Adderall: The academic steroid

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Raskolnikov. Rodya. Rodion.

Svidrigailov. Zossimov, Zamyotov, Lebezyatnikov.

Those crazy Russians and their patronymics, their confusing nicknames, their horribly long and dreary novels. Awash in a sea of consonant clusters at 4 a.m., a student finds those names alone might inspire a Raskolnikovian surge of nihilism. Why, it’s almost enough to drive someone to the point of insanity — to murder an old lady just to get some sleep.

It used to be that if you battled the biblical-length “Crime and Punishment” with less than 48 hours to go and a term paper hanging on your back, you lost. Dostoevsky’s ghost would sleep soundly in the marshes of St. Petersburg, and you would sleep soundly next to your emptied Starbucks cups.

But times have changed, and so have stimulants. Pop a few orange pills of the prescription drug Adderall, and you’re still buzzing at 4 a.m., at 12 p.m., even later.

With the aid of Adderall, Liam, a junior, climbed the literary equivalent of Mt. Everest. (Liam’s name and the names of all students in this article have been changed to protect their identities.) He conquered “Crime and Punishment” and a 15-page paper — in just 30 hours. It was an intellectual banquet. Liam devoured those consonant clusters, feasted on those 39 chapters of glorious angst. His interest in the novel consumed him.

He was really, really into it.

“When you’re on [Adderall], your mind is just racing,” Liam says. “I feel this overwhelming urge to get various things done.”

An athlete with a 3.9 GPA, Liam is not a slacker, nor is he an out-of-control drug addict. But like many intelligent, driven college students, he does procrastinate. Life is simply too full to do everything in advance. So he occasionally uses Adderall to help him cram a lot of work into a small amount of time, and he is certainly not alone in this practice.

Adderall, a drug prescribed to treat children and adults with Attention Deficit Hyperactivity Disorder, commonly known as ADHD, is allowing a significant number of students at universities across the country to keep up with the hectic pace of studying and socializing. A relatively new drug approved by the Food and Drug Administration in 1996, Adderall is a close cousin of the older ADHD drug Dexedrine but contains an additional amphetamine salt and two isomers.

Designed to reduce the three main symptoms of ADHD — inattention, hyperactivity and impulsiveness — Adderall decreases distractibility and improves attention span. It comes in dosages of 5, 10, 20, 25 and 30 milligrams, is relatively inexpensive and lacks both the harsh up and down — as well as the street stigma — of the better-known ADHD drug Ritalin.

“Adderall is the drug that works the best,” Jenna, another Adderall user, explains. “It helps you concentrate more than either Dex or Ritalin, and you feel physically better on it than any other ADD medication.”

For these reasons, Adderall is quickly catching up with, replacing and — in places like Yale — even outpacing non-prescribed Dexedrine and Ritalin use. High school students are using it to help boost their SAT scores. Newspapers across the country and national news sources such as ABC are reporting use of the drug at colleges and universities. Clearly, illicit use of Adderall is on the upsurge.

Joseph Zelson, a School of Medicine professor who practices as a pediatrician in Orange, Conn., says college students have been using drugs like Dexedrine for many years, at least since he himself was in college 45 years ago. Like any drug, Dexedrine has waxed and waned in popularity. Although he is unsure of the incidence of use on college campuses, Zelson says the growing prominence of Adderall may simply be because of increased societal awareness of ADHD.

“Why there’s an upsurge now? It well might be that ADD is in the spotlight, and there’s more of the drug around,” Zelson says.

But there may be more to it than simple awareness. Reports of over-diagnosis have haunted ADHD since the condition first gained notoriety in the press. Especially with disorders like ADHD, where symptoms such as inattention are common among a wide swath of the population but may not necessarily indicate a true physical impediment, there is no definitive way to tell if a patient needs medication. Although there are objective criteria for doctors to follow, there remains a great deal of leeway, says Dr. Carl Baum, director of the Center for Children’s Environmental Toxicology at Yale-New Haven Children’s Hospital.

“I do know that in young children, it’s probably over-diagnosed,” Baum says. “Ultimately, it’s a clinical diagnosis. You can interpret an individual patient’s symptoms any way you want.”

And obtaining a prescription for ADHD may be easier than any health professional is willing to admit.

“They say [doctors] usually will prescribe [Adderall] if you’ve had a prescription in the past,” says Eleanor, a Yale student who occasionally uses Adderall. “If you want it and you’re tactful and persistent, you can get it.”

