Staying Informed: Prescription Stimulants

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)