History and Statistics of “Study Drugs”
- Table of ContentsPrint
- What are "Study Drugs?"
- Prescription Stimulant Abuse
- Who’s Abusing Prescription Stimulants?
- The Market for Prescription Stimulants
- "Study Drugs" and the Law
- How Dangerous Are Prescription Stimulants?
What are "Study Drugs?"
The colloquial term “study drugs” typically refers to prescription stimulant medications (such as Ritalin and Concerta) that are used to enhance aspects of a user’s mental functioning, such as:
The technical term for such agents is “nootropic,” a term coined in 1972 by Corneliu E. Giurgea, a psychologist and chemist from Romania, meaning “mind-affecting.”
Other popular terms used to describe this loosely defined classification of drugs include:
- Smart drugs.
- Neuro enhancers.
- Cognitive enhancers.
Such terms may also be used to refer to health supplements, nutraceuticals, and other substances purported to have cognitive-enhancing effects.
For the purposes of this discussion, the "study drugs" are all potent stimulants used primarily in the treatment of attention deficit hyperactivity disorder (ADHD) in adults and children. All except for dexmethylphenidate are also used to treat narcolepsy, a disorder that causes affected individuals to experience excessive daytime sleepiness and fall asleep suddenly and without warning.
- Methylphenidate (Ritalin, Concerta).
- Dexmethylphenidate (Focalin, Attenade).
- Amphetamine & dextroamphetamine (Adderall).
- Lisdexamfetamine (Vyvanse).
Methylphenidate is better known by its trade name Ritalin. An additional trade formulation is branded as Concerta—a longer-acting formulation that can be taken once a day. Methylphenidate was synthesized in 1944 by the chemist Leandro Panizzon, who worked at the Ciba pharmaceutical company in Switzerland. The name Ritalin was derived from the nickname of Panizzon’s wife, Rita, who had low blood pressure and took methylphenidate before playing tennis.
Methylphenidate was introduced on the US market in 1956 after the Food and Drug Administration (FDA) approved it for use as a treatment for depression, senility, lethargy, and narcolepsy.
Methylphenidate first began to be used as a treatment for ADHD in the 1960s, based on research in the 1930s that showed stimulants could successfully treat hyperactivity and impulsivity. In the brain, methylphenidate acts to increase the amounts of the neurotransmitters dopamine and norepinephrine in the brain, which are both important for an individual’s energy and attention levels.
It does this by blocking transporters on the surface of brain cells that remove these neurotransmitters from the synaptic cleft between neurons. Methylphenidate binds to dopamine transporters more strongly than norepinephrine transporters; therefore, it has a stronger effect on dopamine levels.
Methylphenidate is actually a mixture of 2 different forms of the drug, called dextro-threo-methylphenidate (D-TMP) and levo-threo-methylphenidate (L-TMP). The molecular structures of D-TMP and L-TMP, though chemically identical, are mirror images of each other, and nearly all of the effects of methylphenidate come from D-TMP, while L-TMP is relatively inert.
Dexmethylphenidate, also known by the trade names Focalin and Attenade, contains only the D-TMP form of the drug, meaning that a smaller dose is needed compared to Ritalin to get the same effect.
Dexmethylphenidate was first introduced in 2002, and Focalin XR, an extended release formulation, became available in 2005.
A Romanian chemist named Lazar Edeleanu first synthesized amphetamine in 1887. However, researchers could find no practical use for it and it was forgotten for over 40 years until American chemist Gordon Alles revisited the same compound in an effort to develop a new asthma medication.
Alles tested a 50 mg dose of this new drug on himself (5 times more than the standard dose today) and reported feeling:
- Heart palpitations.
- A feeling of euphoria.
- A “rather sleepless night.”
Though it soon became apparent that amphetamine had little effect on asthma, its stimulant properties made it popular for many other uses including depression, weight loss, and as energizing “pep pills” for soldiers in World War II.
Today, amphetamine is used as a treatment for ADHD and narcolepsy.
The Adderall brand was introduced in 1996, and consists of a mixture of 2 different molecular structures of amphetamine. In 2006, an extended release formulation, Adderall XR was approved for release.
In the brain, amphetamine binds to trace amine-associated receptor 1 (TAAR1) and vesicular monoamine transporter 2 (VMAT2). Though the effects of this binding on neurons are fairly complex, the end result is to increase the amount of dopamine and norepinephrine in the synaptic cleft similarly to methylphenidate and other stimulants. Additionally, amphetamine increases synaptic levels of other neurotransmitters such as serotonin, histamine, epinephrine.
