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Dr. Ronald Ricker and Dr. Venus Nicolino

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Adderall: The Most Abused Prescription Drug in America.

Posted: 06/21/10 03:48 PM ET

Adderall is abused mostly by college students and young adults. Estimates are that somewhere between 20-30 percent of college students regularly abuse Adderall.

Adderall has the dubious distinction of being the latest addition to the rogue's gallery of lawful drugs that have made the transition to the black market. In recent years, abuse of Adderall and its imitators has increased by nearly 200 percent. Calling it an "upper" is like calling a hydrogen bomb a grenade. It is made of pure amphetamine, it's already picked up its share of street monikers: Speed, Beans, Black Beauties, Christmas Trees, and Double Trouble, amongst others.

What are the pluses in this wonder-drug? In ordinary people it often but not always offers increased concentration. It also keeps people awake for more studying and lots more partying. It often offers a sense of euphoria and happiness and a lot better and more frequent sex, all fun at parties.

Between the glut of pop-psychology theories (often fraudulent) and the never-ending blitz of promotion by Big Pharma, people now believe they can diagnose themselves with something like ADHD as easily as ascertaining if they have a head cold and believe they have the ability to determine the correct medication for their condition. Sometimes they're grandiosely right. Most of the time, however, they're wrong on both counts. Even more of the time, diagnosis is irrelevant. The relevant question is where's the "connection?" Sadly, that's where many of us physicians fit in. We certainly don't intend to, but often serve as the 'connection'. Then, of course, there are those 'patients' and doctors that inhabit the bottom of the barrel: lying 'patients' and immoral doctors. Scripts can and are sold, for lots of money. Never mind the human cost, there's money to be made and drugs to be copped. Take that prescription to the pharmacy. Or, take your money to a nearby local University. You'll pay $30 to $40 dollars per pill for a very small amount of Adderall, usually sold to you by a student. Sales are usually student to student although the numbers of genuine drug dealers are growing rapidly in numbers, bringing with them all the problems of low-life, criminal drug dealers. Dealers recognize good business opportunities. Imagining little Johnny, having just finished Geography 1A, dealing with a real dealer chills the mind.

Illicit Adderall is taken in many ways. Most obviously, a pill can be swallowed. Pills can also be chewed, ground up and snorted, and ground up and injected (the most dangerous way of administration, by far). And then there's 'Stuffing'. This is accomplished by 'stuffing' Adderall in any orifice with a mucous membrane (anus, vagina, penis, mouth, etc.). Shooting gets the most immediate and strongest effect. Snorting is second, chewing third, and stuffing fourth. What 'stuffing' lacks in immediate 'oomph' and the loss of whatever dignity the person may retain, is made up by the length of effect and allows for the greatest amount of Adderall to be used at one time. The anus and vagina are big places and can hold a great deal of Adderall.

Sadly, there's no free lunch.

1) Side effects are numerous. Some are minor, some serious, and some very serious. Most users have no clue as to negative side effects and usually don't care. Ignorance, we suppose, is bliss. The most important and most negative side-effect is the Overdose. Overdose with Adderall is nasty. Results include Cardiac and/or pulmonary arrest, death, severe and lasting mental effects/defects. Which one happens to you is a matter of chance. If you're in an Emergency Room and still alive your chances are relatively good. If you overdose at your apartment and are alone, the chance of your living is slim. If you Over Dose at a party, maybe a Frat Party, you've probably bought it. Drunken, high Frat boys are not known for their medical skills or even a modicum of clear thinking. Minor side effects include anxiety, and transient depression. More serious effects include heart palpitations, elevation of blood pressure, Tourette's syndrome, seizures, stroke, and psychotic episodes or plain old psychosis.

2) Adderall is very, very addictive. Along with the 'fun' of physical and psychological damage, this drug opens the awful Pandora's Box of addiction, with all its' sadness, pain and misery. Adderall not only opens this Box, but also resides within. It is a 'gateway' drug, often leading to other fun drugs like cocaine, heroin, E, etc.

3) The Law. The sale, possession and use of Adderall for illegitimate purposes is a felony. The Drug Enforcement Administration and police are getting better and better at catching end users. Jail, fines and a criminal record are doled out more and more frequently.

