One in 10 teenagers, 2.3 million nationally,
has tried Adderall and/or
Ritalin without a prescription,
according to a recently released 2004 Partnership for a Drug-Free
America study. Twenty-nine percent of those surveyed said they have close friends who have abused Adderall or Ritalin.
As the number of legitimate prescriptions across the
nation continues to rise, so too does the number of students illegally popping Adderall pills for academic and recreational reasons. Most, including the University student arrested in April for selling his Adderall pills to other students in his residence hall, aren’t aware of the severe criminal penalties and health risks associated with the drug.
The drug is highly addictive, and the penalties for illegal possession and distribution are identical to those associated with drugs such as methamphetamine and heroin.
In the early 1990s, many children were diagnosed with Attention Deficit Hyperactivity Disorder, and as those children hit their college years, some are filling prescriptions for stimulants they no longer need and are selling the pills illegally as a study aid.
Adderall’s addictive nature
The number of Adderall XR prescriptions continues to rise, but the long-term effects and risks associated with the stimulant are shrouded by a veil of uncertainty, according to leading psychiatric experts, the U.S. Food and Drug Administration and Health Canada, the Canadian equivalent of the FDA.
The Drug Enforcement Administration has classified Adderall as a Schedule II drug because of its highly addictive nature. Other drugs in this category include cocaine, methamphetamine and opiates such as heroin.
“There is a high potential for abuse” whether the person is taking Adderall to medicate ADHD or for other reasons, FDA spokeswoman Susan Kruzan said.
Adderall is a stimulant, manufactured by Shire Pharmaceuticals, that contains a combination of mixed amphetamine salts. Since being launched in 1996, both Adderall and Adderall XR, the newer, once-a-day version of the drug, are increasingly being prescribed to treat the symptoms associated with ADHD.
The drug’s labeling contains an abuse warning stating: “Taking
amphetamines for long periods of time may lead to drug addiction.”
According to the Partnership for a Drug-Free America study, nearly
50 percent of teens believe using prescription medications to get high is “much safer” than using street drugs.
In a statement to the U.S. Congress in September 2000, Dr. Peter R. Breggin, director of The Center for the Study of Psychiatry and Psychology, said stimulants such as Adderall often become gateway drugs because the same neurotransmitter systems in the brain affected by amphetamines, such as Adderall, are also affected by cocaine and methamphetamine. Breggin cited a study of University of California students that showed people who were prescribed stimulants as children became prone to cocaine addiction as young adults.
“I haven’t seen any quantified data that outlines these cases of abuse,” Shire Pharmaceutical spokesman Matt Cabrey said. He did, however, say there “seems to be misuse” because of the inquiries he has been
receiving from the media on the topic of illegal use.
In 1999, the National Institute of Mental Health released the results of a 14-month study indicating that the use of stimulants is an effective way of treating the core symptoms of ADHD.
Adderall affects the body for an average of five to seven hours, during which time it increases the release of dopamine, norepinephrine and reuptake blockade in the brain, according to “The Clinician’s Practical Guide to Attention Deficit Hyperactivity Disorder.”
The perils of taking Adderall
Prescribed drugs are not without danger, and Adderall is no exception. On Feb. 9, Health Canada suspended and withdrew Adderall XR from the Canadian market because of its “association with sudden unexplained death,” Health Canada spokeswoman Jirina Vlk said.
There have been 20 deaths and 12 reports of strokes in patients
taking prescribed amounts of Adderall and Adderall XR, according to a Health Canada press release. Fourteen of the deaths and two of the strokes occurred in children.
“We are continuing to move forward with very positive conversation,” Cabrey said.
Shire and Health Canada are forming a drug
committee that will provide additional findings to Canada’s minister of health.
While Adderall as a direct cause of death is still under review, additional rare cases of drug-induced psychosis resulting in deaths have stood up in court.
In Jan. 1999, University of North Dakota student Ryan Ehlis, 27, shot and killed his five-week-old daughter and wounded himself after taking Adderall for a couple of weeks.
According to court documents, Ehlis, who had taken Ritalin as a child for his ADHD, was having trouble with his studies and went to a psychiatrist who gave him a 30-day prescription of Adderall.
Ehlis’ girlfriend, also the mother of his children, testified that Ehlis stopped acting like himself the first day he took Adderall. After the first week, he began to describe delusions and hallucinations. After he ingested the remainder of the prescription, he began talking with God and his dead grandfather. Claiming to be acting on God’s orders, Ehlis killed his baby before turning the gun on himself.
Charges were dismissed after various doctors reported he was suffering from “Amphetamine-Induced Psychotic Disorder.”