Abuse of amphetamine has long been a problem in the US, and both diverted prescriptions and clandestine laboratories are sources of this drug on the black market.
In contrast, according to the Drug Enforcement Agency (DEA), there are no known unregulated sources of prescription methylphenidate. The illicit supply of many of these drugs is, therefore, derived exclusively from diversion from patients with legal prescription, prescription fraud, doctor shopping, and pharmacy theft.
Learn more about illicit use of Adderall in our article, Rise of the Study Drug.
This drug – marketed in the US as Vyvanse – was developed as an alternative to amphetamine that would be longer-lasting and have lower potential for abuse. It received FDA approval for use in adults in 2008, and it is currently the newest anti-ADHD on the market.
Lisdexamfetamine is a prodrug, which means it is inactive until it is metabolized by the body into dextroamphetamine, one of the active ingredients in Adderall, and L-lysine, a naturally occurring amino acid. By attaching the lysine molecule to dextroamphetamine, the drug is more slowly released into the body over the course of the day.
Also, the free form of the drug cannot be released from tablets through methods such as crushing, a common practice among abusers of prescription stimulants.
Prescription Stimulant Abuse
All 4 of the stimulants described above have a relatively high potential for abuse and dependence because they raise levels of dopamine in the brain. Although at therapeutic doses this increase in dopamine is key for the calming and focusing effects needed to treat ADHD, elevated dopamine can also:
- Suppress appetite.
- Increase energy and wakefulness.
- Produce a feeling of euphoria.
Therefore, stimulants are often abused by individuals who do not have ADHD to:
- Control weight.
- Enhance academic performance.
- Get high for recreational purposes.
Who’s Abusing Prescription Stimulants?
The demographics of stimulant abuse cover large segments of the population—from veterans after World War II, to Beatnik artists in the 1950s, to housewives in the 1960s. Misuse is even common among those who have legitimate prescriptions for such drugs. A 2007 study published in the journal Human Psychopharmacology reported that of adults who were prescribed methylphenidate by a doctor, 29% admitted misusing it.
However, those primarily abusing these substances specifically as “study drugs” have always been people under the age of 25. Some important statistics about modern prescription stimulant abuse include the following:
- According to the Monitoring the Future Survey of adolescent drug abuse, the use of study drugs, including Adderall and Ritalin, among 12th graders declined from 2003 to 2009, but has since begun to rise again—approaching nearly 9% for amphetamine and 2% for MPH in 2013.
- The National Survey on Drug Use and Health (NSDUH) estimates that nearly 6.5 million Americans over the age of 12 have used methylphenidate for non-medical uses in their lifetime.
- There were 21 million stimulant prescriptions in 2011 for patients aged 10 to 19 years old, out of a total population of 25 million children aged 12-17.
Within a decade of Alles’s rediscovery of amphetamine in 1929, college students were already using it to enhance their academic performance. This population continues to report extremely high levels on non-medical use of these substances.
A survey by the Partnership for a Drug-Free Kids in 2014 reported that 20% of college students reported abusing prescription stimulants.
The most popular drug in this survey was Adderall, used by 60% of those taking stimulants, followed by Ritalin and Vyvanse. Of the students that reported using stimulants for non-medical reasons, half cited a desire to improve academic or work performance as the reason.
The Market for Prescription Stimulants
Many of these so-called study drugs are available in generic versions, and are therefore relatively inexpensive for those with valid prescriptions; for example, 20 tablets of 10 mg methylphenidate can be purchased for less than $20, or less than $1 per pill. However, newer drugs without a generic alternative are much more costly. Vyvanse costs in excess of $200 for 30 capsules, or nearly $7 per pill.
Unlike other prescriptions, profit motive plays a potentially smaller role in the diversion of study drugs for illicit uses. Even though amphetamine and other stimulants are sold for profit – especially to older buyers – such drugs are available to many college-age users from friends and peers who have legal prescriptions.
Personal relationships and the perception that study drugs are being used for “legitimate” reasons like academic success, and not for getting high, lead many young people with prescriptions for these drugs to distribute them at cost, or even for free.
The 2007 study cited above also reported that in their sample of patients who were prescribed methylphenidate, 97% of those who diverted their prescriptions gave it away to peers for free. Also, the survey by the Partnership for Drug-Free Kids reported that 56% of college students considered study drugs easy to obtain through friends and extended social networks.
