Can you recognize any of the pills above? According to today’s front page New York Times, if you’re a student high school age or above, chances are you either recognize one of these drugs or know someone who takes them. From left to right, they are Adderall XR, Vyvanse, Concerta, Focalin XR, and Ritalin. Of course, we as clinicians recognize all of these drugs as commonly prescribed medications for ADHD, and the Times article is a bit of a wake-up call to the widespread abuse of these drugs.
Adderall XR and Vyvanse are amphetaimes. XR is the most popular “study drug” among high school students. Its duration of action is 8 to 12 hours, and its generic equivalent is less expensive than Vyvanse. Small beads in capsules can be crushed and snorted. It increases dopamine levels in the brain but also can affect sleep patterns. Vyvanse has become the #1 prescribed drug for ADHD in children ages 10-19, with 4.1 million Rxs written in 2011 as compared to 263,000 for Ritalin. Although Vyvanse is absorbed more smoothly than Adderall, it tends to suppress appetite more and can therefore result in unintended weight loss.
Convergence insufficiency, or CI, is a visual condition that can be misdiagnosed as ADHD. Given the overlap of signs and symptoms between these two conditions when someone is engaged in sustained visual tasks such as reading, studying, or taking long written examinations, the public health imperative of differentiating the two conditions becomes even more important.
This begs two questions:
1) How many students with CI put on amphetamines without first having evidence based treatment for CI?
2) How many students with CI self-medicate with amphetamines because they’ve been told their vision is normal?
Naturally these two conditions can be co-morbid, and there doesn’t have to be a cause-and-effect. But every family deserves the right to have all treatment options laid out, with full informed consent. How ironic that when the Rolling Stones sang of sanctioned Rx suburban drug abuse in the mid ’60s, it was mother who was under the microscope. The new lyrics for the NY Times Story might be:
Kids are different today,
I hear every mother say,
Johnny needs something to study and stay calm.
And though he’s not really ill, there’s a little yellow pill …