Exhilarating.” That’s how John* describes it. He was on top of the world, making good grades and feeling in control of his heavy workload— all thanks to a little pill he scored from a classmate.
“Everyone else was walking around school all bummed out, and I’d be on this high” from Adderall or Vyvanse, he remembers. “I would make charts, graphs, plan out my entire next month. I felt completely, 100 percent dedicated to what I was doing.”
John’s experience isn’t unusual for a student on a college campus. But he wasn’t enrolled in a university. He started taking Adderall during the spring semester of his junior year at Baltimore City College high school. He doesn’t have ADD. He bought the 30milligram pills for about $2 each from a student who did, and took one or two each week.
John was part of a not-so-underground group of high school students using prescription stimulants to enhance their performance in challenging academic situations. Those with attention-deficit disorder or ADD need these medications to help stabilize their energy levels. For boys diagnosed with ADD, the medicines typically level out hyperactivity; for girls with ADD, the medications can eliminate excessive daydreaming.
But for students with normal brain chemistry, Adderall, Vyvanse and Ritalin provide a few-hour burst of energy, extending the time they can concentrate on a tough research paper or study for an exam, and potentially improving their performance on tests. It can, the students say, mean the difference between earning good grades and scoring competitive college-worthy grades.
For several years, prescription stimulant misuse has been recognized as a problem on college campuses. But the problem is not confined to higher ed institutions. A National Institute on Drug Abuse survey in 2010 showed that 6.5 percent of high school seniors nationwide have taken Adderall without a prescription. According to the survey, Adderall is the fourth most popular drug for high school students behind marijuana, synthetic marijuana and Vicodin.
With heavier workloads, the stress of getting into college and a teenage brain that asks, “What could go wrong?” some high school students see prescription stimulants as a practical approach to managing the pressure. As John says, “I remember junior year being the most stressful year of high school, and [Adderall] was too easy and cheap of a solution for me not to use it.”
And, he says, he didn’t worry about getting caught. “I think the teachers in general knew it was a problem somewhere in America,” he says, “but when it comes to [me] abusing the drug and taking it without a prescription, I don’t think they were able to tell.”
John didn’t see himself as having a drug problem, which is typical of young students using prescription stimulants to gain an academic edge, notes Dr. Alain Joffe, a primary care physician with additional certification in adolescent health who is director of Johns Hopkins University’s Student Health Center. “They tend to believe they can control it, or they’re not doing anything different than other students.”
Joffe is well-acquainted with Adderall misuse. “Anybody who works in a college health center is keenly aware that there is an active secondary market for stimulants on college campuses,” he says. At Hopkins, all freshmen are required to attend a lecture on the brain science of alcohol and drug use that includes specific facts and warnings about prescription stimulant use.
Joffe says teens and young adults who take prescription stimulants without an ADD diagnosis typically fall into one of two categories: misuse or abuse. When the medications are snorted or injected, the user can experience a huge dopamine surge, which leads to a feeling of euphoria. Like cocaine or heroin use, this is classified as abuse.
But most often Adderall is misused. Students take the pills orally so they can stay up to study or even party, giving them a boost in mood, energy, focus and even cognition.
An Adderall high is like an inverted U, notes Dr. David Goodman, director of the ADD Center of Maryland and an expert on the diagnosis and treatment of attention-deficit disorder, especially among adolescents and adults. Soon after taking a pill, “dosing goes up, becoming optimal,” he says. “But if you overshoot [or take too much of the drug], performance can decline.” John experimented with dosage until he found one that gave him the effects he was seeking. “I started with a 10-milligram pill and felt a small effect, and then went with a 30-milligram and it felt like a high octane drug,” he says. “I vividly remember the increased effect: the feeling of orderliness and business extended throughout the day after school, and I also remember not even needing to eat at all after a small breakfast for the entire day because my appetite completely disappeared.”
Teens think about prescription medications differently from other illicit drugs, Joffe says. “In contrast to marijuana and other kinds of street drugs, [teens] perceive [ADD drugs] as safe, because they’re prescription medications,” he says. “They have been approved by the FDA.”