4) There are the "grown-up" ramifications, those real-life, practical consequences that aren't even on the radar of the average college kid. For example, life and health insurance: If one lies about a diagnosis, such as ADHD, they still have the diagnosis on their medical records. Health Insurance companies do not have a reputation for being the most empathetic or understanding of institutions, and that's not just towards those who are actually sick. "I have ADHD (lying or not), and I take Adderall" are very good, probably, certain reasons for turn down. Arrests usually aren't flattering criteria for getting a job. Anybody know about Google? Police records are as easy to find as Adderall on campus. More and more employers search prospective employees backgrounds.

Can one live without Adderall?

As far as the fun, this seems to come with the package (you're the package). There's already a place producing more than enough chemicals on its own to make you horny and rowdy: your own body. And, at least, those are free and legal.

The first six pack of 40's is on us.

 
 
 
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03:27 PM on 07/01/2010
Adderall is more widespread than you think. I'm a senior in college graduating in August 2010, and I can confidently say that 50% of the students at my university consume adderall. If you take a second to observe the students in an 8:00a.m accounting class, you will realize how many of these students are on a little magic upper pill! I know what to look for because I have been prescribed for over 3 years now, and I also know how easy it is to obtain a prescription from a doctor. What is the rationale for handing out a Schedule II controlled substance so easily? "Adderall can be beneficial to anyone, it will increase focus and improve memory, so why not?"

This is all true, and it is also true that amphetamines are highly addictive.

Adderall is a serious problem. I have friends who have three prescriptions, yet still have to buy off the black market. I also know of doctors who admittedly prescribe over 2000 students to adderall (this includes Adderall XR & Vyvanse). This means that one doctor alone sends 2000+ patients to the pharmacy each month to stock up on amphetamines. A handful of these people intend to sell.

