It's the day before a final. You haven't opened a textbook in weeks and your class attendance is spotty, but it's too late to drop the class. The pressure to do well is immense, but your stress and anxiety are keeping you from studying effectively. Good thing there's a pill for that.
Prescription drugs have helped ameliorate the symptoms of various medical conditions, such as attention deficit disorder (ADD), depression and chronic pain. The widespread availability of these drugs, however, has also led to an increase in prescription drug abuse.
In recent years, a growing number of students have begun to abuse prescription medications such as Adderall, Concerta and Vivance. According to the National Institute of Drug Abuse, a branch of the National Institute of Health, these stimulant medications — typically those used to treat individuals with ADD — are among the most abused class of prescription drugs.
Many college students who use stimulant medications without a prescription do so to help them concentrate better.
One Tufts sophomore, who requested anonymity, admitted to using a stimulant without a prescription at times when she has to spend long hours completing schoolwork.
"I take it to study for tests mostly. It mellows me out and makes me not notice distractions. I just sit down and focus. It takes away my personality," she said.
All sources quoted anonymously in this article requested anonymity because they did not want to be publicly associated with illegal activity.
A junior said that he takes a stimulant drug when he feels stressed. "[I take it] whenever I have class or when I need to study a lot. I take it because it focuses my thoughts and makes me feel driven to work," the junior said.
Supervising Staff Psychiatrist at Health Service Nandini Talwar explained that stimulants are prescribed to ADD patients because they release a chemical that is produced in insufficient quantities in the brains of sufferers of the disorder.
"Stimulants are diagnosed for attention deficit disorder to increase the amount of dopamine the brain produces," Talwar said. "The theory is that someone with ADD isn't producing enough dopamine in certain parts in their brain, and the medication makes up for this, especially in the frontal lobe of the brain, where tasks of concentration, learning, focus, organization are centered."
However, stimulants do what they are programmed to do, regardless of the chemical makeup of the patient's brain — they will release dopamine even in brains that are not chemically imbalanced.
"For someone who doesn't have a deficiency, it still results in a rise in dopamine, which can improve someone's ability to hyper−focus, which is why they are tempting drugs to use," Talwar said.
In addition to granting the ability to hyper−focus, ADD drugs mimic the side effects of other stimulants, many of which are dangerous, Talwar said.
"It's like taking a version of cocaine. These are very highly abusable medicines," she said. "They increase heart rate, blood pressure and can lead to cardiac issues. It is also an appetite suppressant and can cause people to not eat and the problems that ensue."
In the long term, the drugs also have the potential to cause cerebral atrophy and dependency.
"In a person who has ADD, the stimulant is working to correct a deficiency," Talwar said. "In a non−ADD brain with adequate amounts of dopamine, excess chemicals can produce [these] side effects."
Unsurprisingly, student requests for stimulant medications spike before midterms and finals, Talwar said.
"With the numbers of requests coming in and recognizing this as a problem on a national level, we decided we needed to take more vigilant measures about accuracy of diagnoses," she said. "We have a lot of measures in place to make sure that we are not over−prescribing. We require that anyone who has been diagnosed with ADD and prescribed stimulant medication … provide us with comprehensive psychiatrist evaluation — not from a pediatrician or a family doctor."
Julie Ross, the director of mental health services, explained that Health Service tries to crack down on ADD prescription drug abuse — even students with existing prescriptions cannot receive refills through Health Service, and students who think they may have ADD are required to undergo a psychiatric evaluation and a clinical diagnosis. To a certain degree, the stringent process has worked, she said.
"The bottom line is, because … we work on a university campus, it's harder to get stimulant medication here than it is for other prescribers in the community," she said. "We have this obligation because we know that this is an issue in colleges and universities."
Focusing on schoolwork is not the only reason why students abuse attention−enhancing stimulants, though. One female junior explained that she enjoys using the drug in conjunction with other drugs, such as alcohol, because it alters their respective effects.
