Add it up

The speed-freak coed has long been an established archetype in the social stratification of college campuses, right up there alongside white kids with dreads and Pabst-swilling hipsters. Wide-eyed, jittery and acutely productive, you can spot them in libraries during midterms and finals, with their books, laptops and pill bottles shuffling, tapping and clinking in concert.

The rise of speed on college campuses across the country has been well-documented in recent years, and its popularity is evident in countless studies. Its appeal is undeniable; hell, we wouldn't have Kerouac's On the Road without it. After all, who needs coffee or sleep when you've got crystal meth sprinkled on your Wheaties?

Recently, however, one brand of Schedule II amphetamine has become the overachiever's drug o' choice. It's not necessarily an illicit party favor, but rather an FDA-approved med for which many students have legitimate prescriptions. Prescribed for treatment of Attention Deficit Hyperactivity Disorder (ADHD), Adderall is a dextroamphetamine combination stimulant that increases alertness and concentration. Labels on methylphenidate-based ADHD drugs such as Ritalin and Concerta promise the same. So, yeah, it's far cleaner than street meth. 

Online pharmaceutical company Medco Health Solutions reports the number of young adults ingesting these meds more than doubled between 2000 and 2004, and spending on ADHD drugs more than tripled in that time. Sure, Adderall and similar stimulants help ADHD sufferers in everyday life, and have become commonplace and widely stigma-free due to pharmaceutical company PR and positive effects, but the flooded marketplace means higher recreational availability, notably among textbook-toting college kids who exploit its benefits for academic success — or the notion of academic success.

Non-script Adderall users say its benefits — increased alertness and concentration — give an edge when cramming for exams and pulling all-nighters, both quintessential college experiences.

University of Michigan student Robert Vine admits to using Adderall without a prescription. He recently editorialized in Consider, U-M's opinion magazine, that "those ingesting Adderall have a leg up on everyone not doing so, no question about it." The question is: does non-prescribed use qualify as cheating? "As long as the university or other institutions don't see it that way, we might as well take advantage while we can," Vine surmises.

A 2005 national study of undergrads at four-year colleges by researcher S.E. McCabe found that nearly 7 percent of students had used next-gen speed, about 3 percent more than the preceding year. The same study showed that male students, sorority girls, frat boys, students at highly selective colleges, and non-commuter (residential) students all had higher rates of pill-popping.

A Babcock and Byrne study traces nonmedical methylphenidate (Ritalin) use back to 2000, reporting that more than one in five students 23 and younger at a public liberal arts college in Massachusetts had tried Ritalin, compared with the 1 in 50 students with legitimate prescriptions. Here in southeastern Michigan, a 2009 internal study revealed that 9 percent of U-M Wolverines had previously downed such pills, a figure that has risen in the last three years.

If Adderall is the fix-all wonder drug for many students, what about the 93 percent of surveyed learners who didn't take stimulants in McCabe's 2005 study? Taking the opposite stance in the Consider debate, another U-M student addresses the moral implications of using Adderall.

"Non-using students might find themselves in an unhealthy bind," writes Danielle Foley, co-writer of the Consider piece, especially when they need to keep themselves competitive. "Artificial aids are merely crutches," she writes, but notes their use is "unfair" to students who prefer organic learning experiences. 

While Adderall brings increased productivity, higher quality work isn't guaranteed. Ben Rubin, Ph.D., a Williams College professor of classics, says he has spotted a few stimulant-induced papers, and says they may contain "long, rambling digressions ... pages spent analyzing minute details which had little bearing on the overall argument.

"My job is to make my students life-long learners," Rubin continues. "Using these sorts of drugs inhibits that process."

But what if you fail? 

"Honestly," Rubin says, "it is a mark of maturity to fail sometimes, as long as it helps you recognize your personal and professional limits. Using stimulants to complete your work can rob you of that revelation."

A local medical student, who requests anonymity, crammed for a pharmacology exam on Adderall. He passed. "It helps you study, but do you retain a lot of it? No. It just gets the job done," he says.