Adderall is EXTREMELY addictive. I can't tell you how many times I have heard "I am going to lose my job if I don't find/get some adderall." Sometimes I wonder how drastically college drop out rates would increase if adderall completely disappeared one day.
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03:27 AM on 07/01/2010
Regarding diagnosis of ADD, it would be reckless to diagnose ADD after one patient interview unless the patient had evidence like a few years of school records. It's shoddy to just prescribe ADD medication without some kind of broad overview of a patient's history.
02:03 AM on 07/01/2010
I am a 34 year old that has been diagnosed with ADHD, I agree that Adderall as well as many other prescription drugs are often abused. I would like to mention that since taking Adderall my life has changed for the better. I am not a drug abuser or addicted by any means and have a prescription from my MD. This drug does not give me a high. I feel functionally productive at a normal level for the first time in my whole life.
I am a responsible adult who does not want Adderall to be demonized for fear that people that may benefit from this treatment will shy away from it.
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Ann Thurlow
09:34 AM on 06/27/2010
This problem will only continue to worsen, because many families face unrelenting pressure from schools to medicate their kids - against their own, considered judgment. The kids who are prescribed drugs they don't want are certain to meet up with kids who want the drugs (likelier to be higher-achieving) - the market's hand is all too visible. The entire system is rotten right now, and will remain so until people are willing to accept that a messy room or disappointing report card do not indicate a medical disorder.
12:57 AM on 06/24/2010
A couple of thoughts: first, you suggest that users/abusers of Adderall have dignity after
"stuffing", and that Frat boys sure wouldn't know what to do with an overdosed "Addy",( I like that term, feel free to use it, but just you). Curiously, though, as a doctor, at what point is Adderall not safe? And at what age does Adderall change from a medication that calms and controls to one that is like crack? And why in the hell would a parent ever want their child prescribed Adderall after reading this article? I'm just asking!
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
01:31 AM on 06/24/2010
Thanks for your comment. Adderall in small children is helpful. So a parent of a small child should have basically nothing to fear 1) if the diagnosis is correct and 2) there is careful monitoring of the drug itself and it's appropriateness and the amount required. None of these criteria bear any elements of the abuse of Adderall. The need to use Vyvance in young children is not necessary.
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Joe Berner
10:27 PM on 06/23/2010
A shame moral busybodies can make these choices for us. While amphetamine use usually is bad, some have benefited from it(Paul Erdos). I guess us pro-legalization people will always see it differently though.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
11:15 PM on 06/23/2010
Joe If you see morality, then I've confused you. I am a pro-legalization person myself. My problem with that is children. However, this is not a moral issue. Education. Legal and 'moral' approaches don't work. (see 'war on drugs') If I won't dispense a drug that I think harms people, then I won't. That's not 'morality', it's 'duty'. How does it go---"physician do no harm". Someone besides me will have to decide on amphetamine use being moral or legal. Meet the DSM 4 criteria for ADHD I'll write an appropriate stimulant drug and take the time to determine the correct dose. (did you know there are ten stimulant ADHD drugs that all work on the symptoms of ADHD as well as Adderall, but everyone wants Adderall. There's a hint there. Adderall appears to have an extra something that has nothing to do with ADHD or its treatment. Gives a reasonable idea why Adderall is so sought after. It, as well as Vyvanse has amphetamine. Vyvanse even has better quality amphetamine. It has a draw back, however. You can't snort it. Vyvance has to pass thru the liver to release its amphetamine. "Stuffing" doesn't work at all well either with Vyvance---same reason. But it works as well on ADHD as Aderall. I see a pattern here.
05:53 PM on 06/23/2010
I watched a wonderful, creative and generous friend lose their grip on life abusing adderoll. Its dangers are much under-rated and I think affects on mental health also need to be further researched. I graduated from college last year and it is rampant in one of the most prestigious academic colleges in the US. This article, as many have pointed out, is fairly polemical--but it is an issue that at this point will suffer from the cold rationalism of medical journals that have marginalized its ill effects for too long. Thanks for the call to action about patients and doctors patently operating under false pretenses. It makes me sick.
I try to blog about these and other kinds of issues us.reachout.com/blog. Any feedback from you would be much appreciated.
40ozmilkshake
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
08:55 PM on 06/23/2010
You raise many pertinent points. For whatever reason, the usually astute medical establishment has turned a blind eye on this problem. Screening of Physicians prescribing practices are done in a useless way. We have yet to see, although we may have missed them, any attempts to educate physicians about the risks they bring to their patients carelessly prescribing Adderall, knowing next to nothing about short or long term side effects, let alone side effects on bodily organs that can't even now be imagined. The story of your friend is sad, sadder yet in that he is the tip of the iceberg. Do you know anyone who was a long term speed or heroin addict. We do. A great many of them. Their resemblance to an ordinary human usually has long since departed. Ordinary values are gone. Minds obliterated. Standards permanently altered. Like you say,this is polemical. There are no alternative arguments. It, like you, makes us sick.
05:31 PM on 06/23/2010
