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Adderall, a stimulant medication often prescribed to treat attention deficit hyperactivity disorder, has been misused as a “study drug” on college campuses for years. Students with a legitimate prescription have been known to sell their pills for as little as $5 apiece to classmates looking to sharpen their focus or stay up late to finish schoolwork. During the pandemic, however, Adderall misuse among college students declined, though some experts remain concerned—especially because alcohol and cannabis use are on the rise.
According to the latest Monitoring the Future study, the University of Michigan’s annual report tracking substance use among adults, nonmedical use of amphetamines—which includes ADHD medications such as Adderall—reached a 10-year low among college students in 2020. The study, which has been tracking substance use among college students since 1980, found that the share of 19- to 22-year-olds reporting nonmedical use of a stimulant medication declined to 6.5 percent in 2020, down 3.2 percentage points since 2015. Additionally, while college students over the past decade have been more likely to misuse amphetamines than their non-college-going peers, the gap closed in 2020, with 6 percent of the noncollege cohort reporting past-year use, the study found.
Diana Zuckerman, president of the National Center for Health Research, said the decline likely stemmed from the fact that many college students returned home during the pandemic and attended classes remotely or not at all. Some were less likely to misuse Adderall at home because they didn’t want their parents to know, she said, or because they had a harder time obtaining the drug off campus. Zuckerman also noted that because students partied less during the pandemic, they may have felt less need to use Adderall to power through assignments or stay up late studying.
“If students were at home, and they weren’t partying late at night and exhausted the next day—because there was a pandemic, and they were living at home—they’d be getting more sleep, potentially, and there’d be less need for that last-minute studying,” Zuckerman said. “That’s so common when you’re on campus.”
Sean Esteban McCabe, professor and director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan, said that despite the decline in 2020, Adderall remains the most misused prescription medication among U.S. college students.
“Our team is currently examining the impact of the pandemic on drug use patterns among U.S. students, because we know the pandemic had a major impact on drug use, misuse, recovery and treatment throughout U.S. communities,” McCabe said. “Adderall and other prescription stimulant misuse should remain on our radar, because these medications have not seen the same kind of declines in misuse as prescription opioids.”
The Monitoring the Future study panel surveyed 1,550 college-aged adults between March 20 and Nov. 30, 2020. Funded by the National Institute on Drug Abuse and conducted by scientists at the University of Michigan’s Institute for Social Research in Ann Arbor, the study found that in 2020, 10 percent of college men reported Adderall misuse compared with 5.4 percent of college women. McCabe said the fact that one in 10 college men reported Adderall misuse remains a concern.
Charles Smith, an addiction specialist who serves as the medical director at Recovery First Treatment Center in Florida, said that the reasons for Adderall misuse among college students have remained consistent over time. Students with an Adderall prescription sell pills to make money, he said, and their peers buy the pills to enhance their concentration while studying. According to an article from the George Washington University student newspaper, The GW Hatchet, one junior made $2,000 selling 10-milligram Adderall pills for $5 and 25 milligrams for $8.
Smith said students also sometimes use the drug to lose weight or enhance their experience at weekend parties and other social events. In addition to Adderall, students seek amphetamines like Dexedrine and Vyvanse, as well as methylphenidates such as Ritalin and Concerta, which are central-nervous-system stimulants prescribed for ADHD and narcolepsy and tend to have a milder effect, he said.
“Adderall is a stimulant that shares many similarities with methamphetamine, including its highly addictive nature,” Smith said. “When taken illicitly, it alters dopamine levels much in the same way any other illicit substance does, like cocaine or heroin.”
Smith urged caution when looking at studies about college student drug use—including the Monitoring the Future study, which historically has been conducted in person but moved online during the pandemic. That could certainly impact the responses, Smith said. In fact, the Substance Abuse and Mental Health Services Administration issued a statement saying that the findings from the 2020 Monitoring the Future study should not be directly compared to previous years’.