With 6.4 million Adderall prescriptions filled in 2003, the drug is increasingly leaving the legal channels of distribution and ending up in the hands of students like Eleanor.

Eleanor first took Adderall at a fraternity party, when she went upstairs and ran into an acquaintance popping the pills. Under the impression that the drug would make her feel drunker, Eleanor decided to try it.

“That was 10 p.m. I went home, and I couldn’t fall asleep,” Eleanor recalls.

The next day, she was still jittery. And with only two hours of sleep under her belt, she felt energetic enough to go to the gym and carry on as normal. But besides losing sleep and feeling wired, Adderall gave her no other side effects. Coffee, on the other hand, upsets her stomach. At Starbucks, she declines to order.

“I do it when I have a really big thing and I’m stressed out,” she says, her eyes darting about the coffee shop. “It’s cheaper than five cups of coffee to keep you up all night.”

Hardly a heavy user, Liam relies on Adderall two or three times a semester. He never takes more than 40 milligrams at a time (he used a total of 100 milligrams over 30 hours to complete his “Crime and Punishment” marathon) and says he never uses the drug for purely recreational purposes. He likens Adderall to caffeine, or even sleep, for its performance-altering qualities.

“People do alter their biochemistry to perform in situations,” he says.

But Adderall can hardly be compared to caffeine or sleep. Amphetamines like Adderall are classified Schedule II drugs, according to the 1970 Controlled Substances Act. The Act, which set the framework for the federal government’s regulation of the manufacturing and distribution of medicinal and potentially harmful chemicals, classified drugs in five “schedules,” ranging from Schedule I, the most dangerous and least medicinal, to Schedule V, the least harmful and most useful. Crack and opium, like the amphetamines in Adderall, are Schedule II drugs.

Liam, however, remains unconcerned about possible adverse health effects. He, like most students who do Adderall, speaks directly and unabashedly about the drug. He even wrote about his experience with Adderall on his Weblog. Aware of the health risks, including addiction, he shrugs them off.

“I would be worried it would be psychologically addictive,” Liam says. “It’s a great crutch, but you want to be able to function without it.”

At worst, Liam says he feels physically drained after using Adderall.

“You feel pretty shitty afterward. As you’re coming down off it, your body is exhausted, and you’re physically weak, but your brain is still wired,” he says.

Eleanor says she has seen the addictive effects of Adderall among her friends and is careful to avoid reaching that point.

“They do it three or four times a week, anytime they have something to stay up for,” she says. “It’s just a very intense lifestyle.”

The Journal of Emergency Medicine reported 123 stimulant-related deaths in 2003, Baum says. Of those deaths, he says, a significant number were caused by cocaine use, but “quite a few” teenagers died from amphetamine abuse.

“Stimulants as a group are a pretty big proportion of deaths,” Baum says.

Health is not on the minds of either Eleanor or Liam when they have a big paper due the next day. Neither says they believe using Adderall to complete their school work can be classified as academic cheating. Although the drug allows students to complete a large amount of work, they both insist that Adderall is not an “academic steroid,” as it is occasionally called. Liam says he does not use Adderall to help him on tests because he thinks it would have adverse effects in that situation.

“I don’t consider it cheating,” Eleanor says. “I work best under pressure. If I’m staying up the night before, the extra couple hours will help.”

Despite students like Eleanor and Liam who seem to carefully control their use of the drug, Adderall can still be abused.

Read the fine print, and Adderall sounds no different from any other amphetamine. The size-nine font on Adderall’s prescribing information sheet contains scary sounding information few users — especially those without a prescription — ever bother to peruse. Besides the usual bombardment of side effects, including dry mouth, loss of appetite, insomnia, headache and weight loss, Adderall can cause cardiovascular palpitations, elevation of blood pressure and sudden death. Psychotic episodes, depression, seizures and stroke could also plague the user. “Drug dependence,” or addiction, can follow prolonged use of Adderall.

While more and more students are using Adderall, actual data on illicit Adderall use is almost nonexistent. Numbers and studies are few and far between. While the drug is prevalent among a concentrated group of students at Yale, the larger student body still remains relatively unaware of it. It is easy to find students who have never heard of the drug. One thing has become clear: If use continues to rise, Adderall will emerge from relative obscurity into the wider consciousness.

Although he has heard of the trend, Baum says he believes it is normal for the medical profession to remain relatively uninformed about the abuse of newer drugs like Adderall.