This is certainly nothing new. Students have been taking Adderall as mental performance enhancers for years. What is more interesting is how these habits are graduating with them into the workforce... This new generation of young americans see Cognitive Energy Enhancers like Adderall as one of the keys to success (at school and work). There are also now products out there like PROFIDERALL that are positioned as over the counter, prescription free alternatives to Adderall. Either way, legally or illegally, the concept of people using drugs for mental performance enhancement is something that is not just prevalent... but only growing.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
08:25 PM on 06/23/2010
Thanks for the note. When we wrote this piece, we electively decided to focus on the drug itself in general and college kids in particular. The array of adults looking for Adderall Cognitive energy enhancers is great, as you say, and growing by leaps and bounds. Dr. Nicolino wrote a particularly insightful piece on this very topic. Space concerns and me are responsible for that part of the article not being present. "Health Food" stores are filled with the type of products you describe. Not that FDA control guarantees everything (ex. adderal), it certainly is better than nothing. Physicians, also not the answer to all problems, are a vastly better bet at determining side effects, brain damage, addiction than your average health food clerk or 7-11 cashier. If we can get around learning and living the old fashioned way, never mind what what such routes may cost us, many of us are willing. Adults, into this way of life, become addicted, physically and psychologically and who the hell knows what else will happen to them. Thanks again.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
03:02 PM on 06/23/2010
Earth to Ricker. I'm reasonably savvy about this topic, or so I thought. Back to NYU, 6 years ago, found out by me a few days ago. A well known way of spotting adderall snorters was that they had blue snot. Obviously NYU is just an example, made all the more important since is such a good school.
05:36 AM on 06/23/2010
I attend the University of Florida. Adderall is a big deal here, maybe it is because of the "miami" lifestyle drug culture predating several decades ago (Scarface). It seems like everyone does it here; with the exception of me of course. No matter what facet of the school you look towards, there seems to be an abundant supply adderall flowing out of it, from the nerds to the jocks. Sad, especially considering it hasn't been around that long to see the long term effects. Our generation is going to be messed up ;)
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
11:00 AM on 06/23/2010
Clockwork: Sorry to hear your story. Pretty much visit any college campus and you'll find the same issue. Like Joe, below, education may offer something. Educate students, obviously. Educate Physicians about Adderall---what a unique idea, since the vast majority have no idea what they're prescribing. Perhaps we should have bowls of Adderall, jnstead of candy, in our waiting rooms and lists of false statements to make to the all to easily influenced Physicians so that they will write Adderall prescriptions. Lists of 'easy' physicians are available everywhere. Read the list, learn the correct stories and score. Us physicians, in this area at least, are a pretty sad lot.
01:50 AM on 06/23/2010
I am unsure of the whole use of "low life drug dealers". Most are either College kids who have so many precriptions and never maintain their pill regiment or their friends who become the selling middleman in exchange for a cut of the proceeds as with Percocets or Ritalin, etc. Here you have a bunch of College kids that can not drink without being bothered but can still be deployed and die for the nation being innovative. We're trying to regulate bad human decisions instead of raising people who will be responsible enough to not shove pills in their anuses. History is replete with the failed laws that go this route. Precription or not, any drug will be abused by those who wish to abuse it, the real question should not be how to stop the abuse, but rather, what were they using before Adderall? I offer you exhibit A: Alcohol, whose symptoms are much easier to detect and prosecute. Allow the kids to drink responsibly, and teach responsiblility and ownership of action.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
10:45 AM on 06/23/2010
Joe: The whole point of this article is education. Put more succinctly, try to help kids know what they're getting into. Obviously the choice is theirs. Education, some think, does exactly what you suggest---it raises them, or at least some of them. You'd be amazed how many kids don't have a clue what Adderall is and possible effects, good and bad, it may have on them. Teach them.
12:04 AM on 06/23/2010
As a Canadian student who attended McGill University, I know first hand that Adderall has permeated the study culture in Canadian colleges. I am also currently on exchange in New Zealand and I was curious about whether or not study drugs were pervasive overseas so I wrote an article about in a student publication. It turns out that the abuse of prescription drugs for studying is becoming a trend in the land down underer as well. While conducting research for the article I was speaking to some students about Ritalin. Another student overheard me talking about the drug and approached me eagerly asking "Do you have Ritalin?". With exams looming it was pretty clear that he was hoping that I was selling the drug and not writing about it. Check out my article in Craccum Magazine the University of Auckland publication for a student's perspective on the drug: http://craccum.co.nz/?p=2218 .
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
12:29 AM on 06/23/2010
Thnx. I don't know the answer. We used to take 'Dexis' during finals to stay awake. I was talking to my daughter (NYU) 2004 and she said that Adderall was very common, mostly gotten from 'friendly' and naive MD's. As far as snorting, she said what was well known was 'purple snot', a sure sign that the snotter was snorting adderal. This 'snotting' was not intended for studying, but for 'fun
11:11 PM on 06/22/2010
Doesn't this bring us to the question of "why are drugs illegal?" Presumably it's because they ruin people's lives. But if students are taking Adderall once-in-a-while in order to perform better in school, does that merit the same concern as crack cocaine?

