Dangerous Side Effects of Adderall

Ashley Taylor  

Research in Allied Health

Doug Masini

April 15, 2007

Abstract

            ADHD is a very common diagnosis among children in today’s society.  Often children are prescribed Adderall, a combination of dextroamphetamine and amphetamine.  This drug is classified as Schedule II controlled substances, a classification given to medical drugs with the highest abuse potential and dependence profile.   I see this to be very problematic due to dependency and abuse of this drug as well as the dangerous and unknown side effects.  There is a big problem in college students using this drug as a ‘study drug’.  The review of literature notes several incidents of this type of abuse. 

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition related, in part, to the brain's chemistry and anatomy. ADHD manifests itself as a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs more frequently and more severely than is typically observed in people at comparable levels of development.

These symptoms must occur for at least six months and have been present since before age 7.  ADHD begins in childhood and can persist into adulthood as well. While some children outgrow ADHD, about 60% continue to have symptoms into adulthood.

Adderall, which is a combination of dextroamphetamine and amphetamine, is a prescription stimulant used to treat adults and children over the age of six with ADHD and narcolepsy. According to the ADD ADHD help center (no authors name noted) dextroamphetamines are classified as Schedule II controlled substances, a classification given to medical drugs with the highest abuse potential and dependence profile.

Approved by the FDA in 1996, Adderall was the second drug to be approved to treat ADHD.  Shire Pharmaceuticals Group Plc is the manufacturer of Adderall. Millions of people have taken this drug, with and without a prescription.  “Adderall and other prescription amphetamines, such as Ritalin, have become such a crutch for many college students that they believe that only through these drugs will they be able to deal with the pressures of academic life. Students who begin to take these drugs, and who often become addicts, are often surprisingly unaware of the many negative side effects they may have.” Marrer 2004.

The abuse of Adderall can lead to marked tolerance, higher than necessary dosages and addiction. The majority of Adderall abuse cases cited are among adults; however, case studies also prove adolescent abuse as well.  Long-term uses of amphetamines have been linked to abnormalities in brain development, similar to those found with long-term cocaine use.

                                   Problem Statement 

The abuse of the ADHD medication Adderall offers side-effects not normally known to the consuming public.

Review of Literature

Does the abuse of the ADHD medication Adderall offer side-effects not normally known to consuming public?  According to Wikipedia, Adderall is a pharmaceutical stimulant amphetamine (a combination of dextroamphetamine and amphetamine) used to treat attention deficit disorder and narcolepsy.  According to the online ADD/ADHD help center, Adderall is classified as a schedule II controlled substance, a classification only given to medical drugs with the highest abuse potential and dependent profile. 

According to Wheeler (2007) “Stimulants like Adderall are believed to act on two chemicals in the brain, norepinephrine and dopamine. The use of stimulants in people with ADHD is specifically aimed at creating a normal balance of these chemicals. In people without ADHD, the result of Adderall is abnormal, fluctuating highs and lows in these levels. Abusers ought to note that vast amounts of depression research link low norepinephrine and dopamine levels to depression and fatigue and known side effects of taking dosages too large for one's physique or in conjunction with contraindicated medications are serious heart problems and lethal seizures.”  

