Photo illustration by Natasha Ringnalda

Widely prescribed medications help some students to succeed, while leading others to excess

by Matias Grotewold ’13, Patty Huntley ’13 and Cassie Lowery ’13

Thirty minutes until the test. Pop a couple pills; 30 milligrams should be enough for the tunnel vision needed to make it through the four-hour SAT. A mere 200 points is all that stands between boom or bust, average or excellence, McDonald’s or Harvard. And those 200 points are possible in a pill. It’ll just be a one-time thing with a monumentally positive outcome. Definitely worth it, just this once. Test time.

It works; nothing is distracting. There is complete focus on the test at hand, on this one-time shot at success.

The tunnel vision meant to help people who suffer from Attention Deficit Hyperactivity Disorder keeps getting narrower, because here there is no ADHD—just test anxiety and a desire to excel.

After the test, the feeling that the pills helped you focus lingers, so trying again won’t hurt. A Spanish test. Putting the final touches on your Capstone paper as you work late into the night. And then it becomes an addiction because that’s the way it works.

Side Effects of Success

Peter*, a student at UAHS, was told he had ADHD in fifth grade and is one of millions of children in the United States diagnosed with the disorder. According to the Center for Disease Control and Prevention, nearly one in eight kids ages three to 17 have been diagnosed with ADHD. Peter, like many other students, received a prescription along with his diagnosis.

It was not until the seventh grade after his doctor tweaked his prescription several times that he finally switched to Adderall.

ADHD drugs such as Adderall and Vyvanse are amphetamines, stimulant prescription drugs that induce increased alertness, focus and less fatigue. These medications are most commonly prescribed for patients suffering from attention deficit disorders such as ADHD. ADD and ADHD are terms often used interchangeably. However, ADHD is the modern medical term used by the American Psychiatric Association.

Psychiatrists or doctors often prescribe ADHD medications to students who have trouble focusing. Senior Amy Henry said she experienced these problems when she started high school.

“I was diagnosed during the middle of freshman year,” Henry said. “I realized that I was having trouble staying focused and being on task with my homework.”

In Henry’s case, the testing process for the disorder lasted two days, with three hours of testing each day.

“[One of] my tasks was that [each] time [a] small white square moved out of a box I had to click a button,” she said. “When it wasn’t [moving outside of the box] I would just wait for the next one.”

This type of test is called a T.O.V.A. assessment (Test of Variables of Attention), and is an important determining factor in the testing process. Patients’ results are compared with results of those without ADHD in order to determine whether a significant difference exists between the two, indicating the presence of the disorder.

After her tests, Henry said she was diagnosed with ADHD and received a prescription for Vyvanse. Upon taking the medication, she experienced several negative side effects.

“There are side effects I don’t like,” Henry said. “I am very irritable towards other people and get annoyed easily. My appetite is almost gone and I find I lose and gain weight very quickly. If I take my medication too late, I have a hard time falling asleep at night.”

In addition to medical side effects, there are also side effects that have an adverse impact on her school work.

“There are times when I take my medication and start [doing] something else and get so concentrated on [whatever I’m working on] that I don’t get any homework done,” Henry said. “The medication only takes [you] so far.”

Senior Gabby Bongiorno has also been diagnosed with ADHD and takes medication to control her symptoms. Like Henry, she has experienced side effects from her medication.

“I was prescribed Vyvanse at first and tried it for a month, but I had some really bad side effects and ended up switching to a couple different medications until I finally switched to Focalin,” Bongiorno said. “I had to keep upping the dosage, which resulted in me having to have more medication to deal with my short temper.”

Along with a short temper, Bongiorno experienced headaches, trouble sleeping, anxiety and loss of appetite.

Dr. Sophia Kassem, a Child and Adolescent Psychiatry Fellow at Nationwide Children’s Hospital, said that even though these prescriptions can allow students without ADHD to have energy and focus to pull ‘all-nighters’ and be able to stay awake the next day, there are potentially dangerous side effects that can occur, such as depression, mood swings, cardiac arrhythmia or heart palpitations and psychotic symptoms.

Despite the side effects, Henry and Bongiorno are not alone in their diagnosis that resulted in their respective prescriptions. According to the Centers for Disease Control, over two thirds of students across the nation who are diagnosed with ADHD are prescribed a medication for their disorder.

Bongiorno recognizes the problem handing out so many prescriptions and the increasing trend in doctors to simply medicate their patients.

“ADHD is such a buzzword these days; everyone thinks they have it,” Bongiorno said. “There are some obvious signs—like for me it was excessive talking—but other symptoms like fidgeting and daydreaming are common among teens.”

Since these drugs are designed to help students focus, “recreational” purposes, such as staying more awake or getting high, are discovered and occasionally abused by students.

“I stay up for extended periods without sleep,” Peter said. “I could do my homework and be messed up at the same time.”