But there is risk. “Since high school students are not cardiologists, they run into medical problems,” says Goodman. “[A student taking prescription stimulants without a prescription] has no cardiac clearance. He doesn’t know what dose he’s taking. He doesn’t know what dose he can tolerate. We don’t know what other over-the-counter drugs he’s taking.”
For John, however, the benefits far outweighed any drawbacks. And the fact that he knew other kids were using it made it seem normal. “During crunch time, during exams, a good amount of people I heard were asking and looking for Adderall,” he says. “One of my friends used it so much that he kind of forgot what it was like to not be on it. He’s not on it now, and he’s kind of a better person.”
Alison*, who graduated from Towson High School in 2011, has a prescription for stimulants to treat her ADD, which was diagnosed when she was in third grade.
“I was struggling in school. And I was taken to the doctor, got an ADD test and got a prescription,” she says. “I went to camp sophomore year, and my mom told me I had to keep my medicine locked up because people would want to steal it, which I had never thought about before. My mom kept my medicine under lock and key in high school and set out one pill a day.”
That didn’t stop her friends from asking for it.
“At least twice in high school, like the morning of the APs [Advanced Placement exams], people called me and would say, ‘Please bring Adderall, I’m dying,’” she says. “My friends asked me for it, but I couldn’t give it to them because I didn’t even have it.”
Alison, who is now in college, says, “I do know people who went home over break [from college] and went to their doctors and said, ‘I think I have ADD,’ or just asked for a prescription and got one. It seems pretty ridiculous that a 17-year-old girl can go to the doctor and diagnose herself. It’s an abuse of the system.”
Goodman acknowledges that “to walk into a physician’s office and give a good story certainly could be done.” But, he adds, “I would sincerely hope that wouldn’t happen.”
There is an agreed-upon protocol for diagnosing ADD, including a detailed checklist, interviews with parents, teachers’ reports and collateral information about childhood experiences. Still, health insurance restrictions can make it challenging to accurately make these diagnoses, says Goodman. “Primary care physicians are taking on more and more of the initial mental health evaluations,” including those for ADD, he says. “They simply don’t have the expertise or the time it takes to go through a psychiatric evaluation.”
In what seems like an ironic twist, Joffe says some of these teens misusing prescription stimulants may actually have undiagnosed ADD. “Some data shows that kids who misuse stimulant medications have behavioral profiles that show they might have ADD,” he says. “They may not recognize their symptoms as ADHD [attention-deficit hyperactivity disorder]. They’ve just figured out, ‘If I take this, I feel better.’”
Kids who are “bouncing off the wall” are more quickly identified as ADD, he continues. But inattentive students are labeled as daydreamers.
“They fly below the radar,” Joffe says. “If you’re really, really smart, your ability to cope or compensate for ADD may not be tested until the high school or college level. We are probably under-treating a number of kids.”
Despite the fact that many students are aware of the misuse of prescription ADD drugs at the high school level, many local high school administrators seem wary of openly acknowledging the issue, discussing it or enacting programs to address it specifically. Baltimore City Public School officials did not respond to requests for interviews on the subject. Bryn Mawr’s Associate Head of School Peggy Bessent says the school is aware of the misuse of prescription stimulants as a potential problem facing high school students, and offers a comprehensive drug and alcohol education program. Gilman School responded to requests for an interview with a statement: “Like many of our peer schools, we are committed to the Baltimore Independent Schools Covenant for Safety and Health. We continue to develop programmatic approaches to the use and abuse of alcohol and other drugs, including the creation and support of early intervention and peer and parent support efforts.” The covenant does not mention Adderall or other prescription stimulants by name.
According to Charles Herndon, spokes-man for Baltimore County Public Schools, students enrolled in Baltimore County public schools participate in a comprehensive K-12 program that treats prescription stimulants as part of a larger discussion of prescription drugs that can be misused and abused.
