Young people are abusing ADHD drugs with dangerous consequences

A few years ago, a student in my college-level medical anthropology class at SMU Dallas wrote a paper about how students at her Title 1 high school who could not afford a psychiatrist to prescribe “study drugs” were at a disadvantage.

 When did access to performance-boosting prescriptions become a sign of privilege?

A lot of young people use and misuse Adderall to meet cultural expectations of achievement and productivity, and to have fun. At the same time, the misuse of prescription drugs has been on the rise, especially for people who are young, white, male and socially active.

Abusing this class of drugs can lead to psychotic episodes and great personal risk

By Neely Myers

A few years ago, a student in my college-level medical anthropology class at SMU Dallas wrote a paper about how students at her Title 1 high school who could not afford a psychiatrist to prescribe “study drugs” were at a disadvantage.

 When did access to performance-boosting prescriptions become a sign of privilege?

A lot of young people use and misuse Adderall to meet cultural expectations of achievement and productivity, and to have fun. At the same time, the misuse of prescription drugs has been on the rise, especially for people who are young, white, male and socially active.

I felt concerned and wanted to tell them a story about Amy, a pseudonym I am using for one of the subjects in my new book, “Breaking Points: Youth Mental Health Crises and How We All Can Help,” about youth who face psychotic episodes. While misusing Adderall, Amy nearly jumped off a bridge. She thought she was a superhero.

Amy’s saga began when she went to live with her older brother’s family after their parents died unexpectedly. A doctor prescribed her Adderall to boost school performance, but she still failed a grade. She decided to drop out of high school to help her brother with babysitting and housekeeping.

When his kids were grown and her help was no longer needed, she got her own place and a job.  She worked retail, but unpaid bills and parking tickets piled up. Her car was impounded.

A new doctor prescribed more Adderall to help her pay attention. She felt energetic and lost weight — side effects Amy appreciated. She felt more fashionable. Her sister told me Amy appeared to be living on Adderall and Diet Coke.

Amy gamed the system by acquiring multiple prescriptions, which she filled at walk-in clinics, allowing her to tinker freely with her dosage, likely exceeding any single prescribed dose.

Then odd things started happening. She imagined co-workers were talking about her, and she experienced chest and brain zaps. She blamed fellow employees but later confided in me, “It was probably the Adderall.”

Soon she was fired for erratic behavior, lost her place, and went to live with her sister and brother-in-law, who needed help with their kids during a military deployment.

In this setting she failed to notice the paranoia building; instead, she became convinced she was a superhero sent to protect her niece and nephew. But it was a disaster. Her sister, heartbroken and fearing harm to her children, arranged for Amy to move to a women’s shelter.

Amy felt misunderstood. Convinced she was a superhero trying to help, the voices coaxed her to test her ability to fly.  One day she wandered to an overpass and stared into the traffic rumbling below. And then a policeman touched her arm.

Amy’s story is detailed in “Breaking Points,” which is based on researched gleaned from multiple meetings with 47 young people like Amy in the psychiatric emergency room and their loved ones. Of these 47, six were on Adderall or Vyvanse. Six more used methamphetamines like crystal meth.

This means amphetamine products were important for 25% of the cases I observed. In a recent survey of college students,  1 in 6 reported psychotic experiences after using prescription amphetamines.

Amy’s family and clinicians thought Adderall contributed to her psychotic episode. But there was no clinical literature or any research explaining why, even though Adderall is illegal or restricted in many countries, including some European nations and Japan.

I hesitated to sound alarms about an anecdotal Adderall link or share Amy’s story in my classes without more evidence.

Many young adults struggle to meet American social expectations for success. They are expected to become hardworking, tax-paying independent adults by leaving home and proving themselves all over again without the help of their family.

To meet these expectations, many turn to “high-performance” drugs like Adderall and Vyvanse. The U.S. prescribes Adderall and Vyvanse more than other countries. There was a fivefold increase in amphetamine prescriptions between 2004 and 2019.  And between 2020 and 2021, stimulant use increased 10% among commercially insured females ages 15-44 and males ages 25-44.

My students today talk about these drugs openly. They trade them, sell them and have easy access if they were prescribed as children. And they’re unaware these drugs can lead to a psychotic break.

A recent study claims 81% of cases of psychosis or mania could be eliminated if youths did not take high doses of Adderall or Vyvanse. Studies of older ADHD drugs, like Ritalin, have not shown the same negative effect.

Psychosis and mania can lead to injury to oneself or others, lost employment and educational opportunities, broken relationships with friends and family, and long-term disability. People who get help early may avoid these events and get back on track.

Prescribers, people using the medication, mental health professionals, general practitioners, relatives and anyone working with young people must be aware of the danger of a higher dose. They need to spot the symptoms of mania or psychosis.

If patients must take this class of drug, the maximum dosage should be below 30 mg — a good goal for lawmakers to consider in future legislative sessions. If higher doses are recommended, patients need regular screening. And there is always the option to consider the drugs that are “older” and not associated with side effects.

If  you suspect  someone you know is misusing ADHD medications, share this column with them. They need to understand what a safe dose is and consider seeking out a mental health professional if they are having unusual experiences like Amy.

Nobody wants a friend or relative to end up on that bridge. There may not be a police officer there to rescue them.

Neely Myers is a professor of anthropology at Southern Methodist University Dallas and adjunct professor of psychiatry at UT Southwestern Medical Center.