a “negotiation” over the medication to “come up with a realistic quantity,” where they try to determine how many pills a student really needs each month.
“We know that students don’t take these medicines all the time when they’re prescribed, and when someone is reliable for a high quantity, we start (to) wonder if this is to create a surplus for distribution,” Ernst said. “After three to five visits, we can start (to) feel pretty comfortable negotiating.”
Ernst is seriously concerned about the future for prescription drugs on college campuses.
“I do believe the misuse of prescription drugs will continue to become an increasing prevalent problem — and I think college campuses will be ‘ground zero’ for that type of behavior.”
Students misusing prescription stimulants not only face physical side effects, but also expose themselves to major legal consequences if caught. When asked about these consequences, Andrew was unconcerned. He could not remember a single case of someone being arrested or even questioned for prescription drug abuse.
“I guess it’s a ‘strength in numbers’ type situation … I’m not the only person using it, there’s so many other people. One person is not going to get singled out,” he said.
Diane Brown, University Police spokesperson, said campus police very rarely arrest and prosecute individuals for prescription drug abuse.
In 2011, there were only 102 drug arrests on campus — compared to 314 alcohol related arrests or citations — according to the University’s most recent annual safety report. It's not known what amount of those arrests relate to Adderall.
There is currently one drug recognition expert in the University Police. In most cases, however, the University Police’s main responsibility is to assure students receive proper medical attention when prescription drugs present a danger to their health, Brown said.
Mary Jo Desprez, Alcohol and Other Drug Policy and Prevention Program Administrator, leads the University’s effort to educate students about the potential dangers of drug and alcohol abuse. Desprez said that students could face major legal consequences when dealing with prescription stimulants.
“It is illegal to share a prescription drug with someone else,” Desprez said. “The penalties could include jail, although that’s the extreme case.”
Students found with non-prescribed medication in their possession may face different consequences based on whether the police feel the student shows intent to distribute, Desprez said. Therefore, a student found with 100 Adderall pills will face very different treatment than a student found with one or two.
One concern for the University is the trend among students to use stimulants in conjunction with alcohol or other drugs, a potentially life-threatening combination. Desprez's office has worked to create resources to educate about the dangers.
However, due to the prevalence of alcohol abuse on campus compared to prescription drug abuse, the AODPP primarily incorporates drug abuse information within its alcohol abuse educational programs.
“One of the things we try to do is be good stewards of resources and match our outreach to the level of damage and use,” Desprez said.
Even with the sustained efforts by universities across the nation, an increasing number of students are opting to use — in some cases, promoting the use of — prescription stimulants.
Debate erupted last November when the University of Miami student newspaper, The Miami Hurricane, published an opinion article by student Robert Pursell avidly promoting the use of stimulants by students without prescription.
“The worst thing that anyone has ever done on Adderall is clean a dorm room and look up far too many song lyrics,” Prusell wrote. “It’s hard to abuse a drug whose main side effects are productivity and finding linear algebra interesting.”
The article ended with Prusell’s call to action: “Medicate Miami. You’ve earned it.”
Prusell’s article drew criticism and support from across the nation. And here at the University, students are equally divided on the issue. While many support the use of stimulants, some are taking an active role in speaking out against their misuse.
LSA senior Anjali Bisht and LSA junior Clancey D'Isa first studied prescription drug abuse in a Women’s Studies course last semester. As part of the course, they conducted an independent research study to examine the nature of stimulant abuse among University undergrads.
About 370 University students completed the survey. The students were asked a number of questions regarding their experiences with stimulant medications, as well as basic information about their lifestyle and standing at the University.
“(Prescription drug abuse) is prevalent across … ethnicities, race, sex and class,” Bisht said. “We want this (study) to raise awareness to the campus wide community that something needs to happen.”
Their women’s studies profesor, Carol Boyd, was primarily interested in the price of illegal stimulants on campus. Through their survey, D’Isa and Bisht found that students pay an average of $5 per pill during most of the semester, a cost that can rise during exam times.
The study found that for many students, the primary motivation for abusing stimulants is better grades. However the research found almost no evidence confirming an increase in academic performance with the illegal use of these drugs.
D’Isa and Bisht emphasized that these drugs have confirmed positive impacts for individuals with ADHD and other similar conditions, but that there have been almost no studies on students who take the drug as a “study aid.”
“There’s a lot of people who would like to tell you how helpful it is,” D’Isa said. “(However) you could probably give people sugar pills and see them respond the same way.”
D’Isa said that these drugs will present a challenge for University officials to regulate, given how they differ from other controlled substances.
“It’s easier to get stimulant pills than alcohol if you’re underage,” D’Isa said. “The fact that people are getting it from their family and friends means they are connected in a very intimate, personal way — not like going to a dealer.”
Bisht and D’Isa concluded their study with the hope that the University “can lessen the impact that misuse of prescription stimulant medications has had on our campus,” as well as increase education about “the non-medical use of prescription stimulants.”