I think your best point is that a student caught with un-prescribed Adderall will have a criminal record. But here, you and the legal system are also mixing issues. Whatever concern we should have with the un-prescribed use by students is entirely different from the abuse of many types of pharmaceuticals, including Adderall, by junkies. It seems unlikely that individuals who insert 120 mg into their body cavities are only abusing Adderall,--they are abusing everything they can get their hands-on. It makes little sense to demonize Adderall as one element of that complex equation.

You also suggest that doctors are over-prescribing Adderall. Maybe this isn't because those doctors are incompetent drug peddlers, but perhaps they believe, as the Swedish study suggests, that the drug is effective and has modest side effects for normal people who use it under a doctor’s supervision. Doctors often prescribe birth control solely for the purpose of making women’s’ cycles more convenient. That is perfectly reasonable since the drug is effective and has few side effects. Reasonable minds can differ, but there is at least some evidence that Adderall is in the same category. .
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
12:41 AM on 06/23/2010
C'mon Loblaw---no one debates the use of Ritalin for ADHD adults. There is nothing in your reference that refers at all to illicit use of Adderal, let alone Ritalin. As far as Doctors go, you give way to much credit. Trust me, they don't have a clue as to any research by anyone. Like my daughter said, 'they (NYU students) would find Doctors who were lax at prescribing Adderal. You should go back to studying something else if you compare women's birth control pills pills to Adderal. I suppose you would compare anti-lymphoma drugs to Adderal. They do stop the 'natural' development of lymphoma. If you're in favor of Adderall, why don't you just come out from under your rock and say so. Adderal uber alles. Do you have any credentials at all, or just like to argue meaninglessly?
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
12:47 AM on 06/23/2010
Hi Loblaw Nothing much to say other than you have nothing of any value to say.
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Harry Moscatiello
Author/Writer, Stand-up Comedian, Actor
10:26 PM on 06/22/2010
Unfortunatly America is much more into drugs of all kinds, then anywhere else in the world. We live today in a Culture of Greed. The most important things in life, integrity and morality have no value in our society, We have many false solutions to our problems and drugs are one of them. Legal or Illegal drugs, there is an attempt to find some answer to life in a drug. I would say everyone would agree there is a value to truth. Truth and wisdom will make you fee. Drugs will not free you, but instead will make you feel free for a while, all while trapping you more.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
12:45 AM on 06/23/2010
Harry---not much to say. Your wisdom and excellent writing deserve nothing more than admiration.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
12:53 AM on 06/23/2010
Harry: I thought I had responded to you, but it may have gotten lost. "There is value in truth. Drugs will not make us free, but will make 'free' for a while, all the while trapping you more" Amen
05:48 PM on 06/22/2010
This over-wrought article goes against many studies, such as a very recent one from Sweden that showed the drug to be effective and "long-term side effects of the drugs appeared to be few and mild." (http://www.reuters.com/article/idUSTRE65E5P020100615).

Any drug can be abused. But this article assumes that people who take the drug, within prescribed limits, in consultation with their medical providers, are abusers, because there is no legitimate medical usage for this drug. And that is wrong.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
06:28 PM on 06/22/2010
Loblaw Read it again. We agree with you, as far as you go. All users are not abusers. Some are. You saying that our contention that there is no legitimate use for Adderall or amphetamines is just plain incorrect. The group we are addressing are often not legitimate users, do not follow prescribe medical limits, sell Adderal, and generally and often severely abuse it. Talk to college students. Find out what they think, Find out how they use Adderal and why. Then come back to us with 'research' that meets the actual, on the ground use. Nobody does that kind of research. Maybe you would. I certainly wouldn't. I'm going to post my comment since I'm computer illiterate and don't want to lose it. I will then go to the study you recommend and undoubtedly read about stuffing, injecting, snorting, taking 120 mg at a time, ER deaths, strokes from massive overdoses, etc. Such 'research' won't be there. Only an idiot would do it. Thanks for your comment.
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Ronald Ricker
Physician, Psychiatrist, Director, Linden Center
07:18 PM on 06/22/2010
Loblaw The article you cite couldn't be more off point if it tried. It is about adults who have ADHD, most carried from childhood. The researchers found that Ritalin (no amounts specified) is helpful for some of these adults. "Adults with ADHD are extremely susceptible to stress, forgetfulness and restlessness. They also have low self-esteem and are often emotionally unstable."Not that stimulant treatment helps with everything," she added, "but it usually makes life a bit easier for these adults.". The reseachers went so far as to telephone patients to make sure they had taken their Ritalin (form of Ritalin not specified). The researchers sound like thoughtful and intelligent people discovering what all of us already know. To wit, Ritalin helps with ADHD, both in children and adults. The relationship between Dr. Nicolino and my article to the article you cite is zero. We are writing about an entirely different subject.