Adderall: On the Razor's Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death

Abstract

Adderall, as a drug combination, is medically-approved for treating attention-deficit/hyperactivity disorder (ADHD) and nar-colepsy. The active ingredients of Adderall are central nervous system stimulants, affecting neurotransmitters and promoting the synthesis of specific neuropeptides. Pharmacological effects include increased physical energy, improved mental aptitude, hyperex-citability, and mood elevation. In ADHD, Adderall increases arousal, wakefulness, and motivation to execute a task, promoting goal-directed behavior. Regarding physical performance, amphetamine (Adderall) improves endurance and reaction time. Thus, Adderall is banned for use among professional and Olympic athletes. As well as benefits, Adderall has numerous mild to severe adverse effects (including death) and can result in physical and psychological dependence. The sudden cessation of the drug may cause paranoid delusion, psychosis, hallucinations, mood swings, suicidal ideation, panic attack, and tremor. Also, long-term use can result in tolerance to the drug. Adderall has high abuse potential as a recreational agent. It is misused as an academic-enhancer-known as "smart pills"-by students. Although medically-approved for managing symptoms of ADHD and in treating narcolepsy, Adderall has a high abuse and addiction potential and should be taken only if medically prescribed. Realistically, however, Adderall's off-label and unpre-scribed use will likely continue; if so, it should be taken with extreme caution and vigilance.

Full text

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OPEN ACCESS EC PSYCHOLOGY AND PSYCHIATRYEC PSYCHOLOGY AND PSYCHIATRY
Review Article
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic
and Physical Performance, Addiction, Psychosis, and Death
Nicholas A Kerna1,2*, John V Flores3,4, Hilary M Holets3,4, Uzoamaka Nwokorie5, Kevin D Pruitt6, Emmanuella
Solomon7 and Kyle Kadivi8
1SMC–Medical Research, Thailand
2First InterHealth Group, Thailand
3Beverly Hills Wellness Surgical Institute, USA
4Orange Partners Surgicenter, USA
5University of Washington, USA
6Kemet Medical Consultants, USA
7Obafemi Awolowo University, Nigeria
8Global Health Group LLC, USA
Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Contact: medpublab+drkerna@gmail.com.
Received: October 14, 2020; Published: November 30, 2020
Abstract
            -
colepsy. The active ingredients of Adderall are central nervous system stimulants, affecting neurotransmitters and promoting the
-

directed behavior. Regarding physical performance, amphetamine (Adderall) improves endurance and reaction time. Thus, Adderall

(including death) and can result in physical and psychological dependence. The sudden cessation of the drug may cause paranoid
delusion, psychosis, hallucinations, mood swings, suicidal ideation, panic attack, and tremor. Also, long-term use can result in toler-
ance to the drug. Adderall has high abuse potential as a recreational agent. It is misused as an academic-enhancer—known as “smart
pills”—by students. Although medically-approved for managing symptoms of ADHD and in treating narcolepsy, Adderall has a high
abuse and addiction potential and should be taken only if medically prescribed. Realistically, however, Adderall’s off-label and unpre-

Keywords: Amphetamine; Attention; Cocaine; Dopamine; Ecstasy; Hyperactive; Neurotransmitter; Smart Pills
Abbreviations

Control and Prevention; CNS: Central Nervous System; DEA: Drug Enforcement Agency; IOC: International Olympic Committee; IR: Im-
        
National Basketball Association; NCAA: National Collegiate Athletic Association; NFL: National Football League; WADA: World Anti-Dop-

DOI: 

Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and
Death
66
Introduction
          -
  

-


neurotransmitter (dopamine and norepinephrine) activities and trigger epinephrine, serotonin, and histamine release. They also pro-
        -
 
active ingredients is different. Compared to the racemic amphetamine, the drug combination has more potent CNS effects due to a higher
      
[5,6] (Figure 1).
Figure 1: Image of extended-release (XR) 25mg Adderall capsule. Source: public domain.
Discussion
Absorption
Following oral administration, amphetamine is rapidly absorbed by the small intestine, and the peak plasma concentration is achieved
-

for about 48h. The time to reach the peak concentration varies between individuals, but most likely occurs between 3h and 12h after drug
intake [3].
Pharmacological effects: cognitive performance
       -
  
tremor, insomnia, loss of appetite, and depression; these effects being primarily dose-dependent [7].

Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and
Death
67
-

of college students abuse ADHD drugs, more for enhancing academic performance than recreational purposes [8–11]. However, high-dose
amphetamine can impair working memory and diminish cognitive abilities [8,12].
Spencer., et al. (2015) reviewed currently available evidence on amphetamine and found that the drug improved cognition, working
memory, long-term episodic memory, inhibitory control, and attention span in normal, otherwise healthy individuals [7]. They reported
          
cognition enhancement associated with amphetamine use in healthy adults [7].
In a systematic review, Bagot., et al   
young adults for their abuse potential in improving academic performance [13]. The review included 14 studies with participants aged

-
over, it improved working memory in adults [13].
Pharmacological effects: physical performance
Amphetamine improves endurance and reaction time, primarily through reuptake inhibition and the release of dopamine in the CNS
[14,15]. Amphetamine and other dopaminergic drugs improve power output by facilitating a rise in the core body temperature by over-
riding the feedback inhibition process (“safety switch”) that occurs under normal physiological conditions [15,16].
At a therapeutic dose range, amphetamine does not decrease athletic performance, but a higher dose can cause an increase in body
temperature and a rapid breakdown of muscle mass [10]. Thus, amphetamine use is prohibited (unless indicated medically) for athletes
participating in any sporting event, and different national and international authorities regulate or prohibit its use [17].
                 
potential in improving performance. Amphetamine improves anaerobic performance with a modest effect on aerobic performance. Pub-
lished studies reveal that amphetamine improves the reaction time, especially when the athlete is fatigued, increases muscle strength and
endurance, facilitates metabolism by stimulating fat metabolism, and increases endurance. However, at higher doses, the drug tends to
promote aggressiveness. Amphetamine in healthy individuals was reported to increase muscle strength, acceleration, alertness, athletic
performance under anaerobic circumstances, and reaction time and delays the onset of fatigue [14,15].
Prohibition in professional and high-level sports
     -
ciation (NBA), National Collegiate Athletic Association (NCAA), International Olympic Committee (IOC), and World Anti-Doping Agency
(WADA) have banned the use of Adderall among athletes participating in sporting events [17,19]. The athletes are screened daily for the
presence of prohibited substances, including amphetamine, by accredited laboratories. In competitive sports, amphetamine comes under
Category S6, and its presence in urine is considered a severe doping offense [18].
Adverse effects
-
       

Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and
Death
68


accident (stroke) may occur [21,22]. Adderall (amphetamine) can produce both physical and psychological dependence. Thus, sudden
cessation of the drug may cause withdrawal syndrome characterized by paranoid delusion, psychosis, hallucinations, mood swings, sui-
cidal ideation, panic attack, and tremor [20,23].

reports of amphetamine-induced sudden cardiac arrest among cyclists during competition [25]. Amphetamine is known to mask pain


Adverse effects in long-term use
Prolonged use of amphetamine causes patients to develop tolerance to the drug. It may also cause physical dependence, often leading
to severe withdrawal symptoms [27]. Amphetamine-dependent individuals demonstrate signs of increased aggression, psychosis, and
anti-social behavior [26].
Summary (indications, contraindications, and prevalence of use)
     
-
havioral therapy. The drug is recommended to be taken in the morning due to its potential to interfere with sleep. Typically, Adderall is
prescribed at low doses, which is increased gradually based on the response and tolerability [3].
              
agencies due to its high abuse potential as a recreational agent and cognition- and performance-enhancer [28]. Adderall is misused as a
recreational drug and academic-enhancer (“smart pills”) by students [29].
-

its derivatives is banned in sporting events worldwide [32].
Figure 2: Comparative chemical structures of Ritalin (methylphenidate), Adderall (amphetamine),
and “Crystal Meth” (methamphetamine). Source: public domain.

Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and
Death
69


 
ADHD and prescribed Adderall or similar drugs in 2015 [26]. However, the massive surge in such prescriptions has led to increased ad-
diction to these drugs.
Conclusion
Adderall is medically-approved for managing symptoms of ADHD and treating narcolepsy. However, it has abuse potential as it en-
hances cognitive and physical performance. Adderall is misused as a recreational drug, academic-enhancer (“smart pills”) by students,
and performance-enhancer by athletes.
Long-term Adderall use and short-term use at higher doses result in mild to severe adverse effects, such as increased blood pressure,
elevated core body temperature, precipitation of psychosis, hallucination, delirium, aggression, suicidal ideation, and insomnia. Although

above-mentioned adverse events. Adderall use in athletes during stressful competitive events may precipitate sudden cardiac arrest,
resulting in death.
Several international and national regulatory bodies have prohibited the use of Adderall among athletes participating in sporting



-
less, when it comes to enhancing physical and academic performance, taking “smart pills” seems “unsmart” and misguided, especially in
the long-term, unless sensibly managed.



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Citation: Kerna NA, Flores JV, Holets HM, Nwokorie U, Pruitt KD, Solomon E, Kadivi K. Adderall: On the Razor’s Edge of ADHD Treatment,
Enhanced Academic and Physical Performance, Addiction, Psychosis, and Death. EC Psychology and Psychiatry 9.12 (2020): 65-71.
Adderall: On the Razor’s Edge of ADHD Treatment, Enhanced Academic and Physical Performance, Addiction, Psychosis, and
Death
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Volume 9 Issue 12 December 2020
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