Riding The A Train

This is your brain: Exam week. No time to sleep. Papers to write. Problem set in desperate need of solutions. No clean underwear left. Lab report due in three hours.

This is your brain on Adderall: What's next?

Mary, a senior, started taking "study drugs" during exam week of the fall semester her sophomore year. "It just makes my life easier," she says. It's four in the morning; she has been typing away for hours on her senior thesis. For the most part she only takes them when she's time-starved and overloaded with school work.

"It makes me more productive," she says. "But it doesn't make me smarter."

Between cigarettes and coffee, Mary says she can get by without Adderall-one of the most popular stimulants on campus. It's also, unless prescribed by a doctor, illegal. But when nicotine and caffeine are no longer enough, she takes 10 milligrams of the drug, getting it for free from friends with prescriptions-though once she paid $5 for a pill, getting it from another student when her friends were out-and taking them about every six hours. "You can get distracted while on it, and the time flies," she says. "You have to make sure you're working."

Mary's not the only one watching the clock. No group is more aware of the need to squeeze productivity into limited hours than college students. They go from class to jobs to club meetings to the gym in a frenetic bustle that leaves little time for relaxation or even studying. They don't sleep.

Or they sleep too much. They spend their Wednesdays over a toilet bowl, Thursdays back at the bar-but the night before the midterm they try cramming all of six books into six hours.

The result is a student body that increasingly uses prescription stimulants. Some studies estimate that as many as one in five college students will take a study drug before they graduate. These drugs, with brand names like Adderall or Ritalin, are complicated stimulants with even more complex sounding chemical compositions. But they're becoming a seemingly un-complicated solution for those that need a quick fix.

It's a drug culture supported by 24-hour libraries and endless pressures to do everything, be everywhere and succeed. They swallow it. Or they snort it. The odds are, the average Duke student knows where to buy it. Most everyone, it seems, knows someone who uses it. One junior overheard another student, during the middle of a class, lean over and ask a friend for a pill. Another reports that nearly half of his friends use the drug.

John is what studies say is a typical study drug user-white, male and in a fraternity. He started taking study drugs his freshman year to study for exams when a friend offered him a pill as if it were commonplace. Now he uses stimulants occasionally, when he's pressed for time and has to choose between sleep or academic work.

He thinks that some Duke students he knows, particularly those from wealthy backgrounds, have parents who are complicit in their study drug use. "They think it's a cure-all," he says, describing how often his friends who use the drug were first prescribed stimulants in high school after their parents arranged for them to meet with psychologists.

John also worries about the long-term health effects of using stimulants, for which there is little scientific data to consider. Prescription stimulants, which comprise a class of drugs called analeptics, are a tightly regulated pharmacological product. Ideally these drugs are carefully dispensed to those diagnosed with attention deficient hyperactivity disorder. Some stimulants have been linked to serious health problems; commonly reported side effects among adults include loss of appetite, difficulty falling asleep, stomach ache, headache and weight loss. Many users report dry mouth as a common problem. A Food and Drug Administration report found that 25 people died suddenly from taking ADHD medications from 1999 to 2003, and in early February an FDA advisory panel suggested these medications-including stimulants like Adderall and Ritalin-carry the agency's strongest warning label.

"The lack of sleep really catches up with you and you just feel exhausted," Mary says of the drugs' downsides. "The crash sucks."

But warnings about the drugs' dangers do little to deter students from abusing prescription stimulants. Even side effects seem to have little impact.

Not all students who burn the midnight oil are buying prescription drugs from friends. Websites abound with shady offers for stimulants through online pharmacies. At a gas station just two blocks from East Campus, ephedrine-based pills promising "Extreme Energy!" are within easy reach. Although the FDA banned ephedra, which has been linked to cardiovascular problems and even deaths, in 2004, not all drugs containing the substance have been pulled from the shelf.

The result is an ethical, and often legal, dilemma: Is getting ahead by taking a stimulant cheating?

Scientific studies have tended to conclude that stimulants improve concentration, but they don't necessarily improve performance. This makes ethical questions over the fairness of taking stimulants, particularly those found legally, murky. If taking a drug simply allows one to study for a longer time-by nixing sleep, for example, or sleeping less-but does not necessarily translate into a better grade on an exam, is that cheating?

"First I think there's a different ethical dimension in that it's a really bad way to take care of yourself to do this," says Elizabeth Kiss, director of the Kenan Institute for Ethics and a public policy professor. "Safety issues are an important part of this in that we want Duke students to be healthy-and respecting yourself and not jeopardizing your health is an important aspect of moral life. I also think it is unfair."

Senior Renee Chang thinks quite a few Duke students take stimulants to improve their academic record. And she thinks in doing so they are compromising their academic integrity.

"It's considered cheating in sports to take steroids," she says. "I think it's comparable."

Mary disagrees. "It's not cheating because it doesn't make you any smarter, any more than a shot of espresso does, or more able to answer on a test," she says.

Despite the moral questions, some students say study drugs-dubbed everything from "kiddie coke" to "the A train"-have become more socially accepted at Duke. It's a pharmacological solution with less stigma than street drugs like cocaine or meth. But students elsewhere use them too. A December report from Columbia University's National Center on Addiction and Substance Abuse found Americans abuse prescription drugs more than any illegal substance outside of marijuana.

And there might just be something about Duke that keeps the pills popping.

A University of Michigan study released last year found that, nationally, about seven percent of college students had reported using a prescription stimulant in a non-medical fashion.

The report found that white men in fraternities were the most likely to use study drugs. Sorority women were also more likely than independent women. Researchers also found that the highest rates of stimulant use-upwards of 25 percent of students-were at schools with highly competitive admissions standards and schools with higher rates of binge drinking. In a nutshell, Duke.

It seems fitting, then, that one of the most popular prescription stimulants is manufactured just a two-hour drive from Duke. DSM Catalytica Pharmaceuticals, Inc. produces Adderall for British-based Shire Pharmaceutical Group in a facility in Greenville, North Carolina.

Only time will tell whether current study drugs will stay student favorites or whether new chemical fixes will come along and take their place. Caffeine, nicotine, taurine, amphetamines-people are always coming up with ways to use chemicals and cheat time, at the very least. But what's next on the horizon?

"What worries me is if we start to move that line from what are generally accepted ways of keeping awake as opposed to [prescription stimulant abuse]," Kiss says. "It's pretty depressing."


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