Spinning Pill

Five dollars, one pill and an “A”.

While easy to access, study drugs are a serious gamble for the mind and body.

Nick Pearce, Features Editor

Four years ago, hundreds of students filed into the rows of desks lining the inside of Grant Hall. The rectors listed instructions, some students fidgeted and one second-year student took a seat.

It was December exams and he’d just tried Ritalin for the first time.

He studied in bursts for most of the previous week. But time spent scouring assigned readings and month-old notes came in 30-minute increments and then he started to drift off. The time he put in wasn’t reflected in the results, he thought.

His girlfriend agreed. She gave him one of her Ritalin tablets. At the time, it looked like a children’s Advil. He gulped it down and an hour later it kicked in.

The exam prep went well. A renewed urgency guided his efforts as he honed in on his studies. A month later, he got his marks back. He was pleased.

He’s one of a growing number of students that are adding study drugs — ADHD medications like Adderall, Ritalin and Vyvanse — to their study to-do list.

The drugs are stimulants meant to raise dopamine in the brain. Chemically, stimulants range from coffee to cocaine. But in terms of study drug stimulants, the two most common types are amphetamines like Adderall and methylphenidates like Ritalin. Both raise dopamine activity in the brain.

A 2013 National College Health Assessment (NCHA) survey taken from 32 Canadian post-secondary schools and 34,039 students reports found that almost four per cent (3.7) of students had taken unprescribed stimulants or study drugs in the past year.

Men are more likely to take them — scoring a 4.7 per cent compared to 3.3 per cent among female students.

However, over one in 10 students admit to taking one or more kinds of unprescribed medication, which suggests these numbers may be higher.

The Journal spoke with Dr. Paul Sandor, a psychiatry professor at the University of Toronto. His research often touches on ADHD.

He said the recent upswing in ADHD diagnoses has been misrepresented. The criteria have simply been more clearly defined, which allows physicians to catch more cases, he said.

“Roughly 4 to 5 per cent of the general population meets diagnostic criteria for ADHD,” he said. “It is unfortunate that there are some people who are incorrectly diagnosed with ADHD, this may include both unwarranted diagnosis and also under diagnosis.”

There’s a misconception that ADHD fades in a person’s teens. Instead, many people just develop better coping methods in their adulthood, according to Sandor.

“They continue to face challenges because of short attention span, impulsive behaviour and restlessness."

Four years later, the second-year student is now a Masters student and has continued to use study drugs. He returned to study drugs in his fourth year of his undergraduate degree.

At the time, he was juggling a full-time student government job, a full course load, and the terminal diagnosis in a close relative, and felt he needed an edge.

He began taking study drugs borrowed from friends and their friends. A “B” student in his second year, his lowest mark was an “A-” in fourth year and an “A” in his fifth year. He would take Adderall or Ritalin on Sundays and dedicate the day to work.

Students often rake in better grades over their stay at Queen’s without taking Adderall. Speaking with The Journal recently, the student agrees that he started getting better marks in third year due to new study skills. But he still attributes most of his success to Adderall.

Dr. Michelle Arnot, a pharmacology professor at U of T, said there’s a psychological factor to dependency. Students might take a study drug for an exam or paper and find they score highly instead of on the assignment. Afterwards, a good mark will be attributed to the drug and not their own abilities.

“Next time they’re in a crunch they think ‘oh, this helped last time, this will help again,'” she said.

Myths surrounding cognitive enhancement help prop up physiological reliance.

The Masters student likes to poke fun at the 2011 film Limitless, where a mysterious pill makes the main character a genius. And it’s not just Hollywood — it’s a common misconception that study drugs cause “brain gain” and increase memory and cognition. Reality, however, resists science fiction.

“There have been a few studies that have shown improvement in focus in novel and attention-based tasks,” Dr. Arnot said.

“But that seems fairly mild. There’s little evidence for pronounced improvement in memory or cognitive enhancement.”

People who’ve taken study drugs also report that they can make people hone in on the wrong task. They might clean their room for hours, but leave homework unfinished.

Effectiveness aside, the Canadian health community has other, more serious concerns.

In 2005, Health Canada banned Adderall XR after 20 heart and stroke-related deaths — 14 of which involved children — were linked with the drug, though none of the deaths occurred in Canada.

Health Canada reversed the ban the same year but doubts lingered. Serious side effects have followed the drug’s prescription and, in some cases, have been suggested to include bodily harm and suicide.

