Medical Students and Stimulant Use

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I wish I could get my hands on the stuff, my doctor wouldn't give it to me.
 
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Plenty of my friends do. I just drink coffee and espresso by the boatload.
 
I don't think many people on SDN are going to admit it. Too many people with a holier-than-thou attitude. :laugh:

I hear people talking about stimulant all the time when I'm in school. I'm not talking about legitimate prescriptions either.
 
If coffee and energy drinks count as stimulants, I'm guilty :oops:
 
Lol seriously, I wouldn't be surprised if the real number is closer to 40%

Also note that tthat study was done at an upper tier Uni. I suspect that the number is much lower at lower tiers
 
GalenAgas said:
Lol seriously, I wouldn't be surprised if the real number is closer to 40%

Also note that tthat study was done at an upper tier Uni. I suspect that the number is much lower at lower tiers
Click to expand...

Why would it matter what "tier" their medical school is as to whether or not the students abuse stimulants?
 
Stellar Clouds said:
Why would it matter what "tier" their medical school is as to whether or not the students abuse stimulants?
Click to expand...

Why do you think it would matter? Things like access, permissive culture (amphetamine use in academia is common), culture and rate of reporting, history of success, selection of specific types of students all come to mind. I'm sure there are more reasons.

The OP's study was done at Yale (20% prevalence of use)

The following study was done at U of Kentucky (10% prevalence of use). Half the reported prevalence of "nonmedical" performance enhancement compared to yale.

http://ap.psychiatryonline.org/article.aspx?articleid=51777#References
 
GalenAgas said:
Why do you think it would matter? Things like access, permissive culture (amphetamine use in academia is common), culture and rate of reporting, history of success, selection of specific types of students all come to mind. I'm sure there are more reasons.

The OP's study was done at Yale (20% prevalence of use)

The following study was done at U of Kentucky (10% prevalence of use). Half the reported prevalence of "nonmedical" performance enhancement compared to yale.

http://ap.psychiatryonline.org/article.aspx?articleid=51777#References
Click to expand...

There's always a misconception that the only people who are abusing amphetamines are the ones who literally party non-stop and leave their work until the last minute, then cram the night before on an Adderall XR.

This couldn't be further from the truth. While this does exist, I do know that there are people at the top of my class who supplement their non-stop studying with amphetamines so they can be even more effective. It makes the stronger even stronger.

I've even read such things where people say that amphetamines will only help someone who already suffers from something like ADHD, but will have no effect on someone who is completely healthy. Well then, if that's the case, then my uncle is a monkey. And meth must be the biggest scam in the drug world because it must be placebo then. :rolleyes:
 
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Planes2Doc said:
There's always a misconception that the only people who are abusing amphetamines are the ones who literally party non-stop and leave their work until the last minute, then cram the night before on an Adderall XR.

This couldn't be further from the truth. While this does exist, I do know that there are people at the top of my class who supplement their non-stop studying with amphetamines so they can be even more effective. It makes the stronger even stronger.

I've even read such things where people say that amphetamines will only help someone who already suffers from something like ADHD, but will have no effect on someone who is completely healthy. Well then, if that's the case, then my uncle is a monkey. And meth must be the biggest scam in the drug world because it must be placebo then. :rolleyes:
Click to expand...

What is the relevance of your post to my post which you quoted? I think we agree.. no?
 
JShephard said:
All actions have consequences. These consequences will probably show up multiple decades from now.
Click to expand...

huh? stimulants such as adderall are some of the most researched drugs and have few side effects...not all actions have consequences, btw.
 
FIREitUP said:
huh? stimulants such as adderall are some of the most researched drugs and have few side effects...not all actions have consequences, btw.
Click to expand...

I'm guessing downregulation of the dopaminergic system? That's gotta suck.

If you talk to people who are into nootropics, they are against stimulants, which they deem the anti-nootropic.
 
FIREitUP said:
huh? stimulants such as adderall are some of the most researched drugs and have few side effects...not all actions have consequences, btw.
Click to expand...
Many of the stimulant abusers tend to crash and burn by the time they reach residency when the desired effect is no longer there due to built up tolerance and the more toxic side-effects have built up. Heart disease is one of the main toxicities that is fairly well documented.

