It makes focusing on tedious assignments much less painful. It allows you to easily pull all–nighters. It lets you party longer and harder. It means you can drink more and black out less. It suppresses your appetite to keep you skinny. And it can be yours for only $12 a pill.
"It’s pretty cool. Have you seen the movie Limitless?” Pablo*, a senior in the college, asks.
He’s referring to a 2011 movie about a man who takes a fictional pill called NZT–48, which is composed of an untested chemical that improves focus and mental acuity so intensely that the protagonist quickly and easily becomes a Wall Street tycoon.
It sounds like the kind of pill that almost every Penn student would take if given the chance.
Of course, NZT–48 has dangerous, even fatal side effects, but that’s not what Pablo’s talking about. He’s talking about the power the pill has to increase concentration and cognitive ability. And Pablo’s talking about it for a reason—he’s comparing the fictional NZT–48 to a very real drug that he happens to take and sell: Adderall.
“It’s actually kind of incredible,” Pablo says.
He isn’t the only one who thinks so. A 2014 Pediatric Academics Society study found that 20 percent of Ivy League students abuse stimulants like Adderall to get ahead academically. To many people at Penn, though, that number seems conservative. Estimates on the percentage of students misusing Adderall, from individuals interviewed for this piece, range from 40 to 70 percent. And while their estimates are based on anecdotal evidence, the fact of the matter is clear: Adderall is, or at least seems to be, everywhere.
Sarah*, a junior in Wharton who buys Adderall illegally, talks about stimulant abuse the way one might talk about the weather: with only the slightest hint of interest.
“You’ll see it happening in Huntsman and stuff. Especially in the quiet study room. I don’t think anyone cares at this point. Everyone knows that half the people in that room are gonna be on Adderall,” Sarah says.
Its prevalence represents something much more complex than the general desire of Penn students to garner a competitive, academic edge. In some ways, a 20 mg tablet of Adderall should be our mascot. It’s an emblem, the perfect expression of our academic and social anxieties, the work–hard, play–hard wonderdrug. And it’s not going away.
* * *
What is it?
Adderall (a mixture of amphetamine and dextroamphetamine), as well as other drugs prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) like Ritalin and Concerta, causes a slight euphoric effect in the brain by mimicking the structure of notoriously feel–good neurotransmitters, like dopamine, and binding to dopamine receptors. This is similar to the effect that other stimulants like methamphetamines (meth) or MDMA (ecstasy) have on the brain. Simultaneously, Adderall simulates the effect of norepinephrine (commonly known as adrenaline), which triggers the body’s fight–or–flight response. This is where Adderall’s legendary, focus–inducing effect comes into play. The same way your body needs to be able to zero in on the task at hand when you’re, say, running away from a tiger, your brain on Adderall takes your midterm paper to be a singularly important, life–or–death task. It sets aside external stimuli and forces you to concentrate until the drug is flushed from your system.
This kind of hyperfocus is necessary for individuals who have ADHD just to get to an even playing field, but it’s simply a form of cognitive enhancement for those who do not. Medically–assisted cognitive enhancement is what Dr. Anjan Chatterjee, the chair of neurology at Pennsylvania Hospital, calls “cosmetic neurology.” Dr. Chatterjee coined the term in a 2004 paper to describe neurotechnologies, including pharmacological interventions like Adderall, that healthy, “normal” individuals use to enhance their cognitive abilities.
“Calling it cosmetic neurology was by analogy to cosmetic surgery, where the same surgical procedures that were used to reconstruct facial injuries and various facial deformities then started being used in people who didn’t have those kinds of disfigurements and to enhance people’s appearance. It’s the same sort of thing, enhancing people’s cognitive and emotional states when they’re within the range of a normal distribution,” Dr. Chatterjee explains.
This kind of enhancement is exactly what most Penn students are looking for when they pop a pill to study for a test or write a paper.