"Study Drugs" and the Law
Prescriptions stimulants are legal substances that have legitimate medical use. However, despite the rather cavalier attitude demonstrated by many young people regarding the possession and distribution of study drugs, all of the common prescription stimulants are designated as Schedule II controlled substances by the DEA. This classification indicates that there are accepted medical uses for these drugs, but also a high potential for abuse and dependence.
Legal Penalties of Abusing Stimulants
Because they are controlled substances, people who handle or distribute prescription stimulants, such as physicians, pharmacists, and researchers, must obtain government licenses and keep meticulous records for law-enforcement review. For the general public, possession without a valid prescription is strictly prohibited.
- The federal penalty for a 1st offense of possession, even 1 pill, can be up to 1 year in prison, a $1000 fine, or both, with escalating penalties for subsequent offenses.
- The penalty for distributing Schedule II substances, like study drugs, is a fine of up to $5 million and up to 20 years in prison for a 1st
- In addition, a charge of distributing drugs in or near schools and colleges could double distribution penalties.
In addition to federal charges, many states also have their own statutes prohibiting stimulant possession without a prescription. Though they vary, charges of stimulant possession in most states could lead to a prison sentence of up to 1 year. Any state penalties levied would be added to federal penalties, increasing the overall prison term or fine imposed.
How Dangerous Are Prescription Stimulants?
The perception by many young people of “study drugs” as harmless, beneficial tools for improving academic and work performance is belied by research showing their high potential for abuse and dependence, and the experience of generations of people who have become addicted to “speed” since the 1930s.
Additionally, the performance benefits that are so often associated with these drugs are, for the most part, illusory.
Individuals with ADHD are thought to benefit from prescription stimulants because they return brain neurotransmitters to a balanced state by increasing dopamine and norepinephrine levels. However, healthy people, or those with ADHD who take excessive amounts of these drugs, increase their dopamine and other neurotransmitters to abnormal levels. Although wakefulness, memory, and concentration can be increased by study drugs, the benefits are often outweighed by the negative effects such as:
- Disorganized thinking.
- The “jitters.”
The National Institute on Drug Abuse (NIDA) reports that students who abuse study drugs actually tend to have lower GPAs than those who do not take them.
In addition to having little to no beneficial effects for people who do not have ADHD, prescription stimulants have many detrimental health effects when they are abused. These include:
- Increases in blood pressure and heart rate, which can cause cardiovascular problems including stroke.
- Decreased sleep.
- Appetite suppression and weight loss.
- Overall decline in health.
Chronic abuse can also cause paranoia and other mental disturbances in some users.
Finally, regular abuse of prescription stimulants can easily lead to dependence and addiction. Once dependent, a user may experience withdrawal symptoms when stopping use, such as:
- Lethargy or fatigue.
- Increased somnolence.
- Depression and/or other mood disturbances.
- Increased appetite.
- Intense drug craving.
Dependence can lead to a feeling of being disconnected from reality and trapped in a hopeless situation, and, as with all addictions, suicidal thoughts and other dangerous behaviors are common.
- U.S. National Library of Medicine. (2016). Dextroamphetamine and Amphetamine
- U.S. National Library of Medicine. (2016). Lisdexamfetamine
- U.S. National Library of Medicine. (2016). Methylphenidate
- U.S. National Library of Medicine. (2016). Dexmethylphenidate
- "Study Drugs" Popular Among High School Students. New York Times. June 9, 2012.
- National Institute on Drug Abuse (NIDA). (2014). DrugFacts: Stimulant ADHD Medications: Methylphenidate and Amphetamines
- Chemical Heritage Foundation. (2012). Fast Times: The Life, Death, and Rebirth of Amphetamine
- Drug Enforcement Agency. (2013). Drug and Chemical Information: Methylphenidate
- Darredeau C, Barrett SP, Jardin B, Pihl RO. Patterns and predictors of medication compliance, diversion, and misuse in adult prescribed methylphenidate users. Hum Psychopharmacol. 2007 Dec;22(8):529-36.
- National Institute on Drug Abuse. (2014). Monitoring the Future National Survey Results: 1975-2014
- National Survey on Drug Use and Health (NSDUH). Data tables. 2012 and 2013.
- Survey shows 1 in 5 college students abuse prescription stimulants. USA Today. November 19, 2014.