The Use of Unprescribed Stimulants
A recent new item quoted a university faculty member, concerned about the use of unprescribed stimulants on campus, warning that the stimulant medications can be dangerous. Epidemiological studies have been unable to find any difference in mortality rates between those taking stimulants and those not. Serious adverse effects like psychosis, seizures, or coronary events are very rare and occurs largely among those who have a predisposing medical condition. Except for occasionally increase in blood pressure, most side effects, like mild appetite loss or insomnia, are obvious and manageable.
Since the tolerable dose of stimulants varies among individuals by a factor of over 20, dosage can only be determined only by trial and error. It is not correct to use the use of a “high dose” as evidence of misuse. In fact, side effects that result in the termination of treatment most often occur at low dose levels among people just starting to take them. It is important that everyone taking stimulants have a professional evaluation and periodic contact with a prescriber experienced in their use to help avoid problems or deal with them when they arise. Most people can take stimulants with no problems,it is wise to have a clinician review the person’s health condition, family history, medications they are taking (especially ones that might seriously interact with the stimulants), history of drug and alcohol use, and assess whether there might be some other condition causing their problem or complicating it.
It is true, as the faculty member stated, that warning about 20 deaths from Adderall worldwide appeared in a Canadian report in 2005. However, the report was officially withdrawn the same year after it was shown these deaths occurred among 3.45 million people taking Adderall, indicating that the mortality rate was no greater than among unmedicated populations.
The statement that “stimulants speed up the nervous system” is at best an oversimplification. The stimulants do have an adrenalin-like effect similar to that of exercise, mild fear, or fascination. This may result in an increased heart rate, insomnia, appetite loss, or increased energy but most people do not experience these effects more than very mildly. However, among people with ADHD, it usually results in clearer mental focus, greater persistence, better organization, and easier access to information stored in the brain.
Though addiction to stimulants marked by physical withdrawal symptoms is extremely rare and there is no craving upon withdrawal, dependence on them for maintaining adequate cognitive function is quite common. Many people who function better on stimulants are usually reluctant to stop them because they know that when their symptoms return they will once again feel depressed about their inadequate functioning and anxious about their constant failings. This, however, is not addiction.
It is tempting but ultimately unwise to use exaggerated warnings about the risks of stimulants as a way to discourage their unprescribed use.
