Adderall: A worthy public health problem?

Renán E. Orellana, Co-Editor-in-Chief

In thinking about recent increases in rates of prescription stimulant medications for attention deficit hyperactivity disorder (ADHD), I asked myself how (if at all) does non-medical prescription stimulant use pose a threat to population health?

At some point or another, a good deal of college students will hear an anecdote about a friend or a friend of a friend who decided to pop an Adderall or Ritalin to improve their concentration while studying, cramming, or pulling an all-nighter the night before an exam. Many college and high school students resort to this sort of illicit amphetamine use in test preparation or to enhance their performance on exams.

But to what extent should we worry about the increasing prevalence of non-medical use of prescription stimulants like Ritalin, Adderall and Dexedrine, particularly among college students?

The findings of a study by McCabe et al. provide evidence of the increasing national prevalence of the non-medical use of prescription stimulants in the US, representing a problem within certain subgroups of college students:

http://www.ncbi.nlm.nih.gov/pubmed/15598197

It posed the non-medical use of prescription stimulants as a high-risk behavior. Their findings included indications that such use was higher among college students who were:

  • Male

  • White

  • Members of fraternities and sororities, and

  • Earning lower grade point averages

What are the possible implications of the prevalence of non-medical use of medications intended for the treatment of ADHD?

First, consider the implications of the medical use of prescription stimulants in terms of health outcomes, including sudden death, cardiovascular disease, liver problems and anxiety.

http://ajp.psychiatryonline.org/data/Journals/AJP/3899/09aj0992.PDF

http://www.fda.gov/drugs/drugsafety/ucm277770.htm

In Gould et al. only one youth appeared likely to have used stimulants illicitly, so the observations by the researchers pertain to the medical use of ADHD medications.

Now, let’s look at illicit use among college students:

On university campuses in Australia, increasing numbers of college students are using ADHD drugs to improve their academic performance. Ritalin and Adderall use has also become a means of prolonging drinking binges on weekends and getting an additional buzz on a wild night of partying.

http://www.smh.com.au/national/ritalin-is-students-new-drug-of-choice-for-parties-and-studying-20100226-p953.html

Taking into account the dose-response effects of Ritalin, it can be inferred that addiction in college students would be a risk behavior like binge drinking in which frequent/prolonged use and/or toxic dose-levels can lead to health complications. Moreover, addiction does seem to happen more often than we may think.

Often people will associate the use of ADHD drugs for prescribed purposes with cardiovascular disease due to stress on the heart from increases in heart rate, but the previous safety update from the FDA mentions the results of a study that did not show an association between use of certain ADHD medications and adverse cardiovascular events.

At the same time, the FDA approved label for Ritalin specifically mentions the risk of cardiac sudden death when Ritalin is given to children with heart conditions.

Taking into consideration these research studies and informed, evidence-based perspectives, the health implications of using stimulant medications for whatever reason is a matter of individual differences. An individual’s particular health status can determine his or her experience with the medication.

It may be that such use will have no consequences other than a good grade on an exam or it could lead to the emergence of health outcomes like anxiety, dysphoria, liver problems, poor eating habits, cardiovascular disease and tiredness.

But one thing seems evident from all this information: the non-medical use of prescription stimulants is a high-risk behavior and deserves further attention in terms of research and policy interventions, particularly on college campuses.

Just remember the wise words of Paracelsus, the “father of toxicology”:

«The dose makes the poison.»

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