Many of my fellow pharmacists have watched the Netflix documentary about Attention Deficit Hyperactivity Disorder drugs (stimulants) called Take Your Pills. I decided to see what the hype was about and watched it myself. I feel like it is very important and relevant in today’s world, and to many different demographics.
As a pharmacist, I have filled a lot of stimulant prescriptions for ADHD such as Adderall, Ritalin, Concerta, and Vyvanse (and their generics). Over the years, I have seen a shift to more and more young adults (as well as children) taking these medications, whereas in the past it was mostly children.
What Do People Say About Stimulants?
Take Your Pills opens with regular people talking about how they rely on their medications. “My mind came alive, my body felt alive.” “Side effects include being awesome at everything.” “Who takes Adderall? Half the kids in Palo Alto.”
College students tell us that they were advised by their parents to lock up their meds, and that almost everyone sells some of their medications. One college student explains that you want to be beautiful, skinny, and have amazing grades, and Adderall “sews it all up for you.” Another student shows viewers a public Facebook group where students buy and sell Adderall as if they were selling candy.
The documentary reports that America diagnoses more children with ADHD (11%) than any other country in the world.
ADHD is defined as “neurobehavioral condition that interferes with a person’s ability to pay attention and exercise age-appropriate inhibition.” (https://www.bbrfoundation.org/research/faq/frequently-asked-questions-about-attention-deficit-hyperactivity-disorder-adhd) This link provides a great resource to read more about the topic.
A Little History:
First studied in 1937, over the years Adderall increased in popularity, with such users as Andy Warhol, Jack Kerouac, and jazz singers. When soldiers in Vietnam became horribly addicted to stimulants, the Controlled Substances Act was created (https://www.dea.gov/druginfo/csa.shtml) which placed all regulated substances into one of five schedules, based on the substance’s medical use, potential for abuse, and safety or dependence liability.
Amphetamine (as well as other stimulants) was placed into Schedule 2, the most strictly regulated legal pharmaceutical class (https://www.dea.gov/druginfo/ds.shtml). Schedule 1 drugs have no currently accepted medical use and a high potential for abuse, such as heroin and LSD. Production of Adderall was also strictly limited – in 1969, 8 billion Adderall pills were produced, and by 1972, only 400 million were made.
Stimulants on the Playing Field:
When Eben Britton (former NFL player) developed a herniated disc, he worried that someone was always out there ready to take his job. When Britton reached his breaking point of exhaustion, a teammate gave him an Adderall and he felt alive and was able to react faster. Now, professional athletes must have documentation of their need for such medications, called a therapeutic use exemption (https://www.wada-ama.org/en/what-we-do/science-medical/therapeutic-use-exemptions).
Take Your Pills showed some eye-opening statistics on the prescribing of stimulants. In 1990, 600,000 children were taking stimulants, and by 2011 3.5 million were taking stimulants. One-third of children are diagnosed before age 6.
An interesting side note on the naming of the drug Ritalin is explained in the documentary – a scientist in Switzerland developed the drug to help his wife play tennis and keep her weight down. Her name was Rita, hence the name “Ritaline” – drug company Ciba later dropped the “e.”
Adults and ADHD:
Dr. Karen Berger wrote this article about stimulants. We (Joe & Terry Graedon) received this message from a reader of our syndicated newspaper column and wanted to share it along with our answer:
Q. My daughter was prescribed Ritalin starting in preschool. She took it throughout her school years, college and graduate school. It was a fantastic medicine for her. Not only did it help with her schooling, but she became a ranked tennis player.
Now her doctor says that adults don’t have ADHD. He doesn’t want to prescribe Ritalin. Is he right?
A. Methylphenidate (Ritalin) is a stimulant medication that has been widely prescribed since 1955. People do not necessarily outgrow ADHD (attention deficit hyperactivity disorder).
A systematic review in the Journal of Attention Disorders (July 13, 2022) concludes that drug treatments for ADHD can improve emotional behavior in adults. Treatment may also improve work performance and reduce the risk of unemployment (JAMA Network Open, April 1, 2022).
