Is Adderall Lethal ?

 Considered a quick fix on campus, health officials are questioning the safety of the powerful prescription drug.

-Christain Falcone

As North America braces for the after-effects of Canada ’s removal of Adderall from its market, unsuspecting college students are still abusing the prescription drug at alarming rates. Healthcare professionals have become so concerned by students’ use of Adderall that its safety has come under serious scrutiny.

Adderall is primarily used to treat patients with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD), because it helps patients concentrate better. But Adderall also allows students without a prescription to focus, stay up late and cram.

 In 2002, one in five college students reported using Ritalin or Adderall without a prescription, according to a study. William Frankenberger, a psychology professor at the University of Wisconsin, said the similarities between cocaine and Adderall or Ritalin are much greater than the differences. Maureen Houck, director of the Health and Wellness Center at Hofstra University, said she considered Adderall “a big thing right now on college campuses.”

The most popular drug used to treat ADD and ADHD, Adderall is considered such a powerful amphetamine that Houck needs a special prescription to administer it. But many do not perceive the stimulant as risky because its use and abuse is so common.

 “Around finals week it was impossible to find,” said one Hofstra graduate student, who wished to remain anonymous. As an undergraduate she had taken Adderall a few times to cram for tests, and said it was prevalent on campus. She said Adderall sellers were actually prescribed the drug and would sell each pill for $5, sometimes increasing prices around finals week.

On occasion, Hofstra junior Kevin Kilroy had two friends who were prescribed Adderall give him pills for free. Kilroy said what set Adderall apart from other ADD/ADHD drugs was its availability on campus. He used Adderall several times to help his concentration for schoolwork and was amazed at how well the drug aided his clarity.

“It definitely works,” Kilroy, an honors student living in Liberty Hall, said. “I’ve written eight-page papers off the top of my head in under two hours using it.”

ADDERALL TAKES A HIT

On Feb. 9,  Adderall was dealt a catastrophic blow when Canada’s department of health pulled the drug from their market, citing the association of 20 sudden deaths and 12 strokes in patients taking recommended doses of Adderall and Adderall XR, an extended release form of the drug. Health Canada has asked manufacturers of other related stimulants approved for the treatment of ADD/ADHD to provide a thorough review of their worldwide
safety data.

According to a Health Canada advisory, the decision follows a thorough review of safety information provided by the manufacturer, which indicated 20 international reports of sudden death in patients, 14 of them children, taking either Adderall or Adderall XR. These deaths, along with 12 reports of strokes, were not associated with overuse, misuse or abuse. None of the reported deaths or strokes occurred in Canada.

Health Canada has never approved the sale of Adderall, the immediate release form, because the manufacturer never submitted the product for review, said Paul Duchesne, a spokesperson for Health Canada. Furthermore, Duchesne said labeling changes would not effectively caution individuals about instances of serious reactions to recommended doses.

Upon news of Canada’s decision, the Food and Drug Administration (FDA) chose not to suspend Adderall sales in the U.S. or change subsequent labeling. A Feb. 11 New York Times article reported the FDA could not handle another “drug safety crisis.” FDA Spokesperson Crystal Rice said their reviews showed no evidence to warrant removing the drug from the market or changing labeling information. Adderall manufacturer Shire Pharmaceuticals would not return repeated calls for comment.

According to an article in the San Francisco Gate, Dr. Robert Peterson, director general of the therapeutic products directorate at Health Canada, said that differing health regulations govern the differing responses of the two agencies.

“Canadian law allows regulators to suspend a drug’s sales while safety questions are investigated; U.S. law does not,” Peterson said.

THE RESULTS

Houck has seen a tremendous increase in students taking prescription medication, including ADD/ADHD drugs, and visits from students abusing the drug in her seven years at Hofstra.

“Open any magazine and you can find ten drug-related advertisements,” Houck said. “We have become a society that tends to use medication.”

According to the federal Drug Enforcement Administration (DEA), Adderall and Ritalin classify as Schedule II controlled substances, meaning they are considered legal. However, according to the Substance Abuse Act, such amphetamines have a high potential for abuse and severe psychological or physical dependence with side effects of depression, irritability, uneasiness and loss of appetite. Kilroy abandoned the drug because of such side effects. “I would get extremely nauseous when I took it,” he said. “I was told that it was due to not eating, but even when I ate it didn’t seem to matter.”

