One day during the midst of the pandemic, Mia Harris opened her laptop and logged into her scheduled Zoom consultation with a doctor. She had been struggling to maintain basic levels of attention and hoped to come away with some sort of verification of the symptoms she had been experiencing, ideally in the form of a diagnosis.<\/p>\n\n\n\n
Instead, she was offered drugs.<\/p>\n\n\n\n
\u201cI essentially logged on to Zoom and proceeded to tell her I thought I had ADHD,\u201d said Harris, now a senior at the University of Southern California. \u201cInstead of asking me why I thought that, or running any diagnostic tests, she just proceeded to ask me if I wanted normal Adderall or Adderall XR.\u201d<\/p>\n\n\n\n
Adderall, the stimulant Harris was prescribed, is one of the most common forms of ADHD (Attention Deficit Hyperactivity Disorder) medication. Along with other forms of prescription stimulants, and in large part amphetamines, it has become increasingly prevalent in recent years, barring a recent shortage. <\/p>\n\n\n\n
The pandemic was a primary facilitator of this increase, particularly due to the rapid growth of telehealth at the beginning of the current decade. <\/p>\n\n\n\n Prescribing in the Pandemic<\/strong><\/p>\n\n\n\n For as long as stimulants have been prescribed, individuals have attempted to obtain them using a variety of means, often through a process called malingering, or rather trying to feign a condition by faking or describing its symptoms. Yet during the pandemic, doing so successfully became a lot easier. What once was an in-depth consultation became a brief chat through a screen. <\/p>\n\n\n\n \u201cAs an ADHD clinician, we spend an hour to an hour and a half with a person trying to understand their history, to be able to get a good sense of what other conditions might explain ADHD,\u201d said Dr. Kevin Anthsel, a professor of psychology at Syracuse University. \u201cTo do a telehealth appointment in 10 to 15 minutes and walk out with an ADHD [diagnosis], to me that\u2019s concerning.\u201d<\/p>\n\n\n\n A study published by the CDC<\/a> in March found that the percentage of commercially insured young adults (females between 15 and 44 and males between 25 and 44) with prescription stimulant fills increased by more than 10% between 2020 and 2021, during the early stages of the pandemic.<\/p>\n\n\n\n Compounding the issue is the fact that there is not a single test to identify ADHD, according to Dr. Terry Church, a professor at the USC School of Pharmacy.<\/p>\n\n\n\n \u201cIt’s my clinical judgment to decide if I want to give them a prescription or not,\u201d said Dr. Church. \u201cNine times out of ten, if you if you tick off the right boxes, they’re going to default to providing the prescription.\u201d<\/p>\n\n\n\n While some individuals misuse stimulants that they have been prescribed, this is not always the case. A significant portion of stimulant misusers are those who aren\u2019t prescribed the drugs but obtain them through other means. A recent assessment<\/a> conducted by the American College Health Association found that of a group of college students who had used a stimulant within three months, nearly two-thirds hadn\u2019t done so on a prescription.<\/p>\n\n\n\n The issue isn\u2019t isolated to college campuses, either. Another new study<\/a> found that in certain middle and high schools across the country, as many as one in four students reported that they had abused ADHD medication. <\/p>\n\n\n\n \u2018Bottleneck of Need\u2019<\/strong><\/p>\n\n\n\n At their core, stimulants are meant to increase brain activity and help those with attention disorders like ADHD to better focus and stay alert. For those who need them, they can be a lifeline in keeping up with peers. <\/p>\n\n\n\n In 2022, the FDA declared a shortage of the ingredients used to manufacture Adderall. Shortly thereafter, other prescription stimulants like Ritalin and Concerta followed, and pharmacists found themselves amid a crisis. \u201cIt’s a hot mess everywhere you go,\u201d said Dr. Kari Trotter Wall, the director of pharmacy at USC. <\/p>\n\n\n\n Though there is no official consensus, experts seem to believe that a multiplicity of factors led to the crisis, including the increase in prescriptions.<\/p>\n\n\n\n \u201cThere was such a such a proliferation of ADHD diagnoses being made during COVID that, actually, the pharmaceutical manufacturers were unable to keep up with demand, and we got into a shortage,\u201d said Dr. Antshel.<\/p>\n\n\n\n Though pandemic-driven demand was certainly a key cause of the shortage of prescription stimulants, it was not the only one. Prescription numbers had been rising for years, and some of the large pharmaceutical companies that produce these drugs were facing labor shortages that led to understaffing, according to Dr. Church. <\/p>\n\n\n\n The shortage produced what Dr. Church described as a \u201cbottleneck of need,\u201d and led to downstream effects for recipients of the affected drugs. Finding the right stimulants became significantly harder both for patients and pharmacists.