Addiction

According to the CDC, with amphetamines, as well as many other types of drugs, users begin to build up a tolerance, so what could start as a quick way to bump up test scores could soon turn into something more serious.

“After a while you have to change medication or [increase] your dosage,” Henry said. “I had to change from 50 milligrams [of Vyvanse] to 70 milligrams.”

Raising dosages became a quick and easy road toward recreational use for Peter.

“When my doctor raised my amount and I realized the different feelings, I began to get high,” he said.

Instead of reporting these symptoms to his doctor, Peter used this to his advantage. The increased dosage allowed him to stay productive while doing his school work, and at the same time experience a high.

“[While taking the drug] I am sped up and have a mild body high that is slightly euphoric,” Peter said. “It’s also compared to the illegal drug meth [because] it is highly addictive.”

Just like any other drug, Adderall and other ADHD medications can have dangerous side effects if they are misused. Bongiorno said it is important that only patients with prescriptions take the drugs due to the risks that come with abuse.

“I think [taking advantage of these medications] can be pretty dangerous,” Bongiorno said. “Prescriptions are designed to fit your needs, so if you’re taking someone else’s prescription you’re putting your whole body in jeopardy. These are serious drugs and they can do some intense things to your brain.”

Peter said he has experienced these side effects of abuse firsthand. After building up a tolerance for the drug, he began to need progressively higher doses in order to still get a high.

“I got hospitalized for three days for taking way too much–320 milligrams all at once. I threw up a lot, but didn’t go unconscious. They were extremely worried and kept monitoring my heart,” Peter said.

Despite the seriousness of these drugs, Peter said there is a limited amount of enforcement when it comes to ensuring that only those with prescriptions can get them. Peter added that the accessibility creates an increased likelihood that more students will end up abusing the medication as he has done.

Easy Access

As the number of students diagnosed with ADHD increases, so do the number of prescriptions. According to the CDC, one in every 10 children is diagnosed with an attention disorder. The CDC also showed that in the past decade, these cases have risen over 30 percent.

With more teens having legal access to these medications comes a greater chance of the drug getting into the wrong hands. Both Henry and Bongiorno have reported students approaching them looking to get a hold of part of their prescribed drugs.

Although both refused to illegally distribute their medications, Bongiorno added that there will always be a way to get the drug for those that want it.

Peter has also experienced the demand for the drug but he decided to illegally sell his prescription.

“I first started [selling Adderall] when I became a freshman… It wasn’t long before I was selling it to students every morning and making almost $100 a day, and close to $300 on exam days,” Peter said.

According to assistant principal Andrew Theado, illegal possession of amphetamines results in a 10-day suspension by school policy. However, the penalty for selling them is considerably more serious.

“[Selling amphetamines] is definitely more serious than just being [caught] in possession,” Theado said. “We would recommend for expulsion [in that case].”

Despite the school’s policy on substance abuse, Peter said students can easily obtain the drugs, either through illegal means by buying someone else’s prescription, or by having a doctor prescribe them.

“There are plenty of people who’ll fake symptoms of a disorder to get ahold of Adderall or substances that produce the same effect,” Peter said. “My friends have said obtaining a prescription is incredibly easy, and a lot of people will find out ahead of time from other people which doctors will prescribe it.”

According to Children’s Hospital’s Dr. Kassem, while obtaining an unnecessary prescription may be difficult for children, whose diagnoses usually depend on reports by teachers and parents, it becomes much easier for adults to report their own symptoms.

“Diagnosis of ADHD in adults usually relies on self-report, so they can potentially fake or exaggerate symptoms,” Kassem said.

Kassem emphasized that selling medications can have legal consequences, something that Theado also wanted to make clear.

“The number one issue when we’re dealing with a student [who is selling drugs] would not be the test score,” Theado said. “It’s the idea that they are in possession and using a controlled substance that is illegal.”

According to Peter, a fairly large market exists for these medications, motivating those with a prescription to sell despite the associated risks. He believes this is due largely because of the multiple uses the drug has, its appeal to a variety of students, and the large number of students who have prescriptions for the medication.

“It is already readily available to the student body illegally; if you’re trying to sell Adderall at the school, it is very easy to find buyers,” Peter said. “I wouldn’t say that everyone is doing it, but you definitely find that there are people out there who use Adderall but don’t use any other drugs or alcohol.”

The fact that normally conscientious students are abusing this medication separates this type of drug abuse from others. Rather than trying to get a high, these students are attempting to gain an educational advantage. This creates an additional concern as many students believe that by using amphetamines for improvement in school, it crosses over into cheating.

A Question of Fairness

While little debate exists over students taking these medications to help with their ADHD symptoms, people hold differing opinions on the seriousness of students taking these drugs illegally.

Senior Ellen Herd said she is strongly against the illegal use of ADHD drugs for students looking for a competitive advantage in standardized tests and other school-related assessments.

“In the case of a person not prescribed the drug, I would equate taking Adderall to a MLB player using steroids,” Herd said.