Pablo, who acts as a middleman–type Adderall dealer (in that he doesn’t have his own prescription, but he sells someone else’s extra pills), believes that he, alongside the majority of his 40+ person client list, doesn’t actually need the medication. He just likes it.
“I just do it because it makes me feel really good, and I know I’m gonna be super productive, and I happen to know that I write better when I’m taking Adderall...For the most part, I would say people think it’s just like, a nice thing,” Pablo says. “An added bonus.”
* * *
Is it Legal?
It’s a nice thing that comes with some risks, though. Adderall is classified as a Schedule 2 controlled substance by the Drug Enforcement Administration (DEA). Schedule 2 drugs are the most addictive substances that simultaneously have a medical purpose (by contrast, Schedule 1 substances are those drugs that have a high risk for abuse and no accepted medical purpose, like heroin or ecstasy). While many people don’t consider Adderall to be particularly risky, the DEA lists it as having the same potential for abuse as drugs like cocaine, OxyContin and morphine—which means that it carries the same legal risks. Despite the reality that selling (or even giving away) prescription Schedule 2 drugs can be prosecuted as a felony, Penn students who sell and buy these drugs seem to have almost no fear of getting caught.
One such student is Abel* (C’16), who sells his prescribed Adderall to friends and “small circles” of his friends’ friends. Abel doesn’t really think of himself as a drug dealer.
“I don’t know. Drug dealer to me has all these other associations of like, slimy and money laundering and all this shit. And I guess I do that. But I don’t really view myself in the same way as somebody who deals. Like, I definitely don’t think I’m in the category of people who deal, like, heroin and meth and crack because you’re ruining people’s lives with that stuff,” he says, cracking a smile and adding, “But yeah, I guess I am a drug dealer, by definition of selling drugs to people.”
Drug dealer or not, Abel isn’t afraid he’s going to get in trouble for selling.
“I’m less and less afraid every day of getting caught. I feel like the police here care more about the image of the school than catching people who are selling drugs that help people study and get higher grades. We’re almost helping the image of the school. And it’s going to hurt if we get caught and that becomes news.”
Similarly, Pablo, who jokingly says he prefers to think of himself as more of a “salesman” than a dealer, also doesn’t worry about getting caught, but for a different reason: He actively tries to avoid finding out what the dangers of prescription drug dealing are.
“When I decided that I would sell, I googled the risks, and they were pretty serious so I put it away. I was like, I don’t want to know, I’m just going to be careful,” Pablo said, adding somewhat sheepishly after a pause, ”It’s sort of a federal crime, isn’t it?”
* * *
Is it Fair?
At the going black–market rate, not everyone can afford Adderall. While the value structure varies slightly from dealer to dealer, the general price for the drug is structured on a scale of 50 cents per milligram, or $10 for a standard, 20 mg, instant release (IR) pill. Prices decrease slightly if you’re buying in bulk or buying extended release (XR) pills, since XR pills don’t work as well for some people, and thus can be harder products for dealers to move. No matter what you’re buying, Adderall comes with a hefty price tag.
Joan*, a sophomore in the Engineering school, says that the price of the drug is what keeps her from using it too frequently.
“Since they’re so expensive, I don’t use them as much as I wish I did, since I find them wildly helpful…. It’s a luxury when I can because it’s like, I can study. I wish I could take it every day,” Joan says. “I don’t have the money for it. But like, kids here definitely have the money for it. So the richer you are, the more prevalent it is.”
In some ways the Adderall marketplace exemplifies in microcosm the broad class struggles that underscore our social and academic lives at Penn. Adderall might seem like it gives users just a slight edge—after all, it’s a tiny pill—but the advantages it can provide can be the difference between getting an A and a B in a tough class, or a job offer and a rejection letter.
Dr. Chatterjee expands on this issue. “The use of this kind of enhancement to try to help people get, whether it’s better grades or something else, is just part and parcel of that ultra competitive, winner–take–all environment, where if some people have a slight advantage, the belief is that it gives you disproportionate rewards.”
