RX STIMULANTS FOR ADHD – “STUDY DRUGS”

Laura Schrock, Student pharmacist Fall 2022

ADHD has been described since the early 1900s, the first report coming from Sir George Frederick Still in 1902 However, it wasn’t until 1937 that the first medication Benzedrine (a racemic mixture of amphetamine) was used for ADHD. Ritalin came to the market in 1955 followed by Obetrol (now known as Adderall) in 1960, and since then these prescription drugs have found their way onto the streets. Also known as “study drugs,” these stimulants are known to enhance concentration and increase energy.

ADHD stimulants work by increasing the amount of dopamine and norepinephrine (NE) in the brain. Methylphenidate does this by blocking the reuptake of these neurotransmitters. Amphetamines are sympathomimetics that promote the release of these neurotransmitters and may also block their reuptake. Increased levels of dopamine and NE can improve memory, concentration, wakefulness, motivation, and attention. Amphetamines also may increase serotonin, histamine, and epinephrine levels, which may lead to other effects such as improvement of mood.

Too much dopamine and NE can have negative effects such as anxiety, disorganized thinking, and the “jitters.” Negative physiologic effects include increases in blood pressure and heart rate and decreased sleep.

Methylphenidate (Concerta, Ritalin) and Amphetamine (Adderall, Vyvanse)

AKA

Vitamin R, R-ball, Rids, Rit, Diet Coke, Kiddie Cocaine, Skippy, Pineapple, Skittles, Smarties, Poor Man’s Cocaine and Addys, Uppers, Speed, Dexies, Zing, Beans, Black Beauties, Pep Pills

Image From: Reference 11

Drug Interactions:

• Antidepressants

• MAOIs

• Antihypertensive drugs

• Other CNS stimulants

• Alcohol

• Caffeine

• Antacids

Fun fact:

In 2014, 20% of college students reported abusing prescription stimulant drugs.

Image From: Reference 12

Prescription ADHD stimulants are classified as Schedule II controlled substances, which identifies them as having a high potential for abuse and dependence. While these are legal prescription drugs, possession without a prescription can lead to substantial lawful penalties. The federal penalty for possession of a CII (1st offense) can be up to a year in prison, a $1000 fine, or both. A 2nd offense can be up to two years in prison, a $2500 fine, or both. Illegal sale and distribution of CIIs can lead to up to 20 years in prison, a $1 million fine, or both.

References: https://www.snohd.org/DocumentCenter/View/2516/Drug_Names_Sla ng_2019_05_09?bidId

1. Street or Slang Names for Drugs. Snohomish Health District. Accessed October 5, 2022.

2. Iannelli, Vincent. ADHD History and Medication Timeline. Verywell Mind. Updated May 12, 2022. Accessed October 5, 2022. https://www.verywellmind.com/adhd-history-of-adhd-2633127

3. Gunnerson, Tate. A Brief History of ADHD. WebMD. Updated August 25, 2022. Accessed October 5, 2022. https://www.webmd.com/addadhd/adhd-history

4. History and Statistics of “Study Drugs.” American Addiction Centers. Updated May 6, 2022. Accessed October 5, 2022. https://drugabuse.com/stimulants/adderall/history-and-statistics-ofstudy-drugs/

5. Pirius, Rebecca. Sale and Possession of Amphetamines: Criminal Penalties and Laws. Criminal Defense Lawyer. https://www.criminaldefenselawyer.com/resources/distributionamphetamines-criminal-penalties-and-laws

6. Methylphenidate. Lexi-Drugs. Lexicomp Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. http://online.lexi.com

7. Amphetamine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. http://online.lexi.com

8. Estrellado, Nicko. Methylphenidate (Ritalin) Interactions. Addiction Group. Updated September 15, 2022. Accessed October 5, 2022. https://www.addictiongroup.org/drugs/stimulants/ritalin/methylphenid ate-interactions/

9. How Long does Ritalin Stay in your System? American Addiction Centers. Updated August 19, 2022. Accessed October 5, 2022. https://americanaddictioncenters.org/ritalin/how-long-in-system https://www.nationaldrugscreening.com/amphetamines-drug-test/

10. Amphetamines Drug Test. National Drug Screening Inc. Accessed October 5, 2022.

11. Coping with an Adderall Crash. Medical News Today. Accessed October 5, 2022. https://www.medicalnewstoday.com/articles/321492

12. Sohl, Dalya. Adderall Abuse. The Evanstonian. Accessed October 5, 2022. https://www.evanstonian.net/archivedfeature/2014/03/10/adderall-abuse/

Monitoring:

Methylphenidate and amphetamine can be detected with a drug urine analysis for 1-3 days following use. Many drug tests used by employers will include amphetamines on the drug panel.

Professional Opinion:

Prescription stimulants have been used for many years to treat ADHD and narcolepsy. They are effective drugs in medical conditions that may benefit from an increase of dopamine and NE. However, because they act on these popular neurotransmitters, these drugs have the potential for abuse and addiction, which has been verified by the reports of misuse over the years. However, I don’t think it is beneficial to remove these drugs from the market, since they have positive medical effects and are not as deadly as other abusive drugs. ~L.

Schrock