By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
The U.S. Food and Drug Administration attaches this “black box warning”—the government’s strongest measure short of banning a drug—to Adderall and extended-release Adderall XR: “Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided. . . . Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events.”
The FDA only issued that warning after the drug’s maker, Shire Pharmaceuticals Group PLC, issued a statement in early 2005 acknowledging that 20 sudden deaths and a dozen strokes had been suffered by patients taking Adderall XR. Children were the victims of 14 of the deaths and two of the strokes; the adverse reactions were not associated with overdoses, misuse or abuse. The Canadian government immediately yanked the drug off shelves, but the FDA investigated and concluded that most of the deceased had pre-existing heart conditions. The Canadians then lifted their Adderall XR ban.
The American medical community is split over whether ADHD is under- or overdiagnosed and, therefore, whether its treatments are under- or overprescribed. A Walnut Creek physician says the case was made at a medical conference he attended a few years ago that the condition is both under- and overdiagnosed, the implication being that too few ADHD drugs are getting to poor kids and too many are going to the wealthy.
Many mental-health professionals say the wrong doctors are writing the prescriptions in the first place. A diagnosis should come not from the family physician, they believe, but psychologists or psychiatrists who have properly evaluated whether the child has an attention disorder, a learning disability, a mental-health issue or something else. Or nothing at all.
Jack M. Gorman, professor of psychiatry at Columbia University and director of the New York State Psychiatric Institute, writes in 2007’s The Essential Guide to Psychiatric Drugs that prescribing Adderall XR as a front-line drug to treat ADHD in children and young adults, “is, in my opinion, a very serious mistake.” He calls Adderall “a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first.”
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There is little stigma attached to taking Addys in a country that consumes 80 percent of the world’s stimulants. Adderall is indeed popping up everywhere, even pop culture.
When Tom Cruise went apeshit on NBC’s Today show in June 2005, Adderall was among the medications he complained children were being prescribed without parents fully being told of their harmful effects. “Do you know what Adderall is?” he barked all wild-eyed to a defensive Matt Lauer.
Adderall was onboard when Al Gore III, the then-24-year-old son of the vice president-turned-Nobel laureate, was pulled over for driving 100 mph on Interstate 5 in Laguna Niguel on July 4, 2007.
After an April 10 New York Daily News gossip column ended with this blind item—“Which show keeps its dim-witted if ultra-popular ‘reality’ stars peppy with Adderall supplied by a producer in handfuls between scenes?”—bloggers outed the show as MTV’s The Hills, which follows the exploits of Lauren Conrad after she left Laguna Beach: The Real Orange County.
IMS Health, which conducts health-care-market research, found that of the 11 million prescriptions written for amphetamine products in the U.S. in 2004, 7 million were for Adderall. Sales of the medication soared 3,100 percent in America between 2002 and 2005.
Adderall and two other ADHD medications owned by Shire Pharmaceuticals combined for more than $336 million in sales for the quarter that ended June 30. Shire’s other ADHD medications are Daytrana and Vyvanse, which the Basingstoke, England-based company is pushing hard because its Adderall patent expires in 2009, at which point a generic version will come out and cause sales of the original to plummet. But Adderall, Vyvanse and Daytrana are “on their way to blockbuster status this year,” according to popular market researcher the Motley Fool.
Too many prescription meds are reaching abusers, however. Sales of drugs without prescriptions from Internet pharmacies, which are generally headquartered outside the U.S., have reached alarming proportions, according to separate reports various public and private drug watchdogs have released in the past year. The Drug Enforcement Administration (DEA) has also tracked a huge jump in medications bound for pharmacies being stolen off delivery trucks.
Of course, it’s much easier to simply get them from family and friends, which is how 59 percent of Americans who report abusing prescription drugs say they acquired them, according to the 2006 National Survey on Drug Use and Health, the largest substance-abuse survey in the country.
Many young abusers who wind up at SouthCoast Recovery get Adderall through “doctor shopping,” according to Larkin.
“Kids are sophisticated; they’ll go to their family doctor and cite the symptoms of ADHD,” he says. “The doctor will suggest they try Adderall. If you try that with a few doctors, you’ve got a pretty good thing going.”
The nonprofit advocacy group Partnership for a Drug-Free America reports one in 10 teens, or 2.3 million young adults, has used Adderall without a doctor’s prescription. Abuse and addiction often follow them to college campuses, where Adderall is nicknamed “college crack,” “the miracle drug” and “steroids for the brain.”