Although tracking the misuse of prescription stimulants like Adderall among college and high school students is nearly impossible, experts and students agree that more people are turning to the drug to do well on exams and keep up with daily demands.

Officials with Fort Bend ISD have reported they notice no issue with students buying or trading stimulants on school property. However, it is possible for students to stay under the radar if they exchange pills off campus or keep a prescription on their person without a teacher or administrator’s knowledge, said Diana Barton, FBISD coordinator of health services.

“It’s real popular in high school and in college,” said Carlos Guerra, medical director of adolescent psychiatry at the Memorial Hermann Prevention and Recovery Center. “It’s like baseball players and steroids: If everybody’s doing it then I’m not going to be able to win, so I might as well do it, too, so I’m at an even par with everybody else.”

Attention deficit hyperactivity disorder can be lifelong, and taking stimulants regularly can result in dependency, said Vanessa Tilney, University of Houston Student Health Center executive director and chief physician.

“We certainly know [misuse is] going on, and I think social media also drives things,” Tilney said. “There are all sorts of apps out there, and I’m sure there’s ways [students] can connect with others and obtain [Adderall].”

Easy access

Adderall—a stimulant used to help people with ADHD focus—increases dopamine levels in the brain. Continual misuse can lead to mental side effects, such as psychosis, agitation and depression, as well as physical side effects, such as decreased appetite, increased heart rate, hypertension and tremors, Guerra said.

According to a 2012 study from the Journal of American College Health, 61.8 percent of 1,253 college students surveyed were offered prescription stimulants for nonmedical use by their fourth year, and 31 percent used a stimulant that was offered. About three-fourths of students surveyed used stimulants to study.

“It is not something just confined to Texas campuses,” Tilney said. “It’s all over because it’s that age group because they have more pressures to achieve. I feel like  we’re in a different time than when I was in college.”

UH student Paul Garcia said he has used Adderall to perform better on exams a few times in college.

“I don’t know if it’s increasing or if I’m  more aware of it, but I’ve noticed a lot more people are [taking Adderall],” Garcia said. “I think it starts off as a study aid and then people like the effects, so they use it for recreational use.”

Garcia said he feels like it would be fairly easy to approach someone in the library, and they would either have Adderall or would know someone who has Adderall. He said he has even been approached in the library and asked if he could provide the stimulant.

“There are some people who give it away—it depends who you know,” Garcia said. “Some people that are done with finals and they don’t need it anymore and they just have extra, they’ll just give it away. But, typically, I would say [it costs] maybe $5 a pill.”

Lauren Ibekwe, Community Prevention Coalition specialist with the Fort Bend Regional Council said although at the high school level, stimulant use is not more prevalent than other prescription drugs, it is still prevalent, according to a focus group.

“In the focus group, I think they were focusing a little bit more on marijuana and alcohol, but they did speak to drug use and the reasons that they do it,” Ibekwe said. “It’s kind of mixed reviews, but a lot of what I did hear related to more of they feel more comfortable using [stimulants] because their peers are using it, and, to some extent, their parents accept it and the culture accepts it.”

In FBISD, all prescription and nonprescription medications must be delivered to the on-campus clinic by a parent or guardian, and appropriate forms must be completed, Barton said.

“It is possible for a student to have additional medication on them without a teacher’s knowledge, but if found would then be considered a discipline issue,” she said.

Receiving a diagnosis

As stigmas surrounding mental health have started to diminish, ADHD diagnoses have become more common, and more parents are open to medicating their children, Guerra said. According to data from the Centers for Disease Control and Prevention, diagnoses in children increased from 5.5 percent in 1997 to 9.9 percent in 2015.

“Some of [the increase] has to do with we’re just better at making the diagnosis,” Guerra said. “My own experience: I didn’t get diagnosed with ADHD until I was 31. I had already gotten through medical school.”

Receiving a diagnosis of ADHD cannot be measured by physical means—it is based on an evaluation related to a set of criteria, Guerra said.

“When you look at the criteria for ADHD, it’s based entirely on somebody else’s opinion of you,” he said. “For instance, [the criteria says an individual] often fails to give close attention to details [and] often has difficulties sustaining attention.”

Guerra, who is affiliated with Memorial Hermann Sugar Land Hospital, said pressure to do well in school to get into a good college has resulted in students attempting to lie in their evaluations in order to get a prescription—a practice he said he does not support.

“The top 7-8 percent rule in Texas is hard, especially when the schools like Memorial High School, Taylor [High School in Katy], Clements [High School in Sugar Land]—those high schools are just ultracompetitive schools. Bellaire High School, Lamar, [International Baccalaureate] programs, those are extremely competitive programs and it’s hard to be in the top 10 percent of the class,” Guerra said.

Understanding the trend

Severe dangers associated with the misuse of prescription stimulants, such as stroke or death, are quite low, Tilney said. However, misuse can lead to undesired side effects like chest pain, she said.

“It’s really supposed to make you more alert obviously, but granted the side effects, I would think that could be a deterrent from making it a really attractive drug to get hooked on because of the cardiovascular effects and such,” Tilney said.

Beyond the medical effects, exchanging any prescription drug is illegal. According to the UH 2017 Annual Security and Fire Safety Report, in 2016, UH-Central Campus saw 52 drug violation arrests and 46 drug violation referrals. The UH-Sugar Land Campus saw one drug violation arrest and zero referrals in 2016.

“[People] know [it’s illegal],” Garcia said. “Typically, people buy in small amounts so the dealers probably just know they’re going to take it soon and won’t get caught, or if it’s their friend then they won’t rat on them. Usually, if you’re not getting it from a friend then it’s a friend of a friend. Rarely ever is it a random person.”

Payal Patani, Community Prevention Coalition specialist with the Fort Bend Regional Council, said the coalition is aware of what the school district is doing for prevention, and they are working outside the schools to change social norms surrounding misuse.

“In more of an affluent community, money is not an issue, so access is very easily available,” Patani said.

In high school, Garcia said he noticed Adderall being passed around on and off campus, and he said he feels the longer he has been in college and the more people he knows, the easier it is to get Adderall.

Tilney said it is good to have conversations about stimulant misuse proactively and to stay aware of the fact that it is available starting at a young age.

“Not to sound cliche, but the benefits of exercise alone when you get the natural release of endorphins gives you a natural high,” she said. “[This] is hard for me to preach … with our schedules—take a moment to meditate or stretch. It’s easier said than done.”