What you should know about the dangers of “study drugs”

By Brian McCormick

The misuse of drugs with a goal of enhancing performance has been common practice for decades. Among dancers, amphetamines used to be a problem because they were commonly used in diet pills. Dangerous quick-fix approaches—instead of regimen and nutrition—intersected with misguided body imagery and produced a perfect storm. We’ve learned a lot since the heyday of Dexatrim, but new threats to our health continue to crop up, often touted as a safe and simple way to ensure a competitive edge.

The truth, of course, is far more alarming. The latest drug family to fall into abuse, most commonly by college students, is neuroenhancers—drugs like Adderall, Ritalin, and Provigil. Non-medical terms like “brain boosters,” “study drugs,” “smart drugs,” and “cognitive enhancers” are used to market “off-label” (i.e., non-medical) usage of these prescription drugs. But they are extremely potent and potentially deadly medications, especially if used without a prescription or psychiatric guidance. And they’re alarmingly easy to obtain.

Although neuroenhancers don’t seem to be turning up frequently in dance studios (they’re most often used for pulling all-nighters), it’s important for school owners and dance teachers to be aware of this trend and able to recognize the behaviors and physical symptoms that could indicate abuse among their students.

Adderall and its use
Adderall is a central nervous system stimulant composed of mixed amphetamine salts used to treat narcolepsy and attention deficit hyperactivity disorder. ADHD is the most common diagnosis in child psychiatry (Psychiatric Times, September 1, 2008); an estimated 8 to 12 percent of children are affected worldwide (American Journal of Medical Genetics, January 7, 2009), and over a 10-year period, the number of preschoolers being prescribed the drugs tripled (Learning, November 20, 2004).

Misuse of “study drugs”
In recent years, Adderall, Ritalin, Pyritinol, Piracetam, Deprenyl (aka Juprenil), Modafinil (aka Provigil), Adrafinil, ephedrine, and other related stimulants have been widely adopted as self-prescribed study aids. College students in particular have taken to using these so-called neuroenhancers, not for recreational purposes but to help them stay up all night so they can write a paper or cram for a test. On some college campuses, Adderall is the third-easiest drug to get after alcohol and marijuana.

Many students think these drugs are harmless because they know someone who has taken the drug since childhood for ADHD. The University of Michigan Substance Abuse Research Center reported that in 2004, more than 4 percent of American undergraduates took prescription stimulants like Adderall for off-label purposes. According to an article in The New Yorker (“Brain Gain” by Margaret Talbot, April 27, 2009), other research has found rates as high as 35 percent: A 2002 study at a small college found that more than 35 percent of the students had used prescription stimulants nonmedically in the previous year.

A 2005 report from Partnership for a Drug Free America found that 1 in 10 teenagers had tried stimulants without a doctor’s prescription. While the role of rogue online pharmacies is hard to quantify, Joseph Califano, president of the National Center on Addiction and Substance Abuse at Columbia University, says they are a “significant” part of the problem. In a 2008 article in the Wall Street Journal, he says that’s in part because college students can get online orders sent to their mailboxes without parents’ knowledge. He adds that teenagers also get drugs out of their parents’ medicine cabinets.

Legal concerns
The terms “off-label” or “non-medical” use refer to uses of a drug that do not have the approval of either the drug’s manufacturer or the Food and Drug Administration. Cephalon, the maker of Provigil, was fined $40 million in 2008 for promoting off-label use of Provigil for non-sleep–disorder problems. Although the practice is not illegal, some doctors prescribe Adderall as a treatment for childhood obesity, even though no studies have been done for this off-label use.

Most students who report off-label use get the drugs from a friend who has a prescription. The pills are given away or sold for as little as $2 each. They are also easy to buy online: Adderall is one of the top-selling drugs on the Internet to people without a valid prescription. The Drug Enforcement Administration (DEA) says that a relatively small percentage of people get controlled drugs illegally over the Internet, but that they frequently get them in large quantities—100 to 120 pills at a time, compared to a handful from friends or pilfered from pill bottles at home. The DEA also believes these pharmacies are an “upstream” source of the drugs, meaning they sell them to individuals who then deal them to others.

Under federal law, it is illegal to possess a Schedule II drug without a prescription. The DEA classifies Adderall as a Substance II controlled substance—the same legal category as cocaine and heroin. But on dissidentvoice.org, writer Evelyn J. Pringle said that even certain medications not approved for use in the United States could be obtained online and shipped from overseas without intervention from customs.

The FDA warning on Adderall’s label notes that “amphetamines have a high potential for abuse” and can lead to dependence. No such warning comes with individual dosages purchased through gray markets.

How they work
Drugs like Adderall and Ritalin work, in part, by elevating the amount of dopamine in the brain, which helps to control hyperactivity and impulsive behavior and has been shown to be effective in the treatment of ADHD. Dopamine, however, has many functions in the brain, including important roles in behavior and cognition, voluntary movement, motivation and reward, sleep, mood, attention, and learning. The side effects make these kinds of drugs particularly dangerous if used without a prescription or psychiatric consultation.

Side effects
Drugs like Adderall can cause nervousness, headaches, sleeplessness, and decreased appetite (anorexia). Other common side effects can include weight loss, mood swings, nausea, dizziness, weakness, increased heart rate, confusion; chest pain, shortness of breath, depression, more outgoing or aggressive behavior than normal, agitation or restlessness, fainting, seizures, and uncontrolled movements of the head, neck, mouth, arms, or legs (tics).

After prolonged use, some people have shown a decreased ability to learn that takes a significant period of non-use to recover from.

Overdose symptoms
Overdose symptoms can include heightened reflexes, aggressiveness, high fever, irregular heartbeat, nausea, panic, rapid breathing, restlessness, convulsions, and vomiting. If you suspect an overdose, seek emergency treatment immediately.

Adderall has also been linked to death and cases of serious heart problems, including heart attack and stroke, as well as deaths by suicide, intentional overdose, drowning, heat stroke, and underlying disease.

The future
While a debate goes on about the inevitability of adopting such mental enhancements in an age of cosmetic surgery and bio-technological advancement, the drug pushers (the drug companies and some doctors) continue to sell only what they see as the upside to their product—euphoria, alertness, acuity. But every drug has an A effect and a B effect, which is the inverse of “the high.” Euphemistically referred to as “coming down” a more apt label, particularly in the case of Adderall, would be “the fall.”

According to the New Yorker article “Brain Gain,” although “study drugs” might increase productivity, they appear to stifle creativity—a good reason why they might not be popular among dancers. But awareness of common student behaviors is a good thing. Knowing what teens and college-age dancers might be using to boost their academic performance, and how to watch for symptoms, are two more ways teachers can act in their students’ best interests.

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