An oldie but goodie:
Spoiler alert, the stuff at the very beginning in ALL CAPS could be very important!

http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/021303s005lbl.pdf
:boom:
 
JGimpel said:
Many of the stimulant abusers tend to crash and burn by the time they reach residency when the desired effect is no longer there due to built up tolerance and the more toxic side-effects have built up. Heart disease is one of the main toxicities that is fairly well documented.

An oldie but goodie:
Spoiler alert, the stuff at the very beginning in ALL CAPS could be very important!

http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/021303s005lbl.pdf
:boom:
Click to expand...

no medication is totally innocuous, of course. i was aware of the cardiotoxicity and tolerance, but honestly I think people are making a bigger deal of its use than is necessary. any substance that is abused will cause damage, without a doubt, amphetamines are not a special exception to this. the fact is that they are pretty well tolerated relative to drugs in general. if used casually before tests (i.e., if not chronically used every day) it seems unlikely that any damage would occur.
 
JGimpel said:
Many of the stimulant abusers tend to crash and burn by the time they reach residency when the desired effect is no longer there due to built up tolerance and the more toxic side-effects have built up. Heart disease is one of the main toxicities that is fairly well documented.

An oldie but goodie:
Spoiler alert, the stuff at the very beginning in ALL CAPS could be very important!

http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/021303s005lbl.pdf
:boom:
Click to expand...

In addition, I don't think Adderall has even been around for 20 years yet.

FIREitUP said:
no medication is totally innocuous, of course. i was aware of the cardiotoxicity and tolerance, but honestly I think people are making a bigger deal of its use than is necessary. any substance that is abused will cause damage, without a doubt, amphetamines are not a special exception to this. the fact is that they are pretty well tolerated relative to drugs in general. if used casually before tests (i.e., if not chronically used every day) it seems unlikely that any damage would occur.
Click to expand...

I'm referring to everyday use. To the bolded - it sounds like you're arguing for either your own personal use or someone you know. To that, I don't know the answer. My point was that chronic use will have consequences.
 
JShephard said:
In addition, I don't think Adderall has even been around for 20 years yet.



I'm referring to everyday use. To the bolded - it sounds like you're arguing for either your own personal use or someone you know. To that, I don't know the answer. My point was that chronic use will have consequences.
Click to expand...

haha, no I don't use it; I don't need it. I'm just saying it seems that stimulants are given such a terrible reputation when they're not that bad.
 
JGimpel said:
Many of the stimulant abusers tend to crash and burn by the time they reach residency when the desired effect is no longer there due to built up tolerance and the more toxic side-effects have built up. Heart disease is one of the main toxicities that is fairly well documented.

An oldie but goodie:
Spoiler alert, the stuff at the very beginning in ALL CAPS could be very important!

http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/021303s005lbl.pdf
:boom:
Click to expand...

While it might exacerbate previous heart issues the biggest meta-analysis disagrees with you:

Per UpToDate

"Literature review current through: Jan 2013

Based on currently available evidence, it appears that children without cardiac disease who receive stimulant therapy are not at increased risk for CV events compared with the general pediatric population. As a result, we follow the recommendations of the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) that stimulant pharmacotherapy can be initiated in a child with ADHD if there is no evidence of cardiac disease based upon a comprehensive CV-focused history and physical examination.

Among adult patients who are either current or new users of stimulant medications, there appears to be no increased risk of serious CV events.

In an updated safety review, the United States FDA summarized the findings of the largest cohort study in children that did not show an association between ADHD pharmacotherapy and adverse CV events."
 
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GalenAgas said:
Why do you think it would matter? Things like access, permissive culture (amphetamine use in academia is common), culture and rate of reporting, history of success, selection of specific types of students all come to mind. I'm sure there are more reasons.

The OP's study was done at Yale (20% prevalence of use)

The following study was done at U of Kentucky (10% prevalence of use). Half the reported prevalence of "nonmedical" performance enhancement compared to yale.

http://ap.psychiatryonline.org/article.aspx?articleid=51777#References
Click to expand...

I don't think it would matter...that's my point. Students at lower tier medical schools will try just as hard to do their best as those at upper echelon schools.
 
JShephard said:
In addition, I don't think Adderall has even been around for 20 years yet.



I'm referring to everyday use. To the bolded - it sounds like you're arguing for either your own personal use or someone you know. To that, I don't know the answer. My point was that chronic use will have consequences.
Click to expand...

Adderall marketed for ADHD (which didn't exist 50 years ago) of course not. But Benzedrine which was racemate d and l amphetamine (the same as adderall) has been around since the 1930s....