In 2015, Health Canada issued warnings about the two main classes of ADHD medications — methylphenidate and amphetamines — for “suicidality.”

Suicidality includes everything from suicidal thoughts to actions and in some rare cases, suicides themselves.

These warnings were based on reports, although — there’s little scientific evidence of suicidal dangers. Health Canada readily admits this, but prefers physicians and their patients are aware of the risks.

The drug remains widely prescribed and often serves as an invaluable aid for patients managing ADHD.

But if you’re on campus and need some help to focus, it’ll cost $5 — maybe $20 around exams.

Prescription and its discontents

The summer before his graduate degree, the Masters student, suspecting he had ADHD, began to investigate prescriptions. He had been a class clown growing up: jokes often took the place of dedicated schoolwork. Nonetheless, he says he could still memorize a course’s material, even if he had difficult focusing.

Curious, he went to a now defunct Adderall screening service at Queen’s to get an assessment.

The Regional Assessment and Resource Centre (RARC), located in Macintosh-Corry Hall, is a resource for secondary and post-secondary students looking for psychological or educational assessments.

Last summer, the centre’s ADHD screening process was cut back due to budget insecurities. At the time, RARC Director Dr. Allyson Harrison told The Journal that the tests simply weren’t necessary.

“The [old] complete screening process was costing RARC a significant amount of money, given the cost of test materials and the professionals’ time,” Harrison said.

The diagnostics were extensive, to say the least.

The first round of forms required information surrounding the student’s reasons for seeking an ADHD diagnosis. Students would fill out forms detailing the duration of complaints, and all other associated reasons.

Questionnaires followed. Some were self-reflective, while others allowed friends and family to comment on the student’s complaints filled out related forms.

Finally, RARC staff conducted a clinical interview and the student was asked to complete a series of ADHD-specific screening tests.

The whole process took three to four hours.

“The vast majority of students who were formally screened for ADHD by RARC over the past five years were found to not have ADHD. Of the 201 students screened over the past five years, only 11 (5%) were eventually found to have ADHD,” Harrison told The Journal via email on Jan. 22nd. (The bold and underlining are hers.)

ADHD screening, however, is still an option for Queen’s students. Physicians partnered with Queen’s Health Services provide similar services to the now defunct RARC ones.

“Diagnosing ADHD is a process that takes time,” Dr. Carolyn Borins, Medical Director of SHS, told The Journal via email.

“If a student comes in to Student Health Services and says ‘I think I have ADHD and need medication’, they are taken through a full assessment that includes their health history, a physical, a review of their symptoms, and further testing and screening, often including psychoeducational assessment.”

An ADHD diagnosis requires several visits. Eventually, if the student isn’t diagnosed, they can be directed to Student Academic Success Services (SASS).

There’s also a catch once the prescription is in hand.

“Student Health Services has a longstanding practice that students have to sign a contract when ADHD medication is prescribed, in which they agree that they will use the medication appropriately … they won’t sell it or give any away,” Borins said.

However, The Journal found little evidence that students take that contract seriously.

The Masters student was one of the 190 students turned away at RARC.

He remembers filling out some tests and providing previous report cards. The goal was to find a history of symptoms following a patient through their life.

The response was simple: he showed a good portion of the symptomology but, as he recalls, a high IQ may have made up the difference for most of his life. He said RARC suggested behavioral therapy, but he couldn’t afford it.

Soon after, he visited his family doctor’s office. The student listed his symptoms. 15 minutes later, he walked out with a prescription.

Dr. Arnot, the U of T professor, said symptomology lists may be taken advantage of.

Reliance on self-reporting and symptomology results in a variety of prescriptions. The risk of a student seeking a prescription without ADHD is largely left to an individual doctor’s comfort level, she added.

“[Students] may be trying to get Adderall or Ritalin to help with their college courses or they just want it to sell to make some extra money,” she said. “They look online: “what do I need to report to get medication and they go on the doctor’s office and say I have this and this and this. Ta-dah.”

Indeed, googling “Adderall prescription” brings up a series of articles explaining the process – and how to fake it.

After he acquired a prescription, the Masters student said he shared it with friends with demanding schedules.

Sharing side effects

A second-year ArtSci student’s housemate was curious: what did Concerta feel like?

The second year gave her one, but the housemate was disappointed: nothing happened. The drug had nothing to “correct”, as the housemate’s friend presumably had a healthy level of dopamine.

