College students aiming for an academic edge may explain a surge in the misuse of a stimulant commonly prescribed for attention-deficit hyperactivity disorder (ADHD), new research suggests.
Cramming for exams
Among U.S. adults, the number of Adderall prescriptions stayed stable from 2006 to 2011, but misuse of the ADHD drug jumped 67 percent and related visits to emergency rooms went up by 156 percent, researchers found.
"The majority of adults who are using Adderall nonmedically are in the age range of 18 to 25," said lead researcher Dr Ramin Mojtabai, a professor of mental health at Johns Hopkins Bloomberg School of Public Health in Baltimore. Most get the pills from friends or relatives who have prescriptions, the study found.
Read: Ritalin abuse runs riot in South African schools
Mojtabai and his team suspect college students use Adderall to help them stay up all night to cram for exams. Similarly, young working adults may use it to stay sharp and focused on the job, he said.
"It's possible some of this use is recreational," said Mojtabai. "There's a pattern of concomitant use of other substances in about half of these adults."
Whatever the reason, the use of amphetamines, including Adderall, can lead to dependence, sudden death and serious cardiovascular events, according to the U.S. Food and Drug Administration, which requires a "black box" warning on the drug packaging.
Three national surveys
"They are not harmless simply because they are prescribed by doctors," said study co-author Dr Lian-Yu Chen, an attending psychiatrist at Taipei City Psychiatric Centre in Taiwan. Among the possible cardiovascular effects are high blood pressure and stroke, Chen noted.
Read: Teens abusing ADHD drugs
People with ADHD are often prescribed stimulant drugs and/or behavioural therapy to help them focus, reduce their hyperactivity and curb their impulsivity.
Researchers looked at U.S. trends from 2006 through 2011, spurred by concern about misuse of the stimulants among children and teens. They analysed three national surveys – one on doctor visits, one on drug use and another on ER visits – to track use of the stimulants Adderall (dextroamphetamine-amphetamine) and Ritalin/Concerta (methylphenidate). Ritalin is also commonly prescribed for ADHD.
In adults, the researchers found, treatment visits for Adderall were unchanged, although nonmedical use and ER visits rose significantly.
Concern about stimulant misuse among children and teens did not bear out. In adolescents, treatment visits for stimulants declined, and misuse of Adderall did not increase. Nonmedical use of Ritalin and Concerta declined by about 54 percent over the six-year period, the researchers found.
Read: Long-term safety of ADHD meds not established
The study was published in the Journal of Clinical Psychiatry.
The researchers speculate that college students may prefer Adderall over the other stimulants because it increases two brain chemicals linked with better cognitive functioning and has a reputation for making people smarter.
Dangers of drug sharing
However, stimulant use often causes anxiety, insomnia or agitation, Mojtabai said. In younger children, growth can slow somewhat due to the medication's appetite suppressant effect. Aggressive behaviour and depression may also occur with long-term Adderall use, he said.
The study findings don't surprise Dr Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.
Read: SA has one of the highest prescription rates for ADHD medication
"This study highlights the growing problem of drug diversion as the main factor behind both misused and increased emergency department visits for Adderall," said Glatter.
Doctors need to be aware of this and talk to patients who receive a stimulant prescription about misuse and the dangers of drug sharing, he said.
"Many students mistakenly believe these drugs will make them smarter and more efficient at studying, so in their view the risk is worth the reward," he said. "And because Adderall can improve focus, it may also give some students an unfair advantage, thus constituting academic dishonesty."
For those with legitimate stimulant prescriptions, Glatter recommended locking the drugs away to avoid theft from friends and even family members. "It's important to keep track of pills and do daily pill counts to be assured that no one is removing their medications," he said.
What is ADHD?
Causes of ADHD
Symptoms of ADHD