The ethical concern about using Adderall for cognitive enhancement, then, becomes one of distributive justice: Is it okay for some people to have a cognitive leg–up over non–Adderall users, simply by nature of their financial circumstances?
And, as Dr. Chatterjee explains, it’s possible that many of us are okay with this kind of distributive inequality simply because it has historically worked in our favor.
“Fairness is an issue, and that gets back to this distribution, this inequitable distribution [of Adderall]...Most people that are beneficiaries of the unfairness say yes, it’s okay. Just by definition, if you’re at Penn you’re already the beneficiary of some of these unfairnesses,” Dr. Chatterjee notes.
Pablo echoes this sentiment, saying, “I took [Adderall] my junior year and got much higher on my SATs. And I’m sure maybe like, two percent of juniors who took the SAT that year took Adderall, or maybe like five percent, but some very small percent. So is it fair that I took it? No, it’s definitely not fair...Probably the people who took Adderall are also the people who got tutored, and are white and went to private school.”
* * *
Is it Safe?
Noelle Melartin, the Director for the Office of Alcohol and Other Drug Program Initiatives, sits beneath a poster that reads, “Prescription Stimulant Abuse Won’t Make You Smarter. You’re Smart Enough Already.” She later gives me the poster to keep.
She explains that taking drugs that are prescribed to someone else is inherently dangerous. Doctors write prescriptions only after taking in a patient’s complex web of personal variables, such as her height, weight, pre–existing health conditions and other medications. Melartin’s stance on the issue is firm.
“Unless you have had an evaluation by a prescriber, you really can’t make any assumptions about how safe it will be for you as an individual,” she says.
Some students who have prescriptions, though, don’t seem to be as confident as Melartin is that a doctor’s involvement is a check on abuse.
Abel explains that his doctor readily wrote him a much higher prescription than he thinks is reasonable.
“I’m prescribed 60 mg of Adderall a day. I probably take 40 to 60 mg of Adderall a week. So I am severely over–prescribed, which then means I can turn the rest into profits if I find people to sell to,” Abel says, adding, “I honestly think my heart would physically explode if I took 60 mg of Adderall every single day. I’ve taken 30 mg and felt like that before, so I don’t really know what [my doctor thinks] I do with it.”
Pablo agrees. While the friend who gives Pablo his supply of Adderall acquires the drug legally through a prescription, Pablo believes the doctor doesn’t know or care that his patient does not actually need the pills.
“I mean, it’s so easy to get a prescription from what I hear,” he says. “So if you have a prescription and don’t need it, it’s an easy way to make a quick $150 on something you don’t need.”
* * *
Is it a Party Drug?
Melartin is not just concerned with the off–label use of Adderall for cognitive enhancement, though. She also worries about it being used as a party drug.
“Taking it recreationally can be particularly risky if you’re also drinking at the same time. Any time you’re mixing substances or mixing any kind of drug with alcohol, it’s impacting two different parts of the brain at the same time. It can also have a similar impact as cocaine,” Melartin says.
Her fears are echoed by Dr. Chatterjee, who offers a medical basis for the concern about the recreational use of Adderall.
“If you’re snorting it, that’s different than it dissolving in your stomach and gradually coming in. And so I can imagine that that would have a huge, quick bump in people’s blood pressure, for example, that could predispose even young people to having strokes and brain hemorrhages and things like that,” Dr. Chatterjee notes.
And their apprehension isn’t unfounded. Penn students don’t just take Adderall to study: That would only encompass half of our work–hard–play–hard aesthetic. We take it to party as well.
That being said, Abel believes that of the subset of students who can afford Adderall, it’s an even smaller subset who are willing to pay to take it to go out.
“I think for rich kids it’s less about studying and more about snorting it and partying with it,” Abel says. “Pretty much everyone buys it, at least from me, to study. Most people who are going to buy something to snort are probably gonna buy coke and just skip the Adderall altogether.”