Besides that occasion, the Arts and Science student said, she never sold or handed out Concerta on principle. But she said she would relent in a case where a friend had a full plate of classes and work, even if the friend didn’t have ADHD.

The danger here is that prescriptions are far from universal, Dr. Arnot said.

“It’s not one size fits all. You can’t put on the same dress or take the same medication and the same dose across the board.”

The Masters student agrees. As an 180-pound man, he lends out his prescription carefully. He’s worried someone smaller could take his dose and hurt themselves.

Doses are mostly based off a milligram per kilogram algorithm. While several factors complicate the matter, the model remains a common tool for physicians.

Sharing prescriptions, then, means students may simply take what’s in front of them if they’re apathetic or ignorant about the dosage.

Still, the Masters student said only one of the friends he gave study drugs to reported side effects.

“If you give someone with ADHD low doses of amphetamines, Ritalin or Adderall, you see a change in behavior. If you give it to someone without ADHD, you won’t see as a big a change occur,” Dr. Arnot said.

Stimulants like Adderall raise dopamine levels. If dopamine levels don’t need to be raised, the effects are muted — as the second-year ArtSci student’s housemate discovered.

The risks aren’t limited to disappointment, though.

“Taking a drug that has an addictive profile, it’s a bit like playing Russian roulette,” Dr. Arnot said. “You have no idea how the brain is actually going to respond. As result, you don’t know if you’ll become addicted.”

Dr. Richard Beninger, former head of Queen’s Psychology department, described the possible side effects of study drugs. Without the supervision of a medical professional, the use of prescription drugs is a risky endeavor, he said.

“The short answer is they work,” Beninger told The Journal.

The long answer is that they can lead to side effects ranging from increased heart rates to hallucinations.

The guesswork of prescription drugs needs a physician’s consultation for safety, Dr. Beninger said, and the already-present risk only multiplies with increased doses and the lack of instructions from a physician.

Stimulant overdoses, including ADHD medications, can even lead to schizophrenia-like symptoms.

“Sometimes people come to the emergency room with delusions and hallucinations as possible schizophrenia symptoms and they’re given anti-psychotics [drugs] to settle them down,” he said. “Then [doctors] realize they’ve been snorting cocaine for days or taking amphetamines.”

Milder overdoses, meanwhile, can cause anything from confusion to high or low blood pressure.

As for side effects, Beninger described accelerated heart rates, sweating, runny nose and erectile dysfunction as some milder possibilities.

A student experiencing Adderall’s side effects might start grinding their teeth or develop a twitch. Acne may start dotting their face, or they’ll begin tossing and turning at night, unable to sleep.

“There’s a window in which you want your dopamine activity. If you have too little you may find it difficult to focus and if you have too much you may focus on too many things and be easily distracted. So you don’t want to mess around with your level of dopamine activity,” Beninger said.

All this can be avoided by consulting a physician. But many students obtaining Adderall from friends and friends of friends will never receive this consultation.

Friends of friends

Study drugs are readily available to most students. Upticks in ADHD diagnosis, permissive attitudes and a high-stress academic environment create a ready-made market for unprescribed use of Adderall and similar drugs.

A 2013 NCHA survey of Queen’s found 91.7 per cent of students feel overwhelmed by all they had to do. 58.4 per cent of students surveyed also believed academics were “difficult or very hard to handle.”

One student under such pressure — an ArtSci ’18 — took Adderall multiple times for two weeks during the final stretch of exams in first year.

“[It was] genuinely [the] only way I could have passed first year. I got A’s on my exams and was failing beforehand,” he said while on a break from his homework in Stauffer.

He would ask friends of his, some of whom had prescriptions, to lend him some Adderall or pick some up for him. He would usually pay around $15 for 60 milligrams of pills.

It seemed like the only option at the time, he said.

“I just put myself in a situation where there would be no natural way to cover that much material for class,” he said, adding that he left much of the work up to the last minute.

He feels he was fairly responsible about it: he said he did some research and took Adderall with experienced friends — he called them “mentors” — that had taken it before.

He would start his day by emptying out an Adderall pill into a glass of water. He would drink half, splitting the 60-milligram dose into two 30-milligram doses.

The medication took an hour to kick in and after three or four hours he was at his peak. Fascinated by his studies, he read entire Wikipedia articles for background information.

“You’re happy while you’re working. [Work] makes you happy,” he said.

