Netflix today is releasing for streaming a documentary, Take Your Pill, which highlights how pervasive and deep the use of legal and illegal Adderall has become in the young people of our country. I wrote my first Ritalin prescription for attention-deficit/hyperactivity disorder (ADHD) in 1978. But over the past four decades I’ve spoken out about the over use of prescription stimulants for children. More recently I’ve become very concerned about the misuse and abuse of Adderall. I first mentioned my worries about a nation “Running on Ritalin” in 1998. It’s taken twenty years, but now I’m both saddened and relieved that our country is finally taking notice of this problem.
Exact numbers are hard to come by, but in 2013 U.S. drug companies produced 194 tons of legal speed (amphetamine and methylphenidate, its close cousin, in the forms of Adderall, Concerta and Vyvanse) enough for twenty-seven 20 mg. Adderall pills for every man, woman and child living in America.
In 2012, the number of prescriptions written for adults surpassed those written for children and that gap only grows. It appears the stimulant market for American children has been saturated while the demand in the adult population keeps growing. And that’s what’s worrying me so much these days. It’s estimated that one-third of the legally produced stimulants are being diverted for illegal use. Ask any college student how easy or how cheaply one can obtain a 10 mg. Adderall tablet for studying, cramming or getting high (yes, these tablets are crushed and snorted with a resultant methamphetamine-like rush).
The opioid crisis has grabbed the nation’s attention but the Adderall epidemic is just below the radar. Government data has failed to capture the true extent of Adderall misuse and abuse. Many drug addicts who started by abusing Adderall require the opioids (Oxycontin and Vicodin) and minor tranquilizers (Xanax and Ativan) to “come down” to sleep and become addicted to these sedating drugs. Hospital records show deaths from Oxycontin. What they don’t show is the mixed prescription drug abuse involved or that the opioid addict began with Adderall.
Taking Your Pill makes the case for “we’ve met the enemy and they are us.” Sure, the doctors and drug companies are making a bundle. But they are essentially exploiting our national religion -- capitalist consumer materialism -- which states you’ll be happy if you buy things. If you’re not happy you may have, what I call, achievement anxiety disorder; AAD, not ADD. Performance enhancers will always be attractive in this society. It’s just that the historical record (amphetamine’s been around since 1929) suggests that amphetamine doesn’t work long term and the costs to the society, in terms of abuse and addiction, are simply too high.
In the meantime, I want to reassure the parents of children taking these medications that it is safer giving Adderall to children than prescribing it to adults. Children neither have access to the medication nor do they like higher dosages. Older teens and adults on the other hand get to manage their own meds and very much like the sense of confidence and euphoria higher doses of the medication provide. Parents’ biggest worry, however, is that taking Adderall as a child might lead to later drug abuse. This phenomenon has been studied and studied. The consensus conclusion is that childhood use of Adderall neither protects against nor predicts later drug abuse. Issues of personality, family and neighborhood are far more profound influences on future drug abuse.
As for the adult users, it’s unlikely that our country is going to undergo a Buddhist revolution and give up consuming. Yet there are a couple things that can be done immediately to decrease the threat that Adderall poses to our young people. First, no doctor should be prescribing immediate release short acting Adderall (the preferred form for misuse and abuse) to any teenager or adult. There is a long acting version of Adderall that is harder to abuse and demands a much more scheduled use of the medication. Short acting Adderall, which can be taken at any time of the day, lasts only four hours and actually facilitates the lack of planning, disorganization and procrastination that are the hallmarks of adult ADHD. Parents of college students should inquire of their children if they are taking the short acting med and if so, demand they switch to the long acting version.
Finally, it will be up to trial lawyers, judges and legislators to address the Adderall abuse epidemic. Unfortunately, as long as there’s money to be made, doctors will only respond to threats to their licenses and pocket books. In the meantime, people will continue to use Adderall to try to get ahead. Long term, we must learn to accept our strengths, weaknesses and limitations. To do otherwise will reduce our humanness and result in hundreds of thousands of individual tragic catastrophes.