You're trying to focus on your work, but stray thoughts bombard your brain and you can't think straight. You try to hold down a coherent conversation, but you keep thinking of tangents. Following instructions is a real struggle.
These are some of the symptoms of attention deficit hyperactivity disorder (ADHD). If you're one of the roughly 6.4 million kids or 10 million adults in the U.S. diagnosed with the condition, you've probably taken adderall, a drug that's been dubbed America's favorite amphetamine. And if you haven't been diagnosed, you've perhaps bummed a pill off of a prescription-toting friend in order to finish a long-overdue project or to get in a night of focused studying before that big test.
Doctors have been prescribing amphetamine, a psychoactive drug, for more than a hundred years. These days, it's used to treat ADHD, obesity and narcolepsy, though recently, a new formulation of amphetamine, dubbed Vyvanse, has been approved to treat a new (and controversial) condition known as binge-eating disorder, which is exactly what it sounds like.
Amphetamine was first discovered in 1910, but it took 17 years before scientists cooked up a batch in a lab, and even then it was by accident. The guy trying to synthesize it was actually trying to make ephedrine, a decongestant and appetite suppressant.
When it first hit the market in 1935, amphetamine was sold as a treatment for narcolepsy, a brain disorder that disrupts sleep-wake cycles, depression and some movement disorders. Doctors came to think of it as a sort of cure-all. People also started noticing that it had some powerful cognitive-enhancing effects, and soon students, medical professionals and academics were using it to improve job performance.
At one point, it was actually available without a prescription. Long before it became the go-to med for ADHD, it was widely distributed to British and American troops during World War II as a stimulant to promote wakefulness. As many as 150 million pills of the stuff were doled out to troops during the war, much of which is thought to have ended up on the black market. Soon after, clinicians started documenting cases of amphetamine abuse.
Amphetamine, like flakka, works by disrupting how neurons, or brain cells, use dopamine and norepinephrine, to transmit information. The brain uses dopamine to send messages about rewards and movement, and norepinephrine for fight-or-flight responses. To fully understand how this works, you need to know a bit about how the brain processes information. Let's use dopamine, one of the brain's feel-good substances, as an example.
Say you've been playing at a slot machine for hours, losing your hard-earned cash when suddenly, you win!! Neurons in the part of your brain that process rewards release dopamine. This dopamine travels a short distance and lands on neighboring neurons to relay that "ooooh! yeah!!" message. But there’s usually more dopamine released than is needed to make you feel good. (It’s a little bit like bringing extra cookies to a potluck to make sure everyone gets their fill.) So a dopamine reuptake pathway kicks in to vacuum up the excess. Otherwise, you might get a little too euphoric about that $5 jackpot.
Amphetamine blocks that reuptake process, so that dopamine and norepinephrine hang out between neurons for longer than usual. Beyond making you happy and making you run from danger, dopamine and norepinephrine are involved in helping the brain with alertness and concentration, so the boost in these two compounds helps people stay focused. For patients with narcolepsy, it helps them stay awake.
These effects are probably why adderall is popular among students. A 2010 study found that college students don't think of it as a drug and that they see adderall as "harmless and morally acceptable." Most tend to get it from a friend. Another study found that non-prescription use of the drug was more common among college students who were "male, white, members of fraternities and sororities and earned lower grade point averages."
Some kids have even created their own adderall "commercials" on YouTube to sing its praises. One, set to the tune of Fiona Apple's Paper Bag, stars a student with writer's block who snorts some adderall and moments later is writing her magnum opus. "It's the key to success," reads the final caption. Another calls it a "miracle pill" that'll help you clear your head of stray thoughts and finally focus. Yet another actually goes into some of that drug's common side effects, like sleeplessness. And of course, there's a 'Shit Adderall Kids Say' reel.
Adderall is really a combination of two mirror versions of amphetamine, dextroamphetamine and levoamphetamine. They're made up of the exact same atoms, but because they're mirror images they have different properties. It's kind of like your hands. Your left and right hands each have a palm and five fingers, but try using your left hand on a right-handed set of scissors, and, well, it doesn't go so well. That's because the fit isn't quite right. The same is true with these two versions of amphetamine. Dextroamphetamine, the right-handed version, is better at interacting with the molecules in the brain that vacuum up the excess dopamine and norepinephrine. That's why it was used as an antidepressant up until the 1950s.
Despite what college kids might think, using amphetamine can have some adverse effects, including increased blood pressure and heart rate, nausea, vomiting, diarrhea, restlessness, chest pain, paranoia, fever, seizures, sleeplessness and changes in appetite. Between 2005 and 2010, the number of emergency room visits related to adderall and other ADHD-related drugs more than doubled. Adderall can also be addictive. Amphetamine was put on the federal list of controlled substances in the 70s because of its addictive properties.
Although amphetamine gets a bad rap, it's not as addictive as alcohol, tobacco or cocaine, says Carl Hart, a neuroscientist who studies addiction at Columbia University. Addiction develops in somewhere between 5 and 10 percent of people who use it. In contrast, alcohol, tobacco or cocaine carry addiction rates of 15, 33 and 20 percent, respectively. And under the supervision of a doctor, addiction is even rarer because the doses doled out are low and (at least in theory) well-monitored by the prescribing physician, he said. The notion that there's an adderall epidemic raging in campuses, he said, is also overblown. Some studies do suggest that overall use among high students has gone down a little bit, but they also report that it's becoming more common among older students. Among competitive gamers, though there's been some reports of doping with adderall to improve performance. That's led some competition organizers to implement random drug screening.
Still, the real cause for concern when it comes to adderall and amphetamine is its effects on sleep and appetite, he says. Not sleeping can enhance the drug's psychotic effects, leading to displays of psychosis or paranoia, for instance. And not eating negatively impacts health. People also tend to mix adderall use with drinking alcohol, which can cause problems.
Hart thinks the real conversation around adderall safety should focus on prescriptions given to young children.
"We're being too quick to put kids on medications," he said. "We talk a lot about marijuana and children, saying, 'Well, the brain is still developing.' We never have that conversation with adderall, when in fact adderrall is a psychoactive drug…If you're going to have a discussion about the developing brain and the potential negative downstream effects of schizophrenia or psychosis, you should be having that discussion with adderall more so than marijuana."
Echoing that concern, the U.S. Centers for Disease Control and Prevention's Principal Deputy Director Ileana Arias recently said that doctors should opt for behavioral therapy first when dealing with children with ADHD under the age of 6 instead of putting them on meds straight away. Other scientists have voiced concerns that doctors are overprescribing amphetamines across the board.
For more on drugs, check out Drug Wars.
Daniela Hernandez is a senior writer at Fusion. She likes science, robots, pugs, and coffee.