Even though schools aren’t out in front of the issue, some parents are aware and on guard. “I heard about [Adderall misuse] a couple of years ago,” says Lauri Cebula-Seboch, whose son, Paul, graduated from Baltimore City College this spring. “I kind of made a mental note about it.”
Cebula-Seboch didn’t see it as a problem with her son (who does not have ADD), but she certainly sees the connection between high academic pressures and stimulant misuse. “The workload was pretty heavy,” she says. “It was stressful for me. I know it was stressful for Paul.”
Cebula-Seboch doesn’t remember the school communicating with parents about possible misuse of Adderall and other ADD medications, and Paul says it was never mentioned in health class. “The kids were kind of on their own,” she says.
Janet*, another parent of a City College senior, is aware of the issue for different reasons. Her daughter was diagnosed with ADD when she was younger and takes a generic form of Adderall to manage her symptoms.
“I do know that kids are selling it at City,” Janet says. One boy she knows of gets $10 per pill. But her daughter doesn’t give away or sell her medications because Janet carefully monitors her daughter’s prescription.
Since stimulants are Schedule II controlled substances, Janet’s daughter is only prescribed a 30-day supply at a time, with no refills. Janet keeps a small number of pills on hand in the kitchen, so her daughter can take one each morning with breakfast. The rest are stashed in Janet’s bedroom, along with a supply in the school nurse’s office. Janet’s daughter is supposed to go to the nurse’s office each afternoon to take a second dose, but she often skips it because of the inconvenience. “At the beginning of the year, she wanted to take her Adderall with her [because she didn’t want to go to the nurse],” Janet says. “But there’s a zero-tolerance policy. If they found it on her, she could be expelled.”
Both city and county policy requires students to keep and take prescription medications in the nurse’s office.
Immediate or short-release pills are in higher demand for off-label use than the extended-release version, because they offer a shorter high. For that reason, Goodman prefers prescribing extended-release to his patients— and wishes other doctors would do the same. “If you’re only dosing once a day in the morning, the pills never leave the house,” he says. Unfortunately, the extended-release pills give Janet’s daughter severe headaches, so she has no choice but to take short-acting meds.
Goodman says centralizing medication distribution at school or at home is the most effective method for controlling the supply of prescription medications. But that doesn’t stop some students from pressuring other students to give them a pill— an act that carries risks for the giver. Because Adderall is a Schedule II controlled substance, possessing, selling or diverting (giving it away) is a felony. Now that Alison is in college in a different state, far from her mother’s supervision, she has given in to the pressure at times— and unwittingly risked criminal charges. “I have a lot of people asking for it… and sometimes I give it to them. Some people offer to pay but I don’t make them pay,” she says. “I can’t get my prescription filled whenever I feel like it, so if I give it away that’s one day that I can’t use it.”
As for how to curb prescription stimulant misuse, Joffe says that education alone is probably not sufficient. “You have to couple that with some sort of a program that features real consequences,” he says. Reducing parental pressure at home is also important, he adds. “We live in a society where a lot of decisions are made on numbers. I think kids do feel an enormous pressure to succeed.”
As Janet says, “There’s more pressure on kids now. And, gosh, Adderall is more available now. I can’t believe that lots of people aren’t misusing it.”
The fact that many of the students taking ADD drugs without a prescription do so in the interest of academic achievement raises questions: Should prescription stimulant misuse be viewed largely as an ethical lapse on the part of students wanting to take shortcuts to get ahead— in other words, cheating? Should it be viewed as an issue of drug abuse? Or should it also be viewed as a symptom of an environment— at home, in school, in the culture at large— where the pressure to succeed drives some to extreme measures to perform academically?
In his senior year of high school, John read a newspaper article reporting on young people’s misuse of Adderall. “It was very damning,” he says. “These kids had self-diagnosed in order to get an A. I could identify with them. It kind of scared me….”
Now a sophomore in college, John no longer misuses prescription stimulants.
“It just felt really lame to me, like the easy way out,” he says. “I didn’t want to be a typical, Adderall-popping-to-get-all-my-work-done kid.”