“I think any time you have drug use there is going to be a lag between public knowledge and when doctors are aware of it,” he says. “You can have all sorts of problems with illicit use.”

For Jenna and her group of friends, addiction to Adderall is a reality. Jenna first bought 40 Adderall pills her freshman year from a student with a prescription. Since then, Adderall has become an integral part of her life. Jenna now takes the drug daily, at least 10 to 20 milligrams at a time, and more at night if she needs to work. At one point last year, she says, she would take 60 to 90 milligrams in the course of a night — much more than the recommended amount. This year, she has scaled down to 30 or 40.

Though she has not been diagnosed with ADHD, Jenna now feels that she needs Adderall in order to work effectively.

“I can do work without it, but my concentration is just not there,” she says. “I never had a problem studying before I started taking Adderall. It’s so much easier with Adderall.”

Last year during finals, Jenna says she began experiencing some of the more serious side effects of heavy amphetamine use. When she “binges” on Adderall, which also produces the effects of an appetite suppressant, she often finds she has forgotten to eat and has lost weight as a result.

“There was a time when I saw the sunrise every day,” she says. “By the end of that, your heart starts feeling weak. After three days of no sleep, I started hallucinating. You get anxiety attacks.”

With a wide social network and “intense” relationships (according to her friend Eleanor), Jenna seems to be one of those personalities to whom many people are drawn. She answers most questions with the pronoun “we,” as if she experiences everything from the point of view of her collective friends. She parties, drinks and smokes, and has experimented with more drugs than the average Yale student — cocaine, Ritalin and Dexedrine among them.

On the weekends, she and her friends occasionally use Adderall as a recreational drug. When cocaine is not available, they sometimes turn to Adderall as a substitute, crushing the pills and snorting them for a faster, cocaine-like rush.

“Some people like it better [than cocaine],” Jenna says. “You feel different, more focused.”

Colored snot — blue if Jenna and her friends were crushing the 10-milligram pills and orange if they were crushing the 20-milligram ones — is also a side effect. Eleanor says she remembers sitting with Jenna and a bunch of friends in a residential college common room one evening, watching them snorting the blue pills and laughing about the blue liquid dripping down their faces afterward.

“You see someone on the street, and they say, ‘You have something here,’” Jenna says, gesturing to her nose. “And it’s blue, and you’re like — ‘Oh, it’s paint?’”

Snorting Adderall delivers the drug more quickly into the bloodstream and puts greater strain on the heart. Used recreationally and mixed with alcohol or other drugs in a cocktail, Adderall makes a user super-social. Every conversation is completely engrossing, and the user’s energy seems boundless.

Of course, Jenna is not ignorant of the risks. She talks about pains in her sinuses, the possibility of brain lesions. Her group has tried to cut down on Adderall. But at Yale, she says, Adderall is viewed as a less-severe, less-intense drug. Many of her “straight-laced” friends ask to try it.

Thinking about it, she wishes she had never tried it in the first place.

“If I would go back to when we first tried it, I might not have bought it. It’s like any drug; it does become addictive. Just don’t get started on it,” she says.

When Eleanor, Liam or Jenna need to restock, they often turn to Jamie.

Jamie is one of the campus’ primary suppliers. For an average of $4 a pill, he sells the surplus of his own prescription supply. He rakes in a couple hundred dollars a month — “a little more cash,” as he refers to it — selling Adderall to his 20 or so regular customers.

The volume of requests grows every week.

“I’ve shared more Adderall than I’ve ever taken,” he says. “Literally every week someone new asks me. Today, a freshman came by.”

He admits he is mystified by how quickly word of mouth spreads his name around campus. Students want Adderall. They call his roommate asking for the kid with the prescription. They approach him at parties. They take a pill from a friend of a friend. They pass names along.

And why shouldn’t they, he wonders.

“I think that Adderall is a great thing. If it was a drug that had bad side effects, I would feel guilty giving it out. Adderall’s side effects are very minimal.”

Jamie is the kind of guy who seems as though he would happily give out the pills for free if he thought he could exchange them for a good conversation. (Eleanor would later disagree: “He’s such a sleaze. He tries to get as much money as possible.”) He’s more into weed than Adderall, and during our interview he has the bloodshot eyes to prove it. Disarmingly personable and always willing to digress, he dispenses personal information and anecdotes quickly and easily. You like Jamie. You can’t help it.

