http://www.digitalduke.duq.edu/article.asp?id=1314

Prescribing a problem: Part I

Recent studies show drug abuse among college students is on the rise,
reporting that one in four full-time college students in the U.S. meet the
criteria for substance abuse or dependence. But rampant drug abuse is no
longer limited to illicit narcotics and alcohol. Prescription stimulants are
now being abused at an alarming rate, occasionally leaving some college
students addicted and vulnerable to their serious side effects.

His confidence was no longer a formidable opponent to the stress and
expectations. His focus was all but gone. With school assignments piling
high and the clock ticking away, he knew he had to find a cure-all to his
college problems.

He needed a study buddy.

No longer able to conquer his studies alone, L. managed to find a friend in
the form of a pill. A pill he would regret taking nine months later.

L., a junior at Duquesne, started taking Adderall - an amphetamine-based
prescription stimulant generally used to treat people diagnosed with
Attention Deficit Hyperactivity Disorder (ADHD) - during the fall semester
of his sophomore year at Duquesne. He says he immediately fell in love with
the drug.

Without Adderall, L. says it would take him about two days to read a
300-page novel. With the drug, it would take him just one night.

"You can start reading a book and then look at the clock and realize three
hours have passed and you killed it," L. says. "You wouldn't even bat an
eye."

Results like these are why Adderall and other prescription stimulants are
becoming so popular with today's college crowd. The trend is known as
"pharming," the distributing of prescription drugs - mainly "exam drugs,"
like Adderall - around campuses to help students cram for tests and get an
extra edge in class.

L. says stimulants are used to keep pace "in an age where everything has to
be done yesterday." But studies show that keeping pace by abusing pills can
come with serious consequences.

A March 2007 study by The National Center on Addiction and Substance Abuse
at Columbia University found that prescription drug abuse among college
students is on the rise and is a big reason why one in four full-time
college students in the U.S. meet the criteria for substance abuse or
dependence.

The study, "Wasting the Best and the Brightest: Substance Abuse at America's
Colleges and Universities," ties college students to a worldwide report
showing the major rise in prescription drug abuse across the globe.

According to the U.N.-affiliated Narcotics Control Board's 2006 annual
report, the abuse of prescription drugs will soon exceed the abuse of
illicit street drugs worldwide. The report says stimulant abuse is a major
reason why prescription drugs will soon surpass street narcotics in abuse
levels.

"[Adderall] is pretty much a street drug now," L. says.

If the effects of drugs like Adderall and Ritalin (an older ADHD
prescription stimulant) were just as L. described when he was first
introduced to the drug, few people could complain about their rampant abuse
on campuses across the country. Unfortunately, as L. would later find out,
these stimulants can come at a price much greater than the couple of dollars
it costs to purchase a single pill.

"[Adderall] takes away so much of your life," L. says. "I was so obsessed."

Although L. says he experienced many academic successes and a significant
boost in confidence throughout his first few months of taking Adderall, his
obsession eventually caught up with him. And it all started with his first
purchase.

The Buy

L. bought his first dosage of Adderall from a friend formerly enrolled at
Duquesne. His friend noticed L. becoming stressed with school and offered to
sell him some of the Adderall she was prescribed.

But before L. accepted the offer, he researched the drug to make sure he
would be safe. L. assured himself he would be OK if he stayed at a
consistently low dosage.

"I knew I would only need 20 mg (per day)," he says.

The 20 mg he planned on taking, however, was a pittance compared to the 180
mg three times per day his friend was prescribed. L. says his friend would
visit her doctor and complain that the drug wasn't affecting her enough. Her
doctor would then increase the dosage.

L. is amazed that a doctor would be so careless in prescribing such a potent
stimulant.

"From trying it, 180 mg three times per day just sounds ridiculous," he
says. "That could kill a small horse! The difference between this person's
reality and on the drug must have been insane."