<\/p>\n\n\n\n \u201cI feel like it’s turning into a full-time job for the average person that’s not a pharmacist,\u201d said Dr. Trotter Wall. \u201cThe patient is now working for themselves, so to speak, when it used to be that we were working for you.\u201d<\/p>\n\n\n\n Large numbers of students at USC were unable to obtain the drugs they needed and resorted to unorthodox methods, according to Dr. Trotter Wall, who painted a chaotic picture of the shortage.<\/p>\n\n\n\n Some students switched prescriptions, shifting from stimulant to stimulant until they found a drug that had any level of availability. Other students attempted to take matters into their own hands, and went back and forth in an ever-persistent game of telephone with doctors and pharmacies, hoping to land even a 30-day supply of a stimulant.<\/p>\n\n\n\n The pharmaceutical industry went into overdrive as it attempted to cope with the shortage, but students ultimately felt the impact.<\/p>\n\n\n\n \u201cI feel horrible when I don’t have it and I can’t get it,\u201d said Dr. Trotter Wall. \u201cI know who’s in dire straits and who’s not, but we still remain first in, first out.\u201d<\/p>\n\n\n\n The effect of the shortage was felt hardest by those with attention deficit disorders who rely on stimulants to get through their daily work. Yet, there is another category of people, particularly among student populations, that may not need to use stimulants quite as much. <\/p>\n\n\n\n These users, who either have no symptoms or mild symptoms of such disorders, begin to fall into the category of stimulant misusers.<\/p>\n\n\n\n \u2018Talking Themselves Into an Outcome\u2019<\/strong><\/p>\n\n\n\n The misconception at the core of the college stimulant misuse crisis is that no matter the circumstances, students believe that stimulants will improve academic performance, according to Richard Lucey, a senior prevention program manager at the United States Drug Enforcement Administration.<\/p>\n\n\n\n \u201cStudents who have non-medically misused a prescription stimulant, has it helped them get a better grade? To date, there’s been no large-scale research to show that that’s the case,\u201d said Lucey.<\/p>\n\n\n\n Some experts, like Dr. Antshel, have actually linked the non-medical misuse of prescription stimulants with a potential negative impact on academic performance. Dr. Antshel said that students try to \u201ctalk themselves into an outcome that they want to happen,\u201d though the data tends to say otherwise.<\/p>\n\n\n\n The issue is most rampant on college campuses, where stimulants are misused at much higher rates than elsewhere.<\/p>\n\n\n\n In the general population, the three most prominent categories of prescription drugs that are misused are opioids, sedatives, and stimulants, from most to least prevalent. Yet according to Lucey, on college campuses, this order inverts. Stimulants are generally the category of prescription drug most misused among university students, according to Lucey.<\/p>\n\n\n\n One of the primary reasons why stimulants are misused more on college campuses is that they are incredibly easy to access.<\/p>\n\n\n\n Oftentimes, students with stimulants tend not to completely use up their supply, and maintain a sort of \u201ccache\u201d of extra medication, according to Dr. Antshel. Students, who have a newfound sense of independence, can misuse these extra pills themselves, or give them away to friends. <\/p>\n\n\n\n \u201cYou can tell when it’s happening on campus,\u201d said Dr. Church. \u201cIt’s usually around midterm season and then again around finals, where students who have the prescription who might be managing their disease perfectly well, and might need a little cash, will start diverting some of their prescription to students who don’t need it.\u201d<\/p>\n\n\n\n Students also misuse stimulants in part due to academic pressure. <\/p>\n\n\n\n Today, according to Dr. Antshel, levels of perfectionism are at all-time highs in student populations. This extra weight could be driving students towards drugs that they think will boost their academic achievement.<\/p>\n\n\n\n And the perceptions regarding stimulants only further contribute to their misuse in higher education. Not only do students tend to believe that non-medical use of stimulants will improve their long-term academic performance, but students also seem to overestimate how many of their peers are using the drugs.<\/p>\n\n\n\n![\"\"](\"https:\/\/ascjcapstone.com\/fall-2023\/emasket\/wp-content\/uploads\/2023\/12\/12.7-Checklist-Outline-readings-for-documentary-Read-2-of-them-Add-two-graphics-to-capstone-x-Joel-x-finalize-bday-plan-for-chiara-x-Clean-apartment-x-Resubmit-3-1-1024x576.png\")
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