In a society where, as Herd believes, college can define a student’s future, the potential advantage can make the difference between a top-tier university and an average one.

“When I use Adderall, I can emphatically say that I have seen peak performance reflected in my grades,” Peter said. “[When] I don’t take my prescription, I don’t [care] about school and don’t work or study at all. School is much easier and [more] fun on [Adderall], and homework gets done quickly.”

Henry said she disagrees with this analysis as she puts in many hours on her school work in spite of taking medications.

“Vyvanse doesn’t make me smarter; it only helps me stay focused,” Henry said. “Even though I take Vyvanse, I still have to study longer and harder than the average high school student does.”

However, many see the illegal use of these drugs during standardized tests as indeed making the work easier and therefore cheating. In spite of this, questions from students seeking advice about whether to use Adderall on their SAT and ACT are frequent on online college forums, such as College Confidential. Many are unsure about whether the drug actually helps test scores or if it is just an unnecessary risk.

“While it is never technically ‘good’ to use drugs you aren’t prescribed, there are definitely people out there who use [them] in moderation to get a task done,” Peter said.

Bongiorno said taking ADHD drugs illegally is unwise; however, she doesn’t view it as cheating. “I don’t think it gives [students] an unfair advantage because the medication isn’t giving [them] the answers; it just helps [them] focus,” Bongiorno said. “The classes I take require a lot of attention, and before, I couldn’t focus long enough in class to learn anything. Now I can actually learn and be successful in school.”

Henry disagreed with this. She recognizes the necessity of the drug for students with ADHD; however, using the drug when not prescribed by a doctor is just a way to put less effort into academics.

“In a way, it’s unfair if a person who isn’t prescribed takes medication because they really don’t need it, and it’s sort of just taking the easy way out. The person doesn’t need to have medication to do well; they just don’t want to try as hard,” Henry said. “In my case, I usually end up needing to still work just as hard or maybe even harder than a person who doesn’t need to take medication. I’d much rather be the person who doesn’t need to take it and be able to concentrate on my own.”

As a doctor, Kassem called for more care to be taken with the diagnoses of ADHD.

“I think there needs to be some healthy skepticism in diagnosing college or graduate students who have never had issues with academic performance in the past and may be seeking a diagnosis of ADHD to obtain stimulants for enhancing academic performance,” Kassem said.

Although ADHD drugs are illegal when taken without a prescription, the allure of better test scores through a readily available drug is massive, according to Peter, who said a wide range of students come to him.

Unfortunately, Herd said this problem cannot be solved by doing something as easy as giving out fewer prescriptions. The root of the problem needs to be addressed before progress can be made.

“Changing the way prescriptions are given will not help the overall problem if students are still motivated to cheat. It is up to our education system to create a system where students do not feel compelled to seek the drug in the first place,” Herd said.

In UA, Herd sees this as a growing issue because of the high academic standards set for students and the availability of the drugs because of students’ economic situation.

“In an affluent district like UA where many students can both afford the drugs and are academically motivated, the academic climate [could] heat up very quickly. If the drug were legal I could see how it would become very tempting,” Herd said. “It may prove hard to keep up without use of the drug.”

The point of contention comes in the form of providing a “level-playing field,” for all students. While bills such as the No Child Left Behind Act allot funds depending on the economic level of students at the school, prescription pills such as these tend to be reserved for those who can afford them.

“This brings up an issue of ethics beyond our own district,” Herd said. “What about districts outside of UA? How do we maintain a ‘level playing field’ so to speak, when some students can afford the medication and others cannot? This would widen the already disproportionate gap in test scores between affluent suburban districts and urban and rural districts.”

However, as it is not legal, Herd remains adamantly against the illegal use of these prescription drugs because of the academic difficulties it presents to students not using the drug illegally, but also to students who need prescriptions.

“When you use a drug like [Adderall] without a prescription to cheat on a test, you are indirectly harming those who depend on the drug for everyday purposes by discrediting its purpose and making it harder to obtain,” Herd said.

A Frustrating Dilemma

With admission requirements on a steep upwards incline and scholarships at an all-time premium, the appeal of an easily accessible grade-improvement drug is growing, as is seen on online college forums.

As the June 9, 2012 article titled “Risky Rise of the Good-Grade Pill” by Alan Schwarz in The New York Times noted, “Some students who would rather not take the drugs [are] compelled to because of the competition over class rank and colleges’ interest.”

As long as types of amphetamines are available for students who have a medical necessity, Herd said that there will always be someone willing to abuse them. This can be discouraging for students like Herd who are trying to compete with others who are not following the same rules.

“It is frustrating because you always want to compete at the highest level you can,” Herd said. “Even when you experience failure there is some comfort in knowing you have control over the situation.

“But then what do you do when you see yourself falling behind and you know it has nothing to do with your knowledge or work ethic?” she said. “It can be painful to see others being rewarded for what you view as the wrong decision.”