The Partnership asked Dr. Alain Joffe, Director of the Student Health and Wellness Center at Johns Hopkins University, to weigh in on prescription stimulant abuse on campus

The Partnership: On your campus, are you seeing the non-medical use of prescription stimulants by students? At what level?

Dr. Alain Joffe: Yes, we are seeing this. It is hard to gauge how much. But students clearly state that it is quite common.

The Partnership: Many of the students we interviewed were nonchalant about the whole thing — they didn't see it as a big deal and most didn't see any angerin non-medical use of Rx stimulants. Is that what you're seeing as well? If so, why do you think this behavior has become so normalized?

AJ: Since I haven't seen any students who admit to non-prescription use it’s hard to say. Certainly students seem to indicate that it is a widespread behavior, so that tends to normalize it. But this is a tech savvy generation — a lot of them have done their homework and know that these medications are prescribed for ADHD and have a good safety profile. So I think they believe it will be safe for them. I don't think they think about possible drug-drug interactions.

The Partnership: What are some of the biggest risks for a student using Rx stimulants non-medically?

AJ: Drug-drug interactions for one. Students with underlying heart conditions or high blood pressure shouldn't take it, and I don't think anyone should start on any prescription medication without getting a health assessment first. You want to make sure there are no contraindications. We have seen students who use stimulants along with caffeine and no sleep, and come in nauseous with rapid heart beats and "freaking" that something really bad is happening to them. There’s also the problem of not knowing how much to use (dosage). If you're behind in your work and you want to stay up 2 or 3 nights in a row, you wind up taking a lot of Adderall or another stimulant, and you experience those adverse side effects.

The Partnership: Are you concerned about students’ use of non-medical stimulants? If so, why?

AJ: I'm concerned about any student using any prescription medication without benefit of a doctor's advice or supervision. The whole point of getting aprescription is so that a physician can review your medical history and determine what medication, if any, is right for you.

The Partnership: Are you addressing this issue on your campus?

AJ: We've done some programming on the issue.

The Partnership: Do you think there need to be more programs educating students about this on campuses?

AJ: Absolutely. Students need to understand the potential risk of using these meds without medical supervision.

The Partnership: What are some of the challenges in dealing with this issue on college campuses?

AJ: There is tremendous pressure to succeed, to be academically successful, and students are looking for any advantage they can find. They are under enormouspressure to be successful — being average is not acceptable to them or, too often, to their parents. So using these meds to enhance or augment study skillsis really appealing. And students don't usually see their peers getting into trouble using these meds, so they think they’re safe. If they have a friend with ADHD, they may have heard that friend talk about how their medication helps them study and focus. A student may legitimately wonder, "well, I could use that too." The meds don't make their friends sick, so they think they will be okay too.

The Partnership: What message would you like to give students about the non-medical use of prescription stimulants as a study aid?

AJ: There are risks to using them; we really don't know the effect of using these meds if you don't have ADHD. Using these medications will not make up for a lack of studying, nor will they make you a better writer. Without an assessment by a physician, you don't know if there are reasons you absolutely should not use them, or whether the medication could interfere or interact with one of your other prescription meds.

The Partnership: Is this topic being discussed among leaders of the college health services world? Or, when up against issues like alcohol use or other drugs, does it just get buried since use isn't as widespread?

AJ: It is becoming more widespread and I think people are beginning to talk about it. However, you are correct — compared to the morbidity and mortality associated with alcohol use, non-medical use of prescription meds is associated with fewer problems and so it is somewhat lower on the radar screen. As use becomes more widespread, we will need to watch out for increased morbidity and mortality. And of course we also have to watch out for non-medical use of prescription opioids — that too has me worried, especially if mixed with alcohol and the potential risk for addiction.

Dr. Joffe graduated from Columbia College and received his medical degree from the University of Michigan (Ann Arbor). Before joining the faculty at the Johns Hopkins School of Medicine in 1981, he completed a Masters in Public Health at the Harvard School of Public Health. Dr. Joffe is currently an associate professor of pediatrics with a joint appointment in the Bloomberg School of Public Health. His board-certifications are in pediatrics and adolescent medicine. Dr. Joffe is the founder of the Adolescent Medicine program at the Johns Hopkins Hospital. He’s published over 100 research articles, reviews, and book chapters pertaining to adolescent, young adult, and college health. From 1981 until 1997, he served as part-time medical director of the Student Health and Wellness Center until 2001 when he returned as full-time director. Dr. Joffe also recently completed a 3-year tenure as chairman of American Academy of Pediatrics’ National Committee on Substance Abuse.