After about six hours the dose would begin to die off, and the effects disappeared after eight hours.

While he was studying, he said he was never afraid getting of caught.

Local police have taken preventative steps to combat drug abuse, according to Kingston Police Media Relations Officer Steve Koopman. Police are present at various Queen’s events to discuss the dangers of drug use and recently busted a drug ring operating close to the Queen’s campus, he told The Journal.

But the social nature of study drugs means many students never feel that they’re at risk of being outed or exposed in a sting operation, and easy access and strong demand makes selling the drugs good business for some students.

The Journal spoke with a student who dealt Adderall in his residence at the University of Guelph last year. Although he doesn’t attend Queen’s, he’s a case study in the economics of dealing Adderall.

He said he had an Adderall prescription since the third grade, but he hated the side effects. He felt the loss of appetite, insomnia and difficulty socializing was the tradeoff for doing well in school.

“You’re like a zombie, over-focused on everything,” he said.

In first year, he was given a combination of anti-depressants and antipsychotics as a response, but that too made him depressed.

This past summer, he decided to go off his medication. He says he’s happier now: he’s doing better in school and has no trouble socializing.

But in his first year, he made just under $2,000 selling his Adderall prescription.

“Last year, just kind of being in residence, everybody wanted in. I could also basically get as much I wanted. I had a prescription with repeats on it, [so] every time I wanted, I’d just contact my doctor and they’d send a prescription over to Guelph,” he said.

A reliable supply resulted in mass amounts of Adderall moving through his dorm room.

“I had a friend on [a varsity team] and knew a lot of guys wanted it. So I would give it to another dealer, I was at the top. I would have someone come into my room, he’d give me 300 bucks and I’d give him a bunch of pills and that was all,” he said.

During midterms or exams he would have someone come by his room once a week. He’d be paid anywhere from $60 to $100 and would hand over his pills. Business dried up outside of these periods, however.

When he sold pills individually, he would arrange a meeting place and sell his stock: $10 for 20 milligrams and $five for 10 to 15 milligrams.

“Sometimes if I didn’t know you, I would sell a 10 milligram pill for the price of a 20 [milligram pill,]” he said.

Selling an Adderall prescription has an enviable return on investment.

“It was pure profit, it’s not like you were selling weed and you pick up a $100 worth of weed and sell it for 160 and make a 60-dollar profit. Everything I sold was profit. I paid 8 bucks for the dispensing fee, that’s it.”

He would also deal to friends if they had to spend a night studying or buckle down for an assignment. Some of them would crush it and snort it — maybe for a faster affect, he said.

He was never worried about police or getting caught. No one came knocking on his door, and he rarely dealed directly to begin with.

However, he did receive some heated texts from potential customers.

“Some girl got really mad, really pissed at me once because I didn’t have any. I was like I don’t have any,” he said. “I did [have some], but I didn’t want to give it her. I blocked her on my phone. So there was nothing too crazy.”

He spent some of the money going out with friends or buying alcohol. He tended to buy weed as a sleep aid to counteract the medication he was taking. But most of it’s still sitting in his bank account.

He says he did have some doubts.

“The moral dilemma of being like, shit, I’m moving so much drugs. Some people didn’t even understand how it worked. They would have an exam the next day and they would just take this during exam, which is not how it fucking works.”

Still, there’s not much he regrets about selling his prescription.

His business has quieted down recently. He went off his prescription and consequently has less Adderall available to sell. He’ll still take it himself as a study aid sometimes, but he finds the loss of appetite and lack of sleep exhausting.

Out of residence, he’s only made around $200.

The Masters student doesn’t have any regrets either — for now.

“It changed my life for the better. I went from being a B to an A student. Maybe, I will [become dependent]. Maybe I’ll fall into that deep hole of addiction. It might be naïve for me to say I’ll never have regrets,” he said.

He, like Student Wellness Services, encourage students to eat well, exercise regularly, take some personal time to relax and maintain a support network of friends and family.

“It’s hard to predict to the future, especially with an addictive substance, but I feel like you run the same risk with alcohol on a consistent basis or smoke marijuana on a consistent basis. But it’s been such a positive in my life. I’m really glad I discovered it.”

He continues to take it every third day.

Correction: The Masters student did not sell study drugs, although he did give them to friends stressed about their academics.

This article has been edited to remove a piece of information that could be used to identify an anonymous source.