"I feel like the combination leads to a much more controlled drunk. I'm much more focused and less sloppy," she said. "It's helpful for day drinking or when I am planning to drink for a long period of time. It helps control my drinking, almost."
Ross explained that the ability to focus while intoxicated that results from the use of stimulants is not a reflection of a decrease in the physical effects of alcohol consumption.
"Students find that stimulants help them stay awake and alert while still being intoxicated, but what's happening in their body is not ameliorated by the stimulant," she said. "They don't feel as intoxicated if they are using a stimulant at the same time, but their blood alcohol levels are rising at the same rate."
There are certain dangers that accompany consuming alcohol and prescription drugs together, Talwar said, since alcohol's effects are not lessened but rather just not felt as intensely.
"[The combination] gives people a false sense of alertness, which is dangerous because you are more intoxicated than you realize you are," she said. "It gives you a false sense of ability to attend to things such as driving that could be potentially dangerous. The effects of alcohol on your brain and central nervous system are the same, even though you feel more alert."
But despite its potential hazards, students are willing to buy — and sell — prescription medication illegally.
One anonymous female student said that she buys Adderall pills from various students on campus, though never from her friends. According to several sources, $5 is the standard price for one pill at Tufts, and its effects last for an average of four to eight hours.
"[I buy Adderall for] $5 a pill from people I don't typically know," she said.
Another student, who has a prescription for a stimulant, said that he gives away some of his medication for free and often sells it to other students.
"It's usually only friends that ask, and not many people approach me," he said. "It sells for $5 a pill."
One student who recently acquired a prescription for Adderall said that as soon as word got out about her diagnosis, she was immediately approached by numerous friends and acquaintances who asked her for drugs.
"It was very uncomfortable," she said. "It was hard to say no to my friends, but I need [the medication]. I don't want to give it away."
While prescription medications may seem less harmful than street drugs, the penalties for distributing them at Tufts are severe. Dean of Student Affairs Bruce Reitman admitted that prescription drug abuse is an increasing problem, both nationally and at Tufts.
"Judicial Affairs has taken serious action against many students for distribution of illegal or unprescribed medications," he said. "Whether it's for exam purposes, or writing paper purposes or playing a good game — it's illegal at any time to be distributing those or to be taking them at any time if you are not prescribed. Selling Adderall is the distribution of drugs — it's not the distribution of illegal drugs, but if you do not have a prescription, it backs into being illegal. The school views this as being a dealer, and you will be expelled."
Reitman added that since the distribution of prescription drugs violates federal law, students who do so could potentially be arrested.
Most reported cases of this type have been handed over to Judicial Affairs, a department under the Division of Student Affairs that handles judicial disciplinary action, according to Veronica Carter, judicial affairs officer.
"We had a case last year where a person had lots of different drugs and pills," she said. "The police may have entered a student's room for a different reason, such as marijuana, but they find the pills there."
Both Carter and Reitman cited a case last year in which a student called the Tufts University Police Department after noticing a large amount of foot traffic into her apartment. The investigation revealed that one of her housemates had been dealing drugs out of their home.
The two administrators clarified that while the Division of Student Affairs deals with the distribution and abuse of prescription drugs attained illegally, it does not take disciplinary action against students who abuse their own prescriptions.
"That's a medical issue," Reitman said. "We would view that as a student in crisis and refer them to Health Service."
Tufts officials attributed the spike in stimulant abuse to various social factors on campus and beyond.
"I think there's been a lot of discussion about these drugs for study enhancement. Given the pressure to succeed, people feel as though they need an extra edge to be competent and successful," Talwar said.
Ross explained that since the drugs are legal, students don't feel like they can get into trouble for taking them.
"There's a false sense of safety if you're taking these stimulant medications," Ross said.
Reitman said that the increasing availability of these medications also makes them much more tempting.
"There are many more people in these years, as opposed to 10 years ago, whose physicians prescribe these medications," he said. "The prevalence of them being prescribed, even for borderline diagnoses, means there are a lot of pills out there. The second this happens, this means lots of students get pills illegally."
