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Slusarewicz ’23: In Adderall shortage, unprescribed use harms ADHD patients

My attention deficit hyperactivity disorder shapes many of my behaviors and thought processes on a daily basis. I often impulsively speak in class before raising my hand, become bored easily — even writing this column is difficult. But my experience is far less severe than those of many others.

Many of the people closest to me share the disorder. One in particular struggles to function without Adderall. They space out to the extent that they can have an entire conversation or sit through an entire lecture and retain nothing at all. On top of this, their antidepressants stop working without ADHD medication, making school practically impossible.

As a result of the ongoing Adderall shortage, I haven’t been able to navigate my life as I once had, but even worse is watching the desperation of my friends who rely on Adderall to function at all in their lives. Now that we’ve been forced to go without, the illicit use of Adderall by those without medical need for it feels disrespectful to those who do need it. 

Attention deficit hyperactivity disorder, which has seen a steady increase in diagnoses the past few decades, is a neurodevelopmental disability  characterized by symptoms such as executive dysfunction, emotional dysregulation, impaired working memory and motivation, hyperactivity and impulsiveness. Stimulant medications, such as Adderall, can offer immediate and sustainable relief from many of the symptoms of ADHD, enabling individuals to better navigate their work lives and interpersonal relationships. As a result of increased ADHD diagnoses, Adderall prescriptions jumped by 10.4% from 2020 to 2021, with 41.4 million prescriptions written for the drug in 2021.

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When prescribed correctly, stimulant medication is the most effective pharmaceutical treatment for symptoms of ADHD. Still, while Adderall has enormous value in the lives of certain individuals, its effectiveness for some has popularized the warped idea that Adderall can help all. It’s an especially potent idea at universities; Adderall is popularly considered “the study drug” and is one of the ADHD medications most abused by college students. Adderall floats around college campuses, understood as the perfect pill for anyone staying up all night studying for an exam or, say, writing a column (if only!). But in adults without ADHD, stimulant medications have a minimal effect on cognitive performance and instead result in a potentially addictive high. As Adderall remains scarce, we should reevaluate the ethical implications of a culture of non-prescription Adderall in academia.

For people with ADHD, medical treatment can be essential depending on the severity of their symptoms. People with ADHD are more likely to die young, largely from accidents. Drivers with ADHD are 42% to 47% more likely to be hospitalized or die due to car accidents than their counterparts without ADHD, one study found. However, that same study suggested that medical treatment for male ADHD drivers is associated with lower crash rates

Stimulant medication does far more than treat inattention in individuals with ADHD. Adults with ADHD are more likely to suffer from affective disorders, substance abuse problems and eating disorders. Fortunately, evidence suggests that treating ADHD with stimulant medication can ease the symptoms from some of these associated conditions, such as substance use disorders.

For college students with ADHD, one benefit of taking stimulant medications is particularly relevant: improved focus. This effect is central to Adderall’s appeal to students who don’t have ADHD. After all, if Adderall improves focus in people with ADHD, then it surely must create super focus in people without it!

However, while stimulants are irrefutably potent for staying up all night, the evidence for their effectiveness as cognitive enhancers is underwhelming when weighed against their risks. Psychosis, anger, paranoia, seizures and even death are possible consequences of using stimulants, especially when taken without a health professional’s guidance. Increases in Adderall-related emergency department visits have increased alongside nonmedical Adderall use in adults..

No doubt the perception of amphetamines as a one-stop shop for academic excellence could be attributed in part to the euphoric state the drug elicits. One study found that participants believed they performed better when they took an Adderall tablet than when they took a placebo, even though taking Adderall didn’t actually improve their cognitive performance. The reality is that neurotypical people benefit far less from Adderall than those who would ordinarily be prescribed the drug. 

Unfortunately, those who rely on Adderall to manage their ADHD are struggling to fill prescriptions. Summer worker shortages at Teva Pharmaceuticals, the top Adderall supplier in the U.S., in combination with high demand in recent years, means that Adderall is more difficult to get than ever. In October, Teva Pharmaceuticals officially announced a shortage of immediate-release Adderall two months after announcing delays filling orders. The Adderall shortage has proven especially catastrophic for those who have been using the medication for a long time, as they could experience rebound symptoms that last far past the initial withdrawal period.

During this shortage, it’s difficult not to resent those who take the medication without a prescription. By misusing Adderall, they squander a scarce medication that could otherwise be used by those who depend on it. Evidence shows that while ADHD medication improves cognitive performance in people with ADHD, they still underperform compared to their neurotypical peers. In other words, pharmaceutical intervention cannot fully compensate for the cognitive disabilities that arise from ADHD. Neurotypical people already have an advantage in chasing many definitions of success — when they draw from limited Adderall supplies, they just exacerbate that disparity. 

As someone with ADHD, it’s tempting to point the finger at neurotypical users of ADHD medication in the face of this stressful shortage. However, I sympathize with the choice of some students without ADHD to partake. Misusing Adderall in the hopes of improving academic performance points towards a fear of falling short. Adderall use has been shown to harm neurotypical users’ ratings of their own cognitive and self-regulation abilities prior to use. This outlook on performance could increase psychological dependence on unmedicated prescription amphetamine use and prove detrimental to self-confidence. It’s not fair to blame someone for wanting to be “successful” in a culture that constantly raises its standards for success. But it’s also not fair to take advantage of the medication that others need to perform basic functions. 

Megan Slusarewicz ’23 can be reached at megan_slusarewicz@brown.edu. Please send responses to this opinion to letters@browndailyherald.com and other op-eds to opinions@browndailyherald.com.

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