Staying Informed:
Prescription Stimulants
and College Students
By Andrew Nickel
“Staying Informed”
is an impartial review of the scientific knowledge and realities of
drug-related issues that college students are likely to face. It
neither promotes or opposes the use of any substances; its purpose is
to provide relevant information and facts for students to use to
educate themselves, free from any political, cultural, or moral bias.
Any editorial statements are labeled as such. The following is
written in the context of what is reasonably likely for college
students to be exposed to; rare or impertinent information has been
intentionally omitted.
Stay safe, stay
healthy, and stay informed!
The stress of college often
leads students to seek ways to increase their academic performance in
a variety of ways. Legal stimulants such as caffeine have long been
the staple of late night studying, early morning wake-ups, and exam
preparation. However, other, more powerful chemicals such as
amphetamine and methamphetamine (known as “speed”) have been used
by some students since the 1960's to prolong wakefulness and a
feeling of alertness.
In recent decades,
prescription CNS stimulants, used for the treatment of A.D.H.D., have
become the most commonly used illegal stimulants on campuses across
the country. The high availability of these medications is due to the
large number of A.D.H.D. diagnoses in the past two decades, as well
as the relative ease of 'faking' A.D.H.D. symptoms to fool doctors
into giving a person a prescription. Among college students, 16-35%
report having used stimulants illegally, while 4% of students report
having a legal prescription.
Stimulants encompass a
broad range of chemicals which act to increase Central Nervous System
(CNS) activity, as well as some other bodily systems. In general, CNS
stimulants (also called psychostimulants) have several risks for
improper use, such as the potential for chemical and psychological
addiction/dependence, tolerance buildup over long term use, and they
can also be unpleasant, dangerous, or even fatal in high doses or in
people with cardiovascular issues.
Amphetamine and
methylphenidate are the most common types of medicinal CNS stimulants
that you are likely to encounter on a college campus, both of which
are most commonly ingested in on of two ways.
Modes of
Ingestion
Oral – The
method of ingestion intended for medicinal stimulants, it is also the
most common. Swallowing, or 'popping', stimulant pills typically has
an initially delayed but steadier onset as it is slowly absorbed
through digestion in either the stomach or (for “prodrugs”) other
bodily systems. It also has a longer effective duration of effect
compared to other methods.
Insufflation
(nasal, “snorted”) - Insufflation of stimulants is done by
crushing a pill into powder and then inhaling it into the nasal
cavity. The medicine is absorbed through the mucous membranes inside
the nasal cavity. It is considered “misuse” or “abuse” to
ingest pills this way, even for the prescription holder, because
snorting pills carries several medical risks.
Risks: Snorting can
introduce pathogens into the sinuses, which can cause infections or
transmission of disease in very rare cases. It can cause physical
damage to the tissue inside the nasal passage as well as eroding the
septum; these effects can cause nosebleeds or even lead to the
collapse of the nasal structure. The largest risk, however, is that
snorting often leads to a craving to snort more shortly after the
first snort, leading to a heightened risk for addiction.
Why people snort:
Snorting has a much faster rate of onset (for some stimulants the
onset is nearly immediate) compared to taking stimulants orally.
Because of this, the stimulant effects are much more intense (a
“peak”), but last for a shorter time period, after which the
intensity of the peak causes a more pronounced feeling of “crash”
or “come down” (which is why there is a risk of craving more).
Types of
Common Medicinal CNS Stimulants
Amphetamine
– Adderall (a mixture of 4 types of amphetamine salts), Dexedrine
(dextroamphetamine), Vyvanse (an amphetamine prodrug)
Methylphenidate
– Ritalin, Concerta (an abuse-resistant formula)
Overview
– Medicinal psychostimulants are controlled substances, legal only
by prescription. They create their stimulant effects by triggering
the release of serotonin (amphetamine only), dopamine, and
norepinephrine in the brain, in addition to partially blocking these
neurotransmitters from being broken down or reabsorbed. They are
metabolized in the liver, then excreted through the kidneys via
urine. Amphetamine is detectably present in urine for up to 3 days,
while methylphenidate is detectable for up to 2 days. Some common
medications can cause false positive drug tests for amphetamine, such
as Wellbutrin (bupropion), pseudoephedrine (found in some cold
medicines), certain tricyclic antidepressants such as desipramine,
and some weight-loss medications. The maximum prescribed daily dosage
of amphetamine and methylphenidate is 60mg. The average half-life of
amphetamine is 12 hours, which makes it the longest lasting commonly
prescribed CNS stimulant (compared to methylphenidate which has a 3
hour average half-life).
