“Almost everyone I know with a prescription has given or sold Adderall,” says Tufts student Rachel*. She takes legally prescribed Adderall to treat her diagnosed ADHD but skips weekend doses to have a few pills left over. She started selling and gifting these high-value commodities when friends learned of her diagnosis. Rachel only sells a few pills every other week during most of the year, with an uptick in demand around finals. The cream of the crop, the 25-milligram extended release, sells for around $15 per pill. To Rachel, who only sells the prescription stimulant to a handful of close friends, it is as much an act of kindness as a business transaction. “Part of me enjoys seeing people I know benefit from getting more work done,” she said, noting that any good person would be “inclined to share.”
Adderall is an amphetamine, a class of stimulants that blocks the reuptake of neurotransmitters like dopamine and norepinephrine. Doctors prescribe it to treat Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD). Adderall is classified as a “Schedule II” drug, sharing the second most restricted classification with more commonly known drugs of abuse, such as cocaine and oxycodone.
According to Rachel, the use of Adderall—and similar substances under different brand names—is commonplace at Tufts, both with and without a prescription. Research on U.S. college students paints a similar picture. An eight-year longitudinal study at a mid-Atlantic university found that over one-third of undergraduates had used prescription stimulants nonmedically, second in prevalence only to marijuana. American Addiction Centers explains that female college students are “two times as likely to misuse stimulant medications than their noncollege counterparts.”
Why is stimulant abuse so common? For some, the motivation is productivity enhancement. Over a decade ago, The New York Times reported growing levels of unprescribed ADHD drug use in business and professional settings. Tufts sophomore Bill* takes Adderall infrequently, buying spare pills from his friends to get an extra edge when studying for midterms and writing essays. “Every world leader should be taking Adderall,” he argued. In fact, he wondered why more students don’t enhance their academic abilities with these substances.
Many others at Tufts prefer to characterize unprescribed stimulants as an expedient way to level the academic playing field. John* is both a user and supplier of unprescribed Adderall pills on campus. He sells to a somewhat more extensive network, buying bulk orders of 100 to 300 pills and selling them for $4 each. His customers also tend to buy in bulk, often 10 to 20 pills at a time. Despite this scale, John still sells primarily to friends and acquaintances, intentionally avoiding the moniker of “campus dealer.” He gets “street Adderall” via an online dealer “from the South” who sells other illicit substances. “Street” or “pressed” Adderall is a black market alternative to the legal pharmaceutical option, without the “techie stuff,” like extended-release technology. John’s pared-down version brings a more immediate and acute, shorter-lasting response.
John has been “self-medicating” with Adderall for a couple of years and calls the drug a “game changer” for himself and others who “don’t have the time, energy, or funds to get the specific healthcare that [they] need.” John envies those whose internal motivation allows them to spend long hours studying. For him, Adderall is just enough to “get over the hump of motivation” and perform routine tasks like cleaning his room or calling family members. Rachel, the other dealer, simply calls Adderall “caffeine plus.”
John and his customers point to the pandemic as the genesis of their struggles with motivation and distraction. There has “never been this rate of distraction,” John said, recalling classrooms full of people playing poker and other online games. Many students spent a year online with their phones open just below the Zoom screen while grade inflation suppressed motivation. John hypothesizes that students were “supposed to figure out how to study seriously” or, at the very least, “put a little bit more effort in.” Digital diversions inhibited this process.
Though John and Rachel extol the benefits of prescription stimulants, they are an imperfect solution for the academic deficits that accrued during the COVID-19 pandemic. When asked about “enhancement,” John recounted his consumption of Adderall right before an exam he had neglected to study for. Despite entering with naïvely high expectations, he ultimately concluded, “It just made me fail fast.”
For some, of course, Adderall and its sister drugs are prescribed as medically necessary stimulants. “People who take it unprescribed might very well have ADHD,” argued Emmett Dyer ’27, who was himself diagnosed with ADHD and subsequently prescribed Vyvanse around two years before coming to college. For Dyer, the Adderall equivalent was more than just a study drug. It “completely changed my motivation,” he said, helping in numerous areas of life that are “beyond just academics.”
