In June 2010, The Daily succinctly summarized the debate over the use of Adderall and other cognitive stimulants by students without a prescription: “Some consider it the academic equivalent of performance-enhancing steroids; to others, it’s just a mental booster on par with a large jolt of caffeine” (“All about Adderall,” June 3, 2010). How should we reconcile the gap between these two streams of thought? The question is more than theoretical, for although Adderall is classified as a Schedule II controlled substance – a category that includes cocaine and methamphetamine – it is probably safe to assume that more students at Stanford are using Adderall than these other drugs. Though there are no public figures for off-label ADHD-medication usage rates at Stanford, studies at other colleges report student usage as high as 34 percent of the general student population to 48 percent of students within the Greek system.
How should an institution like Stanford respond to the use of cognitive stimulants, especially in its substance use education? Should these stimulants be treated like alcohol, with efforts focused on safe and responsible consumption rather than a draconian crackdown, or does the illegality of off-label stimulant consumption merit a harsher stance? The primary concerns over Adderall consumption fall into two clusters: moral considerations like equality of access and academic integrity, contrasted with more practical concerns over safety and campus culture.
Some view illegal cognitive enhancer consumption as academically dishonorable. We, however, believe the off-label use of cognitive enhancers should not be considered cheating on par with plagiarizing an essay or copying answers during a test; with cognitive enhancers, the work is still done by the student himself, and there is evidence that cognitive enhancers limit creativity. Additionally, there are moral concerns over equality of access. Whereas caffeine is available for free in the dining hall, students often charge each other for stronger cognitive stimulants. Are wealthier students more likely to purchase off-label stimulants, and if so, is this advantage fundamentally unfair? If it is unfair, is it distinct morally from the fact that wealthier students are also better able to afford private tutors and other study aides above the level provided for free by the University?
Regardless of one’s stance on these ethical questions, we believe that practical concerns offer stronger reasons for being opposed to off-label consumption of cognitive enhancers. Adderall, for example, can have dangerous interactions with other medications or health conditions. Taking Adderall alongside antidepressants such as MAO inhibitors can be fatal, and preexisting conditions like high blood pressure can also result in harmful effects. In addition, Adderall and similar drugs can be habit-forming. In general, students are unlikely to read the fine print when getting a pill from a friend or classmate as opposed to a doctor, and may not realize that they’re at particularly high risk for a bad reaction to a cognitive stimulant. Furthermore, a drug’s approval is contingent upon the estimated benefits and risks for the clinical population at which the drug is aimed, and using cognitive stimulants electively may tilt the balance of benefits and risks.
In addition, several issues of social norms and campus culture arise. As discussed in our Monday editorial, Stanford students can get caught in an unhealthy, “work hard, play hard” spiral. Amidst this overburdening, taking cognitive stimulants becomes another status symbol that you’re working hard and taking advantage of the opportunities Stanford offers. As political philosopher Michael Sandel observes in “The Case Against Perfection,” “Unlike the drugs of the sixties and seventies, Ritalin and Adderall are not for checking out but for buckling down… a way of answering a competitive society’s demand to improve our performance.” Cognitive stimulants can thus be a reflection of a work-obsessed college culture, and the danger may lie less in their medical ramifications than in the productivity-at-all-costs ethos they promote.
In short, the potentially widespread off-label consumption by students who may not be aware of dangerous interactions with other medications merits an active – though not necessarily extensive – endeavor to include discussion of safe usage in health education efforts. We should also be aware of the campus culture that widespread usage of cognitive stimulants may promote. Cognitive enhancers, and perhaps all stimulants, should receive some stigma for promoting this workaholic ethos, and the added safety concerns they entail when used off-label point to a need for more discussion of the risks of their usage.