Although prescribed a dangerous amount, L.'s friend was not taking all of
those pills by herself. That's where L. - the consumer - enters the picture.
And that's also where the illegality of the prescription drug business
begins.

Taking ADHD drugs without a prescription -- or dealing them -- is illegal.
The U.S. Drug Enforcement Administration classifies both Adderall and
Ritalin as controlled substances with a high potential for abuse. Therefore,
any illegitimate use of the drugs is taken seriously.

Still, the drugs are frequently dealt to students at universities across the
nation, including Duquesne.

According to a 2007 Columbia University study, the abuse of Adderall and
Ritalin on college campuses has risen 93 percent between 1993 and 2005.

L. says his friend can sell an entire prescription to about four or five
people in one month. Per 10 milligrams of immediate-release Adderall, it
costs L. just $1.

Immediate-release Adderall is much more desired among college students than
the traditional time-release drugs. L. says the convenience of the
immediate-release pills makes them much more attractive. Students studying
for an exam want to pop Adderall before heading to the library and feel the
effects of the drug right away. With the time-release, users do not feel
focused until hours later when studying is over and sleep is needed.

K., another Adderall abuser at Duquesne, says the time-release gives you a
constant feeling of focus once it eventually sets in, while the
immediate-release produces a quick "punch."
Unlike L., K. doesn't have to take to the streets to purchase her Adderall.
Her dealer is her doctor.

K., a sophomore, has had a prescription for Adderall for about nine months.
The problem is that she doesn't suffer from any problems that would require
the stimulant. But her doctor doesn't know that.

"I knew what I had to tell [my doctor] to get it," K. says.

K. had taken Adderall previously and liked its effects. That's when she
decided to approach her doctor and pretend she was an ADHD sufferer. She
says she tried to look distracted and inattentive in her doctor's presence,
two symptoms of the disorder. Her acting worked.

Robert A. Davis, M.D., of Dublin Medical Center near Philadelphia, worries
about the integrity of a doctor willing to prescribe such a large dosage of
a potentially addictive stimulant. He says doctors and pharmacists have a
great responsibility to prevent prescription drug abuse.

Davis says he sees a red flag whenever he has patients approach him saying
that they've tried a friend's prescription before and enjoyed its results.
He says if patients seem like they might be trying to manipulate him just to
use a drug recreationally, he will find a safe solution to the problem.

"I would not prescribe it or go with non-stimulant alternatives," he says.

One alternative is Stattera. Davis says Strattera is a non-stimulant therapy
for ADHD that "doesn't give an amphetamine high," and, therefore, is
generally not abused or sought after on the street.

There are no blood tests that can determine whether or not someone suffers
from ADHD, so it's up to the discretion of physicians to determine if a
patient truly needs the medication.

Typically, Davis says, physical exams are conducted by the doctor, or school
administrators recommend students to get a prescription for an ADHD drug.

Usually, K.'s doctor would involve her parents in the discussion about
getting Adderall, but she stressed to him that her parents did not know what
was going on with her since she was far away at school. Because of that, the
doctor took her word over her parents', she says.

K. says manipulating her doctor was not hard or rare. A lot of her friends
have influenced their doctors' decisions to prescribe them drugs, too, she
says.

A 90-day prescription generally costs K. about $30, but she is also privy to
the going price for Adderall on the street. According to her, fair prices
usually vary between 10 mg, 20 mg and 30 mg pills, and they resemble what L.
pays for his fix. A 10 mg pill is about $1; $5 can buy two 20 mg or a single
30 mg pill.

B., a sophomore Duquesne student who also abuses Adderall, estimates similar
street costs. He says prices for 20 mg or 30 mg pills range from $2 or $3 to
$5 or $6.

Whether prescribed by a doctor or purchased on the street, abusers don't
generally think prescription stimulants are as dangerous and addictive as
illicit narcotics. But once the buy turns into the high, some abusers begin
to realize why health professionals and higher education administrators
across the country are beginning to think taking these so-called "smart
drugs" might not be so intelligent after all.

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