But the desire to stay up all night isn't rooted in academics: Students have jobs, clubs, volunteering and parties, of course. The McCabe study says speed use is higher among students whose grade-point average is B or lower. While Adderall won't promise straight A's, it could help students juggle "having it all."

Michael Klein, Ph.D., pharmacologist and the FDA's controlled substance staff director, points out that the benefits of pharmaceutical speed don't always outweigh the risks. 

"When a person misuses or abuses a prescription drug, there is no medical oversight of the risks. ... Prescription stimulants," for example, "can lead to dangerous increases in blood pressure." Read the fine print on the Adderall label: "Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events." Ouch.

Then again, to students who are young and invincible with brain cells to spare, what's a minor health risk? In the realm of college indulgences, prescription drugs place a distant third in the ranking of campus chemical concerns, falling in order behind booze and weed, says Mary Jo Desprez, alcohol and drug policy and prevention administrator at U-M. But though the side effects of drugs like Adderall are generally mild, Desprez cautions against the long-term effects of prolonged use. 

When making the grade becomes the all-important goal, Desprez recommends a holistic consideration of student health: "We need to expand our definition of success and focus on graduating students with life skills."

The rise of illegal pharmaceuticals creates new disciplinary issues. Last year, language was added to the U-M Safety Manual to address and outline consequences for students selling or found possessing drugs without a doctor' note.

There are plenty who say the Adderall phenomenon is hardly surprising in contemporary pill-happy America, where any problem can be solved with the right legal dosage, and where self-preservation can mean self-medication with booze, smokes, speed, heroin and whatever. Truth is, doctors and scientists discover amazing new drug therapies daily, and each new medicine will likely be misused.

But what qualifies as misuse? Dr. Klein writes that's "when a person takes a drug not prescribed to him or her," but also "when a person takes a legal prescription medication for a purpose other than the reason it was prescribed." But if students take Adderall for concentration purposes, does it change the conversation from drug misuse to life enhancement?

University of Pennsylvania neurologist Anjan Chatterjee, MD, poses the same question. In his 2004 paper: "If one purpose of medicine is to improve the quality of life of individuals who happen to be sick, then should medical knowledge be applied to those who happen to be healthy?" He coins the term "cosmetic neurology" to describe the use of neurological drugs to enhance life for the healthy rather than provide therapy for an illness.

He quotes professor Francis Fukuyama to effectively summarize the anti-cosmetic approach: "The original purpose of medicine is to heal the sick, not turn healthy people into gods." Chatterjee says the rise in popularity of drugs that increase cognitive function is neither "good" nor "bad" in any simple sense, but too evident and too complex to dismiss without careful consideration.

The neurologist shares Klein's obvious concern for safety when students veer off-label, but he also outlines ethical concerns about character and individuality. 

"Chemically changing the brain threatens our notion of personhood," he writes, and a conventional "no pain, no gain belief" condemns the idea of "getting a boost without doing the work." 

Then there's an issue of distributive justice, Chatterjee says. Who has access to enhancement drugs? While Adderall and others can often be bummed off friends with prescriptions or snagged at a relatively low cost-per-pill, that's still likely too much for a kid struggling to afford textbooks. Will "the rich, in addition to becoming richer, become stronger, smarter and hopefully sweeter than the rest," he wonders?

There's also the issue of the compulsion to take the drug in order to compete on the same playing field as students who do take them and are more productive. 

Given all these ethical concerns, Chatterjee still argues that the continued rise of "cosmetic neuro-enhancers" is inevitable, given the relatively unrestrained market and high demand for them. 

College is extraordinarily demanding. Students, their parents, and those who work with them understand the challenges students face. Every semester, students ask themselves the same questions: How is it possible to take a full course load, build a résumé, have a social life, and become a grown-up, all at the same time? Such demands rarely wane, but only give way to the demands of work, family and financial obligations.

The best a student can do is prepare for the obstacles ahead. The lessons, failures and sacrifices made in college can be ugly. How you choose to deal with them or arm yourself against them is entirely your own gig.

Sallyann Price is a Metro Times editorial intern. Send comments to [email protected]