I suspect Adderall®(amphetamine) abuse will be talked about in the media for the next couple of months. Just like Oxycontin was, Adderall is the next prescription medication to be put under the spotlight. There has been a few highly publicized cases of deaths, suicides, and psychotic behaviours relating to Adderall abuse. Articles, blogs and popular television are all starting to talk. Something has to be done about prescription stimulant abuse.
What is Adderall?
Adderall is a brand name medication. It is classified as an amphetamine. Amphetamines are stimulants that are supposed to increase concentration, focus, alertness and decrease distractedness. That’s why they’re approved for the treatment of ADHD. The chemical methamphetamine is the street drug referred to as ‘crystal meth’. Amphetamine and methamphetamine chemical structures are nearly identical. With the exception with an added ‘methyl’ group seen below. Believe it or not, the street drug crystal meth is available in prescription form and marketed as the brand name Desoxyn® in the United States.
Prescription medications such as Adderall are classified as psychotropics. These medications cause changes in the brain. More specifically, stimulants such as Adderall release the feel-good chemical, dopamine. This chemical, a neurotransmitter, is one of the many chemical messengers in our brains. It is one of the major chemicals that is involved in the reward pathway in our brains. This pathway is extremely important in the biological basis of addiction. It’s no surprise that people find themselves, not only wanting, but needing to take Adderall.
Prescription Stimulant Drug Abuse
Prevalence of non-prescribed stimulant (e.g. Adderall) use is estimated to be between 5-8% in grade-school & high-school students but jumps to 5-35% in college aged individuals. Many people misuse prescription stimulants to give them the edge they need to ace midterms, finish term assignments, and to outperform on their sports team. There’s also been a study showing that stimulants don’t give people that scholarly ‘edge’ to outperform non-users. Other reasons for abuse have been said to be(ACHA Use and Misuse of Stimulants):
- Increase energy
- Reduce pressures of academic life
- Belief that it’s safe
Although the dangers of prescription stimulant abuse are less than those with opioids, there is still grounds for serious concern. Below is a graphic comparing multiple drugs risk of dependence and harm.
I believe prescription stimulant abuse is the next drug epidemic. I couldn’t tell you how many students have come to me complaining of extreme exhaustion and fatigue looking for a quick fix from something over-the-counter. The accessibility of stimulants is increasing. Since the diagnostic criteria for ADHD is highly subjective, anyone could convincingly receive a diagnosis of ADHD from their physician. Most of the diagnosis is based heavily on self-reported measures. It’s no wonder that prescriptions for stimulants such as Adderall are on the rise. (See graph below from National Institute for Drug Abuse).
It seems that the number of prescriptions for Adderall has finally caught up with prescriptions for methylphenidate (Ritalin®). I wouldn’t be surprised that by now, year 2013, we have surpassed methylphenidate prescriptions.
All medications have side effects. The side effects to prescription stimulant use can range anywhere from constipation to psychosis. The list of health concerns start to grow when drugs are abused. Snorting and injecting medications comes with it’s own set of problems. Snorting medications is more dangerous because you end up getting a larger amount into your system. Not to mention it can eat away at your sinuses. Injecting drugs comes with the risk of contracting diseases such as hepatitis C, hiv and bacterial infections. Using oral medications by snorting or injecting increases your risks of potential overdoses. Overdoses of stimulants can cause psychosis, cardiac abnormalities, heart palpitations, seizures and sudden death. Withdrawal from medications like Adderall also is a problem. It can cause feelings of depression, anxiety, irritability and extreme fatigue. But since it’s a prescription medication, a continuous supply is easily accessible so that withdrawal usually doesn’t happen.
The first steps in decreasing abuse is to increase awareness that there’s a problem in the first place. The awareness should start on college campuses since a large portion of these individuals use and/or abuse stimulants. Programs should be available around campuses to those who are struggling with addiction. Educating students about the dangers of misusing stimulants like Adderall should be a priority. These medications give people the false notion that since they’re prescribed, they’re also safe. Diagnostic criteria for ADHD has been around for a while yet prescriptions for stimulants have been increasing. Is the human race becoming so inattentive and hyperactive to the point that we all have diagnoses of ADHD?
There is no doubt in my mind that these medications have improved the lives of those who legitimately have ADHD. However, since Adderall and all other amphetamine-like medications have serious potential for misuse, certain guidelines and monitoring should be done to change the prescribing habits of physicians. There should be more follow-up and monitoring done when these medications are prescribed. This would help identify those people who are misusing. Of course you could go after the prescribers for increasingly handing out Adderall scripts but I don’t believe that’s going to fix things. It requires a combined effort with health care centres, outreach groups, students and prescribers to prevent further misuse of prescription stimulants.