Jamie is more than an Adderall salesman. He’s an Adderall advocate. It’s not just a good drug, it’s a great drug. It’s not just for the “druggies” or the risk takers. Adderall is for everyone.

“I’m kind of an expert on it,” he says, brushing aside concerns. “I’m not going to diagnose anyone with ADHD, but everyone can benefit from it.”

Himself diagnosed with ADHD at the end of eighth grade, Jamie says Adderall has been a consistent part of his life for the past six years. For much of his childhood, he was a class clown, the smart kid that was always in trouble with the teacher. In second grade, a shower of acronyms fell on his every action: O.T. (Off Task), N.F.D. (Not Following Directions) and, of course, the V.O., Verbal Outburst.

“I got a lot of these,” he says with a smirk. “I was always talking to someone else.”

Adderall curbed his errant behavior, helped him focus. After experimenting with varying dosages — at one point he tried 40 milligrams a day, which made him “really jumpy” — he settled on 20 milligrams a day throughout most of high school. He usually did not need it on the weekends or holidays, just for the six or so hours he would be in class. For a long time, he kept his reliance on Adderall quiet, wary of reactions. Toward the end of high school, however, behavioral drugs such as Ritalin and Prozac infiltrated mainstream media. He no longer felt self-conscious about it.

In high school, he says, he knew of a few kids who did sell their prescription pills. One of his girlfriends forced him to sell 60 or so pills at a time to her. But, Jamie insists, more often he would give the pills away for free. Another of his friends liked to swallow three or four pills at a time.

“He would say, ‘Give me four pills,’ and I would,” Jamie says. “He would just take it, and we would cut class and be wired.”

Before he left for college, Jamie’s doctor told him he could begin to take the pills more flexibly, whenever he needed them. While some children outgrow ADHD, about 60 percent continue to have symptoms into adulthood, according to ADHD.com, an ADHD support Web site run by pharmaceutical company Eli Lilly.

“Now at this age, it’s different,” says Jamie, who now takes Adderall only a few times a semester, whenever he has a large amount of school work. “It’s not for my behavior. I’m not misbehaving anymore.”

But despite the fact that Jamie only takes a handful of pills a semester, his doctor has continued to supply him with many more pills than he needs. She gives him 120 20-milligram pills every eight weeks. Even if he took one pill a day, five days a week, he would come nowhere near using 120 pills.

While many people allege ADHD is over-diagnosed, Jamie says the real problem is over-prescription of the medicine.

“My doctor didn’t ever want me to run out. I wasn’t going to run out,” he says.

Jenna says it is common practice for doctors to over-prescribe for their patients.

“So many people have prescriptions. Everyone is over-prescribed,” she says.

And then there’s the somewhat prophetic all-caps disclaimer on Adderall’s prescribing information sheet: “PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.” Jamie’s doctor — and many other physicians across the country — must have missed that warning.

“It might well be happening that as kids get older, they don’t take it on a regular basis,” Zelson noted, acknowledging the possibility that aging patients may slip by their doctor’s notice and continue to receive prescriptions for more pills than they need. “That’s a real risk.”

When Jamie arrived at Yale and noticed the demand, it made sense to begin selling his surplus. Jamie gained his first customer accidentally freshman year, after he and a friend visited his friend’s “big sib” — Jenna — in her suite. The group was talking in the common room when the topic of schoolwork came up.

“We were smoking a bowl [of marijuana], and she said, ‘Man, I have a lot of work this semester. I wish I had some Adderall,’” Jamie recalls.

Jenna’s suite became his first batch of regular customers. After that, business took off. And considering the academic benefits, that’s hardly surprising. In one night, Jamie says, he was able to “blow through” 75 pages of Heidegger and write an eight-page paper.

“Probably 20 percent of students would try it if they could get it,” Jamie estimates. “More and more people hear about it — People always tell me, ‘Wow, I’d pay more.’”

Despite the health risks, Jamie staunchly defends Adderall’s reputation. Pulling out his orange prescription bottle, he reads the warning on the label: “‘May impair ability to use machines. Use care until familiar with effects.’”

“Walk carefully?” he mocks. “What is this? Advice for your life?”

Jenna, however, has become less flippant about Adderall. Jamie’s assertion about the risk-free nature of Adderall does not ring true when applied to her situation. And with more and more students trying the latest study drug, they may in time discover, as Jenna has, that there is no such thing as a miracle pill.

“It does great things,” Jenna says. “I do love doing it. But what you feel afterward — you just feel eaten up.” n