Primary
Effects –
Increases:
alertness, focus, euphoria, motor functioning, blood pressure, heart
rate, subjective sense of “energy”, subjective sense of
“confidence”
Decreases:
fatigue, appetite,
Side
Effects – insomnia, headache, stomach issues, weight loss,
dizziness
Overdose
Effects – Initial overdose effects include: decreased alertness
and focus, dysphoria (“I'm not happy but I don't know why”),
rapid heartbeat, diarrhea, shaking/tremor, increased urination, lack
of appetite, agitation/irritability, and hypomania (which can include
uncharacteristic sociability, rapid and excited speech,
uncharacteristically hyper or flamboyant activity, and racing mind).
Acute overdose produces hyperthermia (overheating), racing heart,
extreme tension, hallucinations, psychosis, ending with seizures,
stroke, or heart attack.
Addiction
and Withdrawal Characteristics – Long term Amphetamine use, or
insufflation of methylphenidate can develop into a chemical
dependency and/or psychological dependency. Withdrawal from a
chemical dependence on stimulants is typically marked by lethargic
apathy and depression, whereas psychological dependence involves
feeling incomplete or inadequate without access to the drug.
Health
Risks – People with structural heart abnormalities or
cardiovascular disease (often unknown to them) are at risk of sudden
death when taking medicinal psychostimulants. People with epilepsy
are at a higher risk for seizures when taking methylphenidate.
Contraindications
– MAOI's can be extremely dangerous in conjunction with amphetamine
or methylphenidate.
Abuse-Resistant
Forms – Concerta is a newer methylphenidate pill designed to be
difficult for a person to abuse. It is made of different layers of
methylphenidate variants that have different rates of digestion.
Additionally, the pill itself is hardened, making it extremely
difficult to crush for insufflation.
Vyvanse,
on the other hand, is an amphetamine prodrug. A prodrug is resistant
to abuse because the chemical in the pill is not a stimulant, instead
it is a chemical that becomes the intended drug after being digested
in the body (Vyvanse itself is fully transformed into amphetamine in
the bloodstream).
Notes
– Amphetamine or methylphenidate are often used in conjunction with
alcohol, to enhance euphoria, prolong a night of drinking, or to
counteract the sedative effects of alcohol. These drugs stimulate the
central nervous system, while alcohol depresses it (opposite
effects). When taken with alcohol, these substances lead a person to
feel that they are much less drunk than they are, because the typical
'drunk' effects of alcohol are counteracted, such as motor skills,
speech, and feeling tired. This can cause people to drink to a toxic
level, or even drive (thinking that since they feel
sober, they must be safe to drive). However, the subjective feelings
of sobriety mask the reality that the amount of alcohol in your
body is no different than it would be without psychostimulants. You
are still just as drunk as you would be, whether you feel drunk or
not. Alcohol with methylphenidate can increase the level of
methylphenidate in the blood, increasing all risks associated with
the drug.
Final
Word
These
stimulants can be attractive to many students who feel overstressed
or have a lot of work to do in too short a time period. However,
while enough psychostimulants can keep you awake for several days
straight, remember that the brain requires sleep in order to stay in
peak performance, and also that you will eventually pay the price for
any chemically induced alterations to your sleep patterns. A two-day
study spree (two days and one all-nighter) will result in low
performance ability over time, and will greatly disrupt your sleeping
patterns for several days. In essence, staying up to write a
last-minute paper could result in sleeping through your upcoming
exam.
If
you suspect that you or a friend has overdosed on psychostimulants,
call emergency services immediately. Immediate care involves keeping
the overdosed person calm, and applying cold, damp rags or towels if
they feel hot.
Whatever
you choose to do, stay informed, and keep your head.
Sources
DeSantis,
A. D., & Hane, A. C. (2010). “Adderall is Definitely Not a
Drug”: Justifications for the Illegal Use of ADHD Stimulants.
Substance Use and Misuse, 45, 31-46.
Special
thanks to Medscape, a division of WebMD (2011), in conjunction with
Reuters Health Information (2011)