Smith also warned against evaluating the Monitoring the Future data in a vacuum, without considering other factors impacting student well-being. He pointed to a study from Frontiers in Psychology, a peer-reviewed journal, which found that students reported significant levels of uncertainty about their academic futures, stress and difficulty coping mentally and emotionally with COVID-19. That could push more students to turn to Adderall, he said.
“[The pandemic] put many students at risk for academic stress,” Smith said. “If we know that a significant reason for Adderall misuse is for academic purposes, it is not outside the realm of possibility to contemplate that Adderall use is at least persisting due to the many obstacles causing college students academic stress.”
Marijuana Use Up
The Monitoring the Future study found that in contrast to the drop in Adderall use, marijuana consumption reached a historic high among 19- to 22-year-old full-time college students in 2020. Those who reported using marijuana daily—defined as on 20 or more occasions in the past 30 days—increased 3.3 percentage since 2015, to 7.9 percent.
That could bode ill for stimulant misuse; according to a study by the University of Georgia, students who reported frequent marijuana use or binge drinking were eight times more likely to have misused prescription stimulants such as Adderall. Study author Ash Warnock, a doctoral student at UGA’s College of Public Health, said his findings challenged the stereotype that Adderall misuse is reserved for ambitious high achievers.
“A lot of my research has shown that this Adderall use seems to really be tied to other kinds of drug use, and especially heavy drinking,” Warnock said. “These students are already using drugs and alcohol to facilitate social situations. And so it would make sense that they would use another type of drug to maybe enhance their academic performance.”
The study, which was published in the Journal of American College Health, surveyed 604 college-aged students at two large universities in the southeastern U.S. One in five students reported ever having used a prescription stimulant, including those who did and didn’t have a prescription, and 8.9 percent reported using stimulants in the past 30 days. For Warnock, Adderall misuse is still a concern, especially among college students who attend “party schools,” or institutions that have a reputation for heavy alcohol and drug use.
“I think that especially any kind of drug use that has negative consequences on your physical health is worthy of being a concern on college campuses,” Warnock said. “But what I think the college campuses really need to focus on is the additive effects of poly-drug use. So not just, ‘Are these students maybe using Adderall?’ but they’re also engaging in heavy drinking over the weekend, or engaging in other heavy use of other types of drugs.”
Zuckerman said the pandemic has made it harder for some institutions to address drug misuse.
“These kinds of efforts to reduce drug abuse have a tendency to get a little weaker when there’s a lot else going on that’s keeping administrators and health professionals very busy and often very stressed out,” Zuckerman said.
She said institutions should always be on the lookout for the next hot drug to capture student interest.
“In terms of what students will do, there’s always a new thing, and there’s always the rumors that ‘This is the new drug’ and ‘This is the better drug,’” Zuckerman said. “There’s often no data at all at the beginning, and then eventually, there’s some data, but you have to actually read it to find out about it. It’s like any other sales pitch—students are being told something, often by people who have a financial interest in selling it to them.”
Awareness of Adderall misuse is growing, among medical professionals and students alike. Over the past decade, some doctors have gotten in trouble for overprescribing Adderall. The Vermont Board of Medical Practice issued a $2,500 fine against a family physician in 2019 for overprescribing Adderall without “properly documenting” the treatment and mandated the physician attend medical training courses, VT Digger reported. Reports of student injuries and deaths from Adderall abuse also serve as a warning; in 2018, for example, a Texas A&M first-year student died of a seizure after snorting Adderall.
Smith said students have also become more aware of the dangers of misusing drugs because of the large increase in opioid overdose deaths. According to the Centers for Disease Control and Prevention, there were an estimated 75,673 opioid overdose deaths in the U.S. from April 2020 to April 2021, up from 56,064 the year before.
“There is the hope that these alarming numbers in conjunction with the proliferation of fentanyl in almost all aspects of society will cause young adults and college students to rethink their use of any medication that was not specifically prescribed to them from a medical professional,” Smith said.