In 2002 Dawn Branson experienced an Adderall-related episode of psychosis in which she caused a car accident, killing her only child, according to a CBS report.
In both cases, the victims said they were never aware of the possibility of psychosis.
Cabrey said it is up to physicians, parents and caretakers to warn patients about potential risks, and Shire works directly with them.
Stimulants are the most-researched ADHD treatment, and a 1998 Consensus Development Conference report on ADHD sponsored by the National Institutes of Health confirmed that the short-term use of stimulants is safe and effective.
The side effects associated with Adderall affect people who do not have ADHD more severely than those who do, although occurrences are present in both categories, University pharmacist Gregg Wendland said.
Common side effects include insomnia, appetite suppression, stomach aches, mood changes, dry mouth, headaches and jitteriness.
According to the FDA, Adderall’s more serious risks are sudden death, abuse potential, worsening mental illness (psychosis), possible decreased growth, weight loss and increased tics.
“Animal studies have clearly shown that drugs like Adderall, the amphetamines kill brain cells at routine clinical doses,” Breggin stated before Congress in 2000.
At the same hearing on “Behavioral Drugs in Schools: Questions and Concerns,” Patricia Weathers, a New York parent of a child with ADHD, said that while her son was taking the stimulant Ritalin, he didn’t grow for three years.
“When I took him off all the drugs, he grew three sizes in three weeks. That is a size a week,” Weathers said. “I will never know what kind of permanent damage it has done to my son.”
Controversy surrounding ADHD
ADHD occurs in 3 to 5 percent of school-age children and is four times more likely to be present in boys than girls, according to a report of the Surgeon General.
Shire Pharmaceuticals estimates the figure to be between 3 and 9 percent, with 66 percent of childhood cases continuing into adulthood, affecting 8.6 million adults in the United States.
The number of ADHD diagnoses jumped from 1 million in 1990 to more than
3 million in 1992. Former Colorado representative Bob Schaffer explained during the 2000 hearing that the reasons f
or this can be found in a number of federal
incentives introduced during the time period.
“In 1990, Supplemental Security Income, a Federal wel
fare program, was opened to allow low-income parents whose children were labeled with ADHD to be eligible for a cash benefit under the SSI program,” Schaffer said.
“In 1991, the Department of Education made hundreds of special
education dollars available every year for children labeled with ADHD and also for those in need of special education,” Schaffer told Congress. “After that, modification schools could receive more than $400 per
student under IDEA (Individuals with Disabilities Education Act) for each child diagnosed with ADHD.”
In the 24th Annual Report to Congress, IDEA reported a 28.5 percent jump in students ages 6 to 21 who were served for specific learning disabilities
between 1991 and 2000.
“One possible explanation for the growth in this category comes from the states, which have reported that the increase is due in large part to the increased
identification and provision of services to children with attention deficit disorder and
attention deficit/hyperactivity disorder,” the report states.
Numerous experts are concerned about high rates of misdiagnosis. According to NIMH, a comprehensive medical evaluation, including input from the parents and teachers, is necessary for accurate diagnosis.
According to the Surgeon General, the majority of children and adolescents receiving stimulant medication do not fully meet ADHD criteria.
Dr. Fred A. Baughman told Congress that in April 1998 he wrote a letter to Attorney General Janet Reno stating: “The biggest health care fraud in U.S. history is the representation of ADHD to be a disease and the drugging of millions of
normal children.” He went on to say that disease equals physical abnormality, which is absent in the brains of children with ADHD.
According to the Surgeon General, because symptoms of ADHD respond well to stimulants, and stimulants increase dopamine in the brain, the “dopamine hypothesis” has driven recent research.
Several reasons for misdiagnoses highlighted at the congressional hearing included an inability to read, problems at home and schools cutting out recess. Until the federal Child Medication Safety Act of 2003, a bill designed to protect children and their parents from being forced into administrating psychotropic medication to attend school, there were various reports of teachers and other school staff pushing the diagnoses of ADHD in students.
Patricia Weathers said her son’s diagnosis was based on a checklist and a short evaluation by a pediatrician, not a psychiatrist, after the principal told her to put the boy on psychiatric drugs.
They put Weathers’ first-grade son, Michael, on the stimulant Ritalin. By the time he was in third grade, he was completely withdrawn. He began chewing on his clothes, paper and other things. Weathers said his behavior became more and more bizarre. When his mother showed research on the side effects of Ritalin to the principal, Michael was dismissed from school.
“I hear lots of stories like Ms. Weathers’. I have heard lots of them in my state,” Schaffer said. “I have heard lots from others around the country.”
Editor’s note: This story is paired with Grades by the milligram by Amanda Bolsinger (May 2, 2005).

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