In a national study performed by the University of Michigan, researchers found that reported recreational prescription drug use was higher among students who were male, white and members of fraternities. Furthermore, recreational users were over 20 times more likely to report cocaine use in the past year. The highest rates of use among ADD drugs were on college campuses located in the Northeast. Researchers are encouraging colleges to ascertain the level of recreational prescription drug use at their own institutions. 

At Hofstra there is no policy dealing with prescription drug use, said Melissa Connolly, assistant vice president of University Relations. The Dean of Students’ office did not wish to comment on the subject, but Connolly said the school’s approach tends to be an educational one, offering classes, seminars and counseling services, as opposed to punishment.

“In the judicial code, the only recourse we have is when we have knowledge of pills being stolen from prescription users,” Connolly said. “This is because it’s difficult to take steps to correct the problem, to monitor the use of prescription drugs since they’re legal.”

“As for Adderall,” she continued, “I don’t have enough information on the subject to characterize it.”

However, Houck’s characterized the drug as, “extremely dangerous and potentially extremely harmful.”

“If you’re using prescription medications that weren’t prescribed for you, then you’re abusing,” she said. “That is why they are called prescription drugs. That is why there are special regulations on them because they can become heavily addictive.”

Dr. John Guthman, clinical psychologist and director of counseling services at the Saltzman Center, said the U.S. needs to look into the reasoning behind assigning Adderall for ADD/ADHD patients and whether it should be reconsidered.  

Houck points to Vioxx—an acute pain medication taken off the U.S. market as a result of unforeseen health complications—as an example of a drug gone wrong. Multi-million dollar lawsuits against its manufacturer, Merck & Co., are being pursued by former patients who were unaware of

the risks. Though the company faces stuis, Merck & Co. made over $2 billion in Vioxx sales annually.

In the U.S., drugs are already more difficult to get onto the market than in other countries, and when drugs are made available in other countries, they are usually still being researched here. Houckk said that in order for a drug to become available, it takes approximately seven years and $200 million. Of the drugs researched, she said, an extremely small percent actually make it to the market. So if the answer is stiffer regulations, “then the question becomes, ‘Is it worth it for any drug company to do research and development on a new drug when their chances are now even slimmer?’” she said.

Since arriving on the market to treat ADD, Adderall has grown in popularity, with more than 700,000 Americans using Adderall and Adderall XR. Shire sold $759 million of Adderall products in the U.S. last year and $10 million in Canada, according to figures from The New York Times.

What partially led to that surge was allowing drug companies to advertise directly to consumers—something that began less than ten years ago. Houck said it has put healthcare providers in a difficult position.

“Patients know their diagnosis and what medications they want because were being bombarded with advertisements,” she said. “So the problem becomes, are you going to satisfy your customer or are they going to go somewhere else?”

THE FUTURE OF CRAMMING

But the question remains whether the students who use Adderall to aid their study habits are in any immediate danger. Rice, the FDA spokesperson, said studies performed on each ADD drug show the benefit versus risk ratio to be similar across the board. This information contrasts with reports published by Health Canada. For its part, Duchesne said Health Canada is continuing discussions with the FDA to compare available information.

Leah Young, spokesperson for the Substance Abuse and Mental Health Administration of the FDA, said Adderall was used more so by the 18-25 age group than any other group identified in an FDA study. Resulting in a 0.3 percent of students in that group using the drug recreationally. And from 2000-2002 there has been a 113 percent increase in Adderall-related visits to emergency rooms for people over the age of six, culminating in 1,355 patients in 2002. This is a stark difference from 1997, when only nine patients were treated, said Young, who stressed that the increase is still considered stable.

Duchesne said Health Canada has advised any person that has taken Adderall to consult a physician as soon as possible and come up with another form of treatment. The anonymous graduate student said she took the drug because she saw so many people using it to accomplish school work.

“If I didn’t know so many people who took it, then I wouldn’t go looking or thinking about a drug to help me study,” she said. She now adopts a drug-free study approach, due to bouts of nausea, dizziness and blurred vision.

Houck said if Adderall can be a quick fix—for those cramming and struggling to get papers in on time, instead of studying and completing assignments in advance—then people are going to continue to use it. But she warns of the danger in that approach: “No one knows what goes on inside your body,” she said. “You could take a drug 100 times and not have a problem, but you could take it that next time and have a reaction with very serious consequences. You just never know.”