The ADD/ADHD help center also gives the following side effects of abusing Adderall: 1. Amphetamine (Dexedrine, Adderall) abuse produce behavioral and psychological effects similar to cocaine.  The side effects of Adderall abuse include marked aggression and irritability, hyperactivity, and personality changes.  2. Abruptly stopping Adderall after prolonged high dosage Adderall abuse results in extreme fatigue and mental depression. The most severe, though rare, Adderall side effects of Adderall abuse is psychosis. This Adderall abuse side effect is often clinically indistinguishable from schizophrenia. And 3. Long-term methylphenidate and amphetamine use has also been linked to abnormalities in brain development, similar to those found with long-term cocaine use. Changes on the sleep EEG are also noted with Adderall abuse.  I feel that these are extremely dangerous side effects.  I also do not think that people are made aware of these side effects.  According to Kondro, (2005) Adderall, a central nervous stimulant used in treating attention-deficit hyperactivity disorder (ADHD), was taken off the market in February after manufacturer Shire Biochem Inc. disclosed 20 sudden deaths and 12 strokes worldwide among patients taking the drug, or its one-a-day formulation Adderall XR (the only version sold in Canada). The committee concluded that it is "biologically plausible" that there is an increased risk of adverse events from using any stimulants to treat ADHD. But, in light of the uncertainties, it recommended Adderall be reinstated on the market as long as a revised label cautioned against the drug's use by patients with structural heart abnormalities.  

This case study, according to Stone (2005), lets us see addiction from the eyes of a parent; Dan Johnson, for one, is trying everything he can to keep his smart, energetic son, Christian, now 8, off "the stuff," as he calls it.   Christian has struggled at school and at home. After he was expelled from school, he was diagnosed with ADHD and meds were recommended. Johnson, a business and church consultant in Chicago, reluctantly agreed to allow Christian, then 5, to try a prescribed stimulant. His behavior improved, but Johnson, who says he grew up seeing how illicit drugs affected some of his close family members, remained skeptical. So when Christian cried out one day in class that he couldn't be a good boy without his medication, his dad discontinued the drug and switched him to an herbal supplement. Though tolerable, Christian's behavior was less consistent after the change.  I agree that medication though helpful is addictive.  I think it is important for children not to depend on any type of drug, helpful or not. 

    Robert A. Herman believes as quoted by The Chronicle of Higher Education 2004 that “taking stimulants in high doses—as college students do when studying—can cause them paranoia and hallucinations, increase the heart rate and even bring on a heart attack”.

It is amazing to me how many people misuse this drug.  Although it has very beneficial results when used appropriately, it has so many side effects that are very dangerous.  To me I think that using Adderall as a ‘study drug’ to enhance their focus and brain performance is not in any way different from athletes using steroids to enhance their performance at a sport.  Merrer (2004) explains that a student quoted during an interview that when he is on Adderall “(He) feels bulletproof and taking the meds is no different than slurping down a triple shot of high octane coffee…. (and that he feels) if a friend had it prescribed it can’t be harmful.”  These are very dangerous assumptions.  People do not know enough about this drug to make appropriate decisions regarding the use of it.  They do not understand that chemicals react differently among different people, and also can counter react with other existing medications that they are taking.  It is not safe to take unsupervised and unregulated. 

            Levine (2006) explained that “In a society that values high grade point average and thinks that everything, from hair loss to erectile dysfunction, can be fixed by swallowing a pill, many healthy college students nationwide rely on ADHD medication, like Adderall, to get better grades.” 

          Levine then goes on to say that “For those with ADHD, Adderall keeps them calm, but for the average student, it provides razor-sharp attention, greater focus and stronger short term memory.”  To me this sounds like a performance enhancing drug, like steroids with athletes. 

         I think that doctors should look into prescribing similar nonaddicting medications when considering the proper way to treat their patients with ADHD.  According to Schlozman, drugs like Adderall and Methylphenidate seem to “offer a modern Devil's bargain: your child's happiness, comfort and success in exchange for potentially dangerous side effects and an unpredictable future for his or her developing brain. Many parents accept the bargain, knowing their children's maladies are real and potentially disabling. Yet the same parents suffer fresh anxiety every time a new alarm rings.

 According to Shillington, Reed, Lange, Clapp, and Henry (2006) who conducted a study designed to examine the risks and protective factors associated with Adderall use among a college sample in Southern California.  The study indicated that 11.2% of students reported past year and over 4% past 30 day use of Adderall.  Being a college student myself, I am surprised the numbers aren’t higher than that.  Even when I was in high school, kids used to crush it up on their desktop and snorting it right in the middle of the classroom.  It really seemed like the more people than not, were using this drug.  This use of Adderall has really “swept the nation”.