That said, prescriptions for stimulants like methylphenidate have risen sharply in recent years (BMJ Open, Aug. 13, 2021). The authors caution that anxiety, insomnia and dependence are potential adverse effects of overprescribing such drugs. They conclude:
“Given that the epidemic in use of prescription opioids continued for years before public health initiatives began to control use, understanding and managing this new resurgence in a class of drugs with a decades-long history of problems should be a public health priority. Physicians seeing patients who request prescriptions for these stimulants should assess with care the risks, benefits and medical need.”
How Much Do We Spend on Stimulants?
Stimulants are a $13 billion industry – the documentary explains that there are “big bucks” for doctors who file through patients quickly and give prescriptions. The United States is one of only two developed nations (New Zealand is the other) that allows for direct to consumer advertising of prescription drugs (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/).
The documentary suggests that with this direct to consumer advertising of drugs such as Adderall, parents feel more comfortable allowing their children to take these medications, as more and more parents are “seduced” by ads that promises better grades, etc.
Dr. Corey Hebert, “Physician for the People,” states that
“What you must do is make the correct diagnosis, do not over diagnose, and do not over medicate.”
If a child has ADHD, he says he does whatever it takes to help that patient, whether it involves therapy and/or medication.
What About Safety and Effectiveness?
Take Your Pills brings up safety risks – cardiovascular risks, risk of psychotic episodes even without a history, and risk of addiction which can bring a horrible fate.
There is an interesting study by Martha Farah at the University of Pennsylvania, which showed that there was no significant difference between Adderall and placebo in children without ADHD (https://www.thedailybeast.com/adderall-concentration-benefits-in-doubt-new-study). The only difference was a feeling of doing better, a feeling of having enhanced cognition.
Dr James Fadiman, a psychologist who has extensively researched psychedelics, speaks in the documentary of research that looks at micro doses of LSD (1/20th to 1/10th of a conventional dose) which produce zero psychedelic effects. Dr Fadiman speculates that this very low dose was under-researched, and if Sandoz had been more active in researching this, there would not have been a market for Ritalin.
Take Your Pills calls Adderall “the drug of our time.” Eben Britton, however, is happy to be on his next chapter and says, “it’s never so bad that you can’t climb out of the hole.” He credits meditation for helping with focus and clarity and is now writing about his experiences.
Parents speak out – they are hurting, they are crying. They are confused.
What Should Parents Do?
So, after watching this, what is one to do?
Let’s look at the side effects of one of these drugs, Adderall, directly from the package insert which is the prescribing information. (https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf) It starts off with a black box warning (the most serious kind of drug warning mandated by the FDA) about abuse, dependence, and that “MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.”
The warnings section discusses risk of sudden death, strokes, heart attacks, even at usual doses. It also warns of psychotic episodes, possibility of aggression, and many other possible effects. It has a long list of drug interactions (another scary consideration where college kids are just taking these medications from their friends). In fact, I would recommend for anyone to thoroughly read this package insert.
When you talk to your kids about drugs, don’t forget to talk about stimulants. Make sure your children are familiar with the names of these medications, both brand and generic (there is a great chart here: http://www.emedexpert.com/lists/adhd.shtml). Just because they came out of a prescription bottle from a legitimate pharmacy for a legitimate patient does not mean they are safe or appropriate for someone else. It’s even against the law – these scheduled drugs are labeled “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed” Look over the above package insert with them and point out the dangers. Knowledge is power, and students need to understand the dangers of sharing these medications.
Let Kids Be Themselves:
Try not to put excessive pressure on your children. Let them be who they are and do their best without feeling the need to resort to these drugs. Keep an open line of communication and talk about this often.
There are many people out there who are against these types of drugs altogether. As with many drugs, I think they have their place. And you can’t judge until you have walked in someone else’s shoes. If you think your child has ADHD, go to a doctor, and don’t be shy about getting a second opinion, especially when the conversation turns to medication. Despite all of the side effects that COULD occur, many children need these medications to function and with proper monitoring, most of these children do fine. I have personally spoken with many parents who have seen their child thrive from these medications, and under close monitoring, have not had any issues.
Giving your child a medication of this type is never a decision that is made lightly or easily, and risks versus benefits should always be weighed. When prescribed, these drugs are slowly increased to the lowest effective dose to minimize adverse effects.
Watching Take Your Pills was very eye-opening to me. There is so much focus lately on the opioid crisis that addiction to stimulants is often ignored, and this documentary was an important reminder.