But individuals like Sarah*, poke holes in Abel’s theory. She buys Adderall to study, but she also buys it to party.
“I will buy it to snort it, like if there’s an event coming up and I know I’m going to want to use Adderall and I don’t have any left, I’ll buy it,” Sarah says.
Joan, by contrast, doesn’t take Adderall to party consistently. She’s tried it before, though, based on her friends’ glowing reviews of Adderall as a party drug.
“Somebody mentioned it to me as, ‘It’s the little brother of cocaine,’ which I thought was funny. People say it gets them more fucked up without having to drink more, and then another person told me it makes them blackout less,” Joan explains.
The comparisons of Adderall to cocaine come up exceptionally frequently.
Pablo takes Adderall orally whether he’s using it to study or party, because, as he explains, “Snorting stuff kind of geeks me out.” He says, “It’s like baby cocaine...you can just go straight through the whole day and night. It keeps you up longer and you can keep drinking and not really get to the point where you’re, like, stumbling and incoherent and not functional.”
In the same way that Adderall helps you push through when you’re studying, it helps pull you together when you’re drunk, partying and wanting to keep going. Abel explains Adderall works to steady him when he’s drunk.
“Snorting Adderall is a lot like taking it, just faster. So you don’t have to wait like, a half hour, but it’s the same thing. You just stay awake, and you feel a little bit more focused, and if you’re drunk you feel a little less drunk and more stable. If you have the spins and you can’t figure out what’s going on and you snort a line you feel a lot, like, clearer.”
* * *
Is it a Culture Problem?
There’s a lot of talk about the ethics of unprescribed Adderall and the comparative advantages it offers its users, but maybe the real moral question isn’t about the pills at all. Maybe the drugs are just a side effect of a larger cultural phenomenon, in which we over–emphasize performance at the expense of safety and mental health.
Dr. Chatterjee certainly thinks so. “To go right after the use of the drugs, I think, misses the larger point. Because you’re just trying to deal with a symptom of a bigger cultural trend...But then Penn gets stuck in the same thing, because they want to be in the US News and World Report top whatever, right, ten schools, so then what's the criteria for that? Penn plays to the test of getting that. So I think it is a very deep and pervasive phenomenon,” he says.
So many of us were under the misguided impression in high school that getting into college was the goal. But it turns out, the rat race never stops. There’s always another hurdle to jump or award to compete for or title to earn, and for many Penn students, that’s where Adderall comes in: It’s simply a means to an end, a weapon in the never–ending arms race for increased concentration and cognition as a way of improving performance.
College junior Regina*, who has an Adderall prescription that she uses infrequently, puts it succinctly: “I don’t crave [Adderall] when I’m not on it, like even when I’m feeling stressed or overwhelmed or depressed or like feeling like I want to cry, like I’d rather do it, I’d rather just like cry and deal with it. And in high school I would just take a mental health day. In college, there are no mental health days.”
Regina sounds sad as she explains what she means when she says that Adderall is the tool that lets her push through the days when she would otherwise be overwhelmed. She does not revere the drug.
She seems resigned as she says softly, “For me, it’s just the sacrifice that I make because I need to get my work done and I need to do well...I see it as I’m taking it for a purpose, and that is, to achieve a goal, to do well in school so that I can succeed in life.”
* * *
Adderall, for many, has become something like a handrail on the winding path towards success, and even students who have moral or safety concerns about it have come to see it as something like a necessary evil. Sarah is one such student.
“I think I don’t need it, and I’m using a drug that I don’t need, and I know that’s wrong. But like, I’m not stopping,” Sarah says. “Studying has become so important to me. Like, doing well, since I started doing well, has been my number one priority, so I don’t think I’ll stop. I think I’d like to stop, but I don’t think I would.”
Mikaela Gilbert-Lurie is a junior studying Philosophy in the College. She is the Managing Editor for Street.