We hear a lot about opioid addiction and accidental opioid overdoses in the media. But there’s much less talk about the harm caused by stimulants such as Adderall, Ritalin, or Vyvanse. The scary (yet seldom discussed) truth, says Dr. Sujith Ramachandran, is that these drugs are widely overprescribed, often misused, and are frequently related to overdoses. In fact, stimulant overdose deaths have increased from just over 5,000 to over 15,000 between 2015 and 2019. That’s a huge number, so why is nobody talking about it?
“When we think about the epidemic of overdoses, we think of opioids first,” says Dr. Ramachandran, who is a featured guest on The Mayo Lab Podcast with David Magee, which serves as a single source of research-based guidance for parents, educators, and students. (Listen at https://themayolab.com and
A big part of the problem is the “Everybody has a little ADHD” culture, says Dr. Ramachandran. It’s very common today to blame normal levels of distraction on ADHD. But this is harmful to people who are misdiagnosed and prescribed a medication they don’t need, and it minimizes the problems of people who truly struggle with ADHD.
Regardless, when everyone assumes they have ADHD, and when well-intentioned doctors offer stimulant prescriptions, more people use stimulants, more stimulants are diverted or used in ways that are not medical, and more people will become addicted.
“Even without a prescription, young people can easily get their hands on Adderall and similar drugs,” says podcast host and student wellbeing activist David Magee, who travels the country talking to students about the risks of substance misuse and struggled with misuse of stimulants prior to recovery. “They can buy stimulants from friends or purchase counterfeit pills from suppliers. Some use these drugs for studying, but many others use them for partying because stimulants allow you to drink more alcohol or use more marijuana. Either way, the trend is disturbing, dangerous, and problematic on many levels.”
Read on for important insights about Adderall misuse and ADHD.
ADHD is widely misdiagnosed, which means Adderall is often overprescribed. ADHD is a very complex mental health condition and diagnosis requires an hours long assessment by a trained psychologist. Yet many healthcare providers offer prescriptions after a short consultation. So, when children and teens (or adults) get a prescription, it’s far less likely that those patients have ADHD or need Adderall or a similar medication.
Adderall is a powerful drug that needs to be taken responsibly (and only with a prescription). Because Adderall is overprescribed and often used recreationally, children and teens may think it is safe to misuse. But Adderall should only ever be taken with a prescription and when there is a legitimate need. Stimulants are powerful drugs (Adderall, in fact, is chemically very similar to the drug methamphetamine) that can become addictive if the patient misuses them or takes too high of a dose. They also can have a range of negative side effects like anxiety, appetite loss, and dizziness.
“When I visited a doctor because for the first time I couldn’t finish a writing deadline, I walked out with an Adderall prescription, which was the catalyst that turned my life upside down,” says Magee. “Looking back, I don’t believe I was really even a candidate for that medication. If this happened to me, how easily must it be for young people to be misdiagnosed and overmedicated?”
Just because you’re easily distracted doesn’t mean you have ADHD. It’s normal to have your attention wander, or to get lost in your social media newsfeed, or to lose your train of thought. In fact, modern life is so full of noise and distraction that it can be difficult for the most disciplined among us to concentrate. This can be annoying and at times difficult, but it’s still not on the level of ADHD, which is a serious and sometimes debilitating disorder.
When children can’t focus, they might just need more sleep. Magee points out that the symptoms of sleep deprivation can mimic the symptoms of ADHD. If your child or teen is experiencing symptoms such as forgetfulness, trouble focusing, and impulse control, they may be experiencing sleep disturbances. Talk to their doctor about their symptoms but also stay committed to helping them establish a healthy sleep schedule.
Counterfeit Adderall is particularly dangerous and deadly. Misusing Adderall is dangerous on its own, but it’s even more dangerous when children turn to the counterfeit market for fake pills. Today, this is more dangerous than ever because many counterfeit pills are now laced with fentanyl, a highly addictive and deadly drug, to keep buyers coming back for more. But when crude production gets the recipe wrong or when even a tiny clump of fentanyl makes its way into the pill, the results can be lethal.
Stimulants DON’T help if you don’t have ADHD. “When I tell students this, they are shocked because taking stimulants like Adderall feels great and can help them study and do well on their tests,” says Dr. Ramachandran. “But stimulants have been repeatedly shown to not have the same effects when a person doesn’t have ADHD. An empirical study on this was published in 2016 using college students, and they found that the GPAs of students who were not stimulant users did not change when the students went on to become stimulant users.”
One final insight: Our hyper-competitive, stressful culture of ambition can make stimulants seem like the key to success. Children and teens face a lot of pressure to get good grades, perform well in extracurricular activities, and get into college. Unfortunately, they often feel the need to cope in unhealthy ways—such as by using stimulants—and this needs to change.
It’s up to all of us to fight against stimulant misuse, says Dr. Ramachandran. Healthcare professionals should carefully assess anyone who believes they have ADHD to determine their diagnosis and whether medication is right for them. (Click here to learn about Dr. Ramachandran’s Subtle ADHD Malingering Screener instrument.) And educators, parents, and all of society should examine the cost of setting too high expectations for our children, teens, and young adult children.
“We need to let kids be kids sometimes,” concludes Dr. Ramachandran. “Expectations for our young people should not be so high that we must add medication or diagnose problems that should not have been diagnosed. When that’s happening, it’s time to change our expectations and reassess our priorities.”
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About Dr. Sujith Ramachandran:
Sujith Ramachandran, PhD, is an Assistant Professor of Pharmacy Administration and Assistant Director for the Center for Pharmaceutical Marketing & Management at the University of Mississippi School of Pharmacy. His research is aimed at improving inequities in health outcomes through work in the area of healthcare quality, and prescription drug use. He teaches doctoral courses on data management, patient-reported outcomes, and pharmacoepidemiology. His research has focused on novel applications of examining structural inequality using social determinants of health in outcomes resulting from maternal care, diabetes management, and vaccine hesitancy among older adults. He has served as a co-investigator on two NIDA awards investigating the safety of management of chronic non-cancer pain among older adults and has led the development of novel methods to identify and prevent non-medical use of prescription stimulants among college-enrolled young adults. He has also led critical work in the development of several quality measures, including serving as a co-chair for a national interdisciplinary workgroup that developed quality measures examining opioid prescribing. He has directed or co-directed 5 doctoral dissertation projects, 5 thesis projects, and served as a committee member on 18 other thesis/dissertation projects. He is a recipient of the American Association of Colleges of Pharmacy’s New Investigator Award as well as the University of Mississippi School of Pharmacy’s New Investigator Award. He has been involved in projects funded by the National Institutes of Drug Abuse, and other governmental, commercial, and non-profit organizations for his research.
About David Magee:
David Magee is the best-selling author of Things Have Changed: What Every Parent (and Educator) Should Know About the Student Mental Health and Substance Misuse Crisis and Dear William: A Father’s Memoir of Addiction, Recovery, Love, and Loss—a Publisher’s Weekly bestseller, named a Best Book of the South, and featured on CBS Mornings—and other nonfiction books. A changemaker in student and family mental health and substance misuse, he’s the creator and director of operations of the William Magee Institute for Student Wellbeing at the University of Mississippi and a frequent K–12 and university educational and motivational speaker, helping students and parents find and keep their joy. He hosts The Mayo Lab Podcast with David Magee, available at https://themayolab.com and on Apple and Spotify podcast platforms, a one-of-its-kind program for parents aimed at helping students and families find lasting wellbeing. He’s also a national recovery advisor for the Integrative Life Network. Learn more at www.daviddmagee.com.
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