High potential for abuse and overdose of prescription stimulants prompts U.S. Food and Drug Administration to research alternative treatments.

Prescription stimulants commonly prescribed for behavior labeled attention-deficit hyperactivity disorder (ADHD) are promoted as performance-enhancing drugs, but new research indicates that these “smart drugs” do not improve cognitive ability and can actually worsen cognitive function in some people. The results suggest that stimulant drugs do not actually make the users smarter.

Researchers from Australia and the U.K. set out to determine whether psychostimulants result in higher performance in the kind of problem-solving required in everyday life.  Study participants were scored after being given four minutes to fill a backpack by choosing among items with differing weights and values, so that the value of the items they fit in the backpack was maximized. The 40 participants, aged 18 to 35, were administered one of three psychostimulant drugs or a placebo before tackling the backpack problem twice on four occasions a week apart.

The researchers found that the stimulant drugs increased motivation and increased the time and effort needed to find a solution, but the steps taken in finding a solution became more random. Because participants were more erratic in their efforts when on the drugs, “a disturbing performance reversal” was observed, the researchers said, in which participants who scored above average when administered a placebo fell below average when given a stimulant drug. Ultimately, the drug-taking resulted in a significant decrease in the value of the items the participants placed in their backpacks.

“While drugs increase persistence, they appear to reduce the quality of effort,” concluded lead author Elizabeth Bowman, PhD, at the University of Melbourne, Australia. The study was published in the journal Science Advances.

The results of this study echo the findings of research last year that found no improvement in academic performance from taking prescription stimulants. “Although it has been believed for decades that medication effects on academic seatwork productivity and classroom behavior would translate into improved learning of new academic material, we found no such translation,” the researchers wrote in their published report on the study.

Prescriptions for stimulant drugs are near record highs in the U.S., having increased by 45% from 2012 to 2021, according to the U.S. Food and Drug Administration (FDA). Stimulant-type drugs prescribed for so-called ADHD include Ritalin, Concerta, Adderall and Vyvanse.

In a letter addressed to the American public in August, the FDA advised that “stimulants are controlled substances with a high potential for abuse, which can lead to addiction and overdose.” The FDA recently required updated warnings in the prescribing information for stimulant drugs “to clearly inform patients, caregivers and healthcare professionals of these risks.”

The FDA’s letter also references “widespread misuse” of stimulants. According to the 2019 National Survey on Drug Use and Health, 1.8 million teens ages 12-17 and 4.3 million young adults ages 18-25 reported taking stimulant drugs in the past year. Among those users, 430,000 teens (24%, or one in four teen users) and 1.95 million young adults (45%, or nearly half of young adult users) reported misuse of their prescription stimulants.

Statistics from the National Poison Data System from January 2018 to September 2020 show that the number of cases of self-harm (including suicide attempts) using stimulants averaged 213 a month for teenagers aged 13-19 and 71 a month for young adults aged 20-29.

Overdose deaths from stimulant drugs have risen sharply in recent years. The Centers for Disease Control and Prevention (CDC) reported that in 2021, nearly 33,000 people died from an overdose involving psychostimulants, which was a 37% increase from the previous year. Psychostimulants include both prescription drugs, like ADHD drugs, and illegal drugs, such as methamphetamine and ecstasy. Over 30% of all drug overdose deaths in 2021 involved psychostimulants. This increase is occurring in the context of a national overdose crisis, in which stimulants are increasingly involved, according to the CDC.

In response to the misuse, self-harm, and overdose problems with prescription stimulants, the FDA awarded a grant to the National Academies of Sciences, Engineering and Medicine to research and reconsider the diagnosis and treatment of ADHD. The research is expected to be used in developing alternatives to prescription stimulants as treatment. “FDA has already taken steps to support the development of alternative treatment options,” its letter to the American public said.

Additionally, the FDA and the U.S. Drug Enforcement Administration (DEA) issued a joint press release earlier this year, warning the public that online pharmacies were illegally selling the stimulant Adderall without a prescription and that the drugs “may be counterfeit, contaminated, expired or otherwise harmful.”

Serious side effects of stimulant drugs requiring emergency treatment include fast heart rate, fast breathing, increased blood pressure, restlessness, tremors, loss of coordination, nausea and vomiting, aggressive behavior, panic, confusion, and hallucinations. Stimulants are also linked to stunted growth in children.

Some 9.6 million Americans are prescribed stimulant drugs for behavior that is far too easily labeled ADHD. The late psychologist Keith Conners conducted the first formal trials on the now-widely prescribed ADHD stimulant methylphenidate, commonly sold under the brand names Ritalin and Concerta. He later realized that ADHD diagnoses were out of control and called ADHD misdiagnoses “a national disaster of dangerous proportions.”

One in three Americans taking ADHD drugs is under the age of 18, but concerns have been raised over prescribing stimulants to children after recent research has shown the drugs may do more harm than good.

A recent study found no convincing evidence of any long-term benefit to children from treatment with stimulant drugs for behavior labeled ADHD.  Another study found that a diagnosis of ADHD does not lead to any improvement in teens’ quality of life compared to teens not diagnosed with ADHD, but is associated with lower self-esteem, worse social behavior, and a significantly increased risk of self-harm. The negative outcomes were greatest in those adolescents who were diagnosed with ADHD earliest (6-7 years of age).

The ADHD drug methylphenidate has been linked to depression in children and teens. In one study, children started on methylphenidate were 18 times more likely to experience depression than before starting, and when the drug was discontinued, the higher risk dropped back to starting levels.  In another study, children who were first prescribed methylphenidate between the ages of 6 and 8 and continued to take the drugs had a 50% higher risk of being prescribed antidepressants for depression during their teen years.

The National Affairs Office of the Citizens Commission on Human Rights urges the FDA to take stronger action to protect Americans, and especially children and teens, from the risks of abuse, addiction, overdose, and other serious harms now linked to prescription stimulants.

CCHR continues to raise public awareness of the serious side effects and withdrawal symptoms from psychostimulants and other psychiatric drugs, as well as the research questioning the effectiveness of the drugs, so consumers and their physicians can make fully informed decisions about starting or stopping the drugs.

WARNING: Anyone wishing to discontinue or change the dose of an ADHD drug or any other psychiatric drug is cautioned to do so only under the supervision of a physician because of potentially dangerous withdrawal symptoms.