The first time someone tried to sell me Adderall was in my high school library. At the time, I did not think anything of it.
I was inspired to write this column by the new Netflix documentary film, “Take Your Pills,” which offers an interesting look into the use of stimulant drugs, such as Adderall and Ritalin, both past and present. According to a study by Johns Hopkins University’s Bloomberg School of Public Health, Adderall abuse is booming among young people ages 18 to 25. In fact, non-prescription Adderall use increased by 67 percent between 2006 and 2011 and Adderall-associated emergency room visits rose 156 percent. At the University of Michigan, 24 percent of students use stimulants despite only 8.95 percent having had a prescription.
Adderall and related drugs are central nervous system stimulants. Adderall, in particular, works as a catecholamine agonist, meaning that it binds to the brain’s receptors for catecholamine, the neurotransmitters dopamine and norepinephrine. The drug also inhibits the reuptake of dopamine and norepinephrine by brain cells, similar to certain antidepressants. Catecholamine is associated with pleasure and motivation, so by taking a stimulant, a person is basically pumping their brain with chemicals that lead to feelings of euphoria, focus and alertness. However, those chemicals can also lead to insomnia, anxiety, increased heart rate, hypertension (elevated blood pressure) and even psychosis.
That same study out of Johns Hopkins also found that treating young adolescents with Adderall was on the decline and that the rate of nonprescription use in the same population was neither increasing nor decreasing. This is eye-opening for the many of us whose exposure to the discourse surrounding stimulant drugs has centered around the perceived overmedication of children diagnosed with attention deficit hyperactivity disorder or attention deficit disorder.
I want to address the idea of the “ADHD business,” a concept featured prominently in the one hour and 27-minute runtime of “Take Your Pills.” In fact, the very title of the documentary implies that drugs like Adderall and Ritalin are being forced onto people. Yes, prescription stimulants are projected to be a 17.5-billion-dollar industry by 2020. However, this boom is being fueled by a trifecta of factors: the increased recognition of ADHD as a disease in foreign countries such as Saudi Arabia and China, more Americans getting diagnosed and treated for ADHD because they now have health insurance under Obamacare and a rewriting of the guidelines for diagnosing adults with ADHD. Prescription stimulants have a valid medical purpose and should not be demonized. Instead, my concerns lie with people, especially college students, using stimulants without a prescription.
Another aspect I found unsettling in “Take Your Pills” is the scene where Lawrence Diller, a pediatrician interviewed for the documentary, equated the severity of Adderall abuse to that of the opioid epidemic, calling it “right below the threshold of the opiates.” It is not so much the claim he made that bothered me but how he, at least in my interpretation, insinuated that Adderall abuse was not getting enough attention because of opioids.
Prescription stimulants and prescription synthetic opioids, such as oxycodone and fentanyl, have some commonalities. They are both classified as Schedule II/IIN controlled substances by federal regulations, meaning that they have a high potential for addiction and psychological/physical dependence. Both are also commonly sold and taken without a prescription. However, not all Schedule II substances are created equal. While Adderall and other stimulants can have life-threatening effects, especially when mixed with alcohol, the fact of the matter remains that opioids are responsible for the vast majority of drug-related deaths in America. In fact, per the Center for Disease Control and Prevention, half of the top 10 drugs involved in overdose deaths in 2014 were prescription opioids. Adderall and other prescription stimulants did not even make the list. Opioids are just more dangerous than prescription stimulants and implying that one gets more attention over the other masks the potential merits behind that reality.
However, the strongest critique I would level against “Take Your Pills” is that the filmmakers make stimulants seem amazing. They even included a snippet of an interview with the late Keith Connors, the psychologist who established the first standards for diagnosing ADHD, where he recounted a time that he tried a Ritalin pill from a barrel of them supplied to his team by the manufacturer for their study. Connors then went on to say with nostalgia that his experience with Ritalin was “great.” After watching the documentary, I had an urge to get my hands on some Adderall despite never being diagnosed with ADHD. I wanted it because I wanted to do better.
Prescription stimulants are good for people with ADHD, but what about the rest of us? Should everyone be taking Adderall? Despite the obvious legal implications of a potential felony, let us turn to the ethical aspect of taking stimulants without a prescription. Everyone wants to get ahead, and the truth of the matter is that grades have the potential to make or break an application to an internship or graduate school. However, stimulants can further enhance social disparities that advantage some and hold back others. Not every University student can afford to buy pills from their peers and for certain students, the consequences of being caught selling or using a Schedule II substance illegally can be more severe than for others.
At the heart of my ethical concerns regarding the use of Adderall and Ritalin as performance enhancers is a question of privilege. In classes with grading curves, students using Adderall to help them score better on the exams are directly disadvantaging their fellow students not taking a stimulant. How? By shifting the curve in a way where the students not on stimulants will get a lower grade than if everyone had taken the class without enhancement.
I doubt that anyone taking stimulants without a prescription will give much concern to thoughts of privilege, after all, we live in a dog-eat-dog world where success is the only objective. Nevertheless, the nonprescription use of stimulants to improve one’s academic performance is inherently unethical. So, you can count me out of the Adderall craze.