The literature notes several case studies relating to college students abusing the “study drug”.  Herman (2004) explained that a student “(He) read 100 pages of his textbook in 3 hours, a task that normally would have taken him much longer.  And the information stuck in his head: he got a 92 on the exam”.  As noted by Margaret Marrer a student said “Desperate times call for desperate measures.  Adderall gives me focus when I study by helping me concentrate” The student also claimed that he generally swallows the pill but “for a quick fix you crush it up and stuff it up your nose.”  I agree that this is becoming a problem.  It seems that more and more people are depending on this drug for mind enhancement.    

The study indicated that 11.2% of students reported past year and over 4% past 30 day use of Adderall.  Being a college student myself, I am surprised the numbers aren’t higher than that.  Even when I was in high school, kids used to crush it up on their desktop and snorting it right in the middle of the classroom.  It really seemed like the more people than not, were using this drug.  This use of Adderall has really ‘swept the nation’.   I personally know of people that take this drug and stay up all night studying.  It is a scary thought that the students today are doing this. 

Method

I conducted a placebo-controlled crossover study to compare the effects of various dosing frequencies of methylphenidate and Adderall.  When determining how to conduct my study, I followed the work of Pelham and his colleges according to Huffman.  Once my study design and parameters were approved by the ETSU IRB, I explained to all of the participants as well as their parents, the risks that may be involved in this study and received consent from each one.  I have followed all measures of patient confidentiality as stated in the HIPPA guidelines.  There are no additional serious risks associated to my patients as all of them had no medicinal contraindications to the use of stimulant mediations.  With that in mind the IRB deemed this study as well as my methods and scale of measure acceptable. My study enrolled children diagnosed with ADHD who were participating in a summer treatment program at James H. Quillen College of Medicine at East Tennessee State University. Out of subpopulation of 22 children, 19 boys and 2 girls, 72% of the children were currently on stimulant medication before I conducted the study.  During the 8 week study participants were crossed over to receive the following:  {1.} placebo three times daily {2.} 0.3 mg per kilogram of methylphenidate three times daily {3.}0.3 mg per kilogram of methylphenidate twice per day plus an additional 0.15 mg/kg in the afternoon {4.} 0.3 mg/kg of methylphenidate once daily {5.} 0.3 mg/kg of Adderall twice daily {6.} 0.3 mg/kg of Adderall once daily plus an additional 0.15 mg/kg of Adderall in the afternoon {7.} 0.3 mg/kg of Adderall once daily.  Each child received a total of 3 pills each day, so a placebo was given in times that active medication was not.  I had the children take part in academic classes and several various activities during the day.  I assessed their behavior with daily report cards.  Each week we conducted group meetings with the parents and taught them behavior techniques.  Children given the placebo had much worse ratings from the teachers versus the 3 drug group; children with twice daily does of either drug had similar grades to one another.  There were significant differences noted from the academic standpoint in ones receiving placebo versus actual medication.  Side effects were not severe and included loss of appetite and sleep delay.  This research also proved no considerable differences in the twice daily methylphenidate and the once daily Adderall as far as academics were concerned. Since this article told no scale of measure, I concluded from its findings that since this contained nominal data, I was able to compare the data using the Spearman rho method when ranking effectiveness.   This study showed the internal validity of these drugs with the treatment of ADHD.  A limitation to this study was that I had to choose children with ADHD, making it hard to randomly select the participants. 

Conclusion

            The dangerous side effects of Adderall need to be known by anyone who consumes it.  A lot of the problems with Adderall abuse and dependency could probably be solved if people knew what they were at risk for.  Ignorance is bliss, but not when it comes to a drug that can lead to your death.  People need to be educated on this subject.  College students need to quit taking this drug to study, and do it the old fashioned way.  This is way more dangerous than people think. 

References

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