For Michelle*, an Adderall prescription resuscitated her attention span after several unsuccessful rounds of behavioral therapy. Taking Adderall made “normal functional things like impulse control or organization…a lot more manageable” for her. Michelle says her parents, who are both doctors, researched the medication extensively and found that it was by far the most effective treatment for her ADHD. John agreed that “mental health is a super valid reason to not be doing well in a class” but wondered how students can cope when “all of our mental health is shit.”
John sees some demographics using and abusing Adderall far more than others. “Anyone who goes to a private school is probably either okay with it or on it” and “know[s] someone who could sell it to them,” he said. Taking stimulants is a “culturally accepted thing” in private high schools. Current research paints a more complicated picture. Prescribed stimulant use among high school students is higher in private school settings, but non-prescribed use is higher in public schools.
An increasing rate of prescriptions is supplying the growing illicit market. Rachel has always found it easy to complain to her doctor about increased ADHD symptoms and return home with a higher dosage. In a CDC analysis, women aged 15 to 44 and men aged 25 to 44 saw their prescription stimulant fills increase more than 10% from 2020 to 2021. “With greater health care accessibility, the change in demand—and manufacturers not being able to keep up with that demand—led to some shortages,” explains PBS. In a college town like Somerville, Dyer is rarely able to fill a prescription at the Davis Square CVS.
But the accessibility of these drugs varies by income level. Dyer’s insurance does not cover his Vyvanse refills, resulting in a hefty monthly price. In John’s case, prohibitive costs drove him to the black market. John initially sought expert help for his executive functioning issues but could not afford the several-thousand-dollar price tag of the neuropsychological evaluation necessary to diagnose him with ADHD. Worst of all, “If you don’t have good insurance,” you are out of luck, he said.
No matter who’s using it, however, Adderall has its downsides. The National Center for Health Research warns that “study drug” abuse does not make students “smarter” and instead can lead to insomnia and weight loss (the latter of which is sometimes a motivation for abusing the drug) as well as potentially fatal risks for users with heart conditions. In addition to these concerns, the pressed alternatives to legal pills notoriously carry a high risk for other, more dangerous additives.
Rachel, who has been taking Adderall pills since the fifth grade, resents needing a substance to be productive. When she was first diagnosed with ADHD, Rachel felt like a different person on the drug. She admits that she “relies” on it but has only seen one instance of clear dependence among her customers.
Many other sources, however, cited dependence as a real concern. John’s longest-running customers began taking the pills “just for midterms” but eventually increased their usage. Bluntly, he added, they are “definitely dependent.” John argued, though, that this dependence is unlikely to be a chemical addiction. John added that he would surely cut off a customer if he were truly worried about their use, given that many of them are his friends. John’s main fear is multi-drug dependency, which he has seen develop in users who try to counteract Adderall’s harmful effect on their sleep with other substances. “Alcohol and stimulants mix in your body till they create a much worse stimulant” that can prove more addictive, he explained. If you stop taking the concoction, “you go through stimulant withdrawal.” Even prescribed users like Dyer and Michelle reported feeling unmotivated and lethargic when pausing their stimulant intake.
Whatever the cause, it is clear the use of “study drugs” is widespread and here for the foreseeable future. Whether they are using prescribed medication, self-medicating on counterfeit pills, angling to get ahead, striving to catch up, or anything in between, a growing number of Tufts students are medicating with stimulants as a standard part of their academic careers. Problems of access, dependence, and more persist while Teva Pharmaceuticals, Adderall’s manufacturer, trades at 83% higher today than at the beginning of the pandemic. Perhaps it’s time to ask ourselves who is benefitting from the current rise in “study drug” use and who is being left behind.
*This name has been changed to reflect the interviewee’s desire for anonymity.
Photo by Sascha Dembling