The source of all knowledge: http://en.wikipedia.org/wiki/Benzedrine
 
JourneyAgent said:
20% seems low. I wouldn't be surprised to see a majority.
Click to expand...

From what I've personally observed and heard in med school and residency, 20% actully seems like a very high number in terms of use of prescription stimulants. Maybe it's a regional thing or an SDN thing. However (ab)use of caffeine and energy drinks seem to be around 99%. Accompanied by about 80% use of antacids and PPIs by late residency.

In residency you will learn that you are much better off if you are able to go to sleep on a dime when you find a free hour or two between pages -- they come too infrequently -- so the last thing you want is a stimulant on board. Which is why residents seem eternally tired.
 
Etorphine said:
Yea I agree. If you count caffeine and energy drinks as stimulants - which in my opinion you definitely should - I'd guess the rate is pretty high. I'm at a top-tier institution, and I'd guess the rate is >95%. If you exclude caffeine, and are really only looking for those abusing amphetamines, it'd be fairly low. I personally don't know anyone, or heard of anyone, taking these drugs. Back in college, it seemed there were more amphetamine abusers than I could count. The funny thing is that despite their attempts to game the system with what are in effect performance-enhancing drugs, the majority of these individuals did not make it into medical school.
Click to expand...

Dose matters. Someone who drinks green tea drinks caffeine, but it's very little compared to a person who drinks multiple energy drinks or 4 cups of coffee a day - that could be 10 times as much caffeine as some tea drinkers.
 
link2swim06 said:
While it might exacerbate previous heart issues the biggest meta-analysis disagrees with you:

Per UpToDate

"Literature review current through: Jan 2013

Based on currently available evidence, it appears that children without cardiac disease who receive stimulant therapy are not at increased risk for CV events compared with the general pediatric population. As a result, we follow the recommendations of the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) that stimulant pharmacotherapy can be initiated in a child with ADHD if there is no evidence of cardiac disease based upon a comprehensive CV-focused history and physical examination.

Among adult patients who are either current or new users of stimulant medications, there appears to be no increased risk of serious CV events.

In an updated safety review, the United States FDA summarized the findings of the largest cohort study in children that did not show an association between ADHD pharmacotherapy and adverse CV events."
Click to expand...
I still would argue that any drug with the risk of cardiotoxicity and sudden death can't be benign and if someone wants to put their kid on dex or meth that's their decision. Having seen first hand what the other effects of stimulants on kids are, I wouldn't. They usually don't do much testing on kids since their systems are still developing, but guidelines I've read strongly suggest that adults have some formal cardio testing for structural abnormalities beyond those found in H&P, this is what I recommend when asked about this subject (I hate that it comes up so often in casual conversation.) If any of the prospective patients has tachycardia and/or HTN (few don't, these days) they shouldn't be playing with psychostimulants either:

I'm not 100% fond of the FDA, but I agree with you on using them or UptoDate as a primary resource directly.

http://www.fda.gov/Drugs/DrugSafety/ucm279858.htm

Strattera caries a black box warning of hepatotoxicty for all patients and increased suicide risk for kids if you're thinking of going that route to avoid the common stimulants.
 
Etorphine said:
Yea I agree. If you count caffeine and energy drinks as stimulants - which in my opinion you definitely should - I'd guess the rate is pretty high. I'm at a top-tier institution, and I'd guess the rate is >95%. If you exclude caffeine, and are really only looking for those abusing amphetamines, it'd be fairly low. I personally don't know anyone, or heard of anyone, taking these drugs. Back in college, it seemed there were more amphetamine abusers than I could count. The funny thing is that despite their attempts to game the system with what are in effect performance-enhancing drugs, the majority of these individuals did not make it into medical school.
Click to expand...

The people I knew in in undergrad that frequently used them, also liked to cut corners in other areas. They wanted the results without putting in the required work. I'm sure this showed in applications and impeded their acceptance in most cases. Come to think of it, most of them didn't even apply. One individual I can remember bombed the MCAT and never came back into the game. Sorry to diverge from the usage in med school topic.
 
Law2Doc said:
From what I've personally observed and heard in med school and residency, 20% actully seems like a very high number in terms of use of prescription stimulants. Maybe it's a regional thing or an SDN thing. However (ab)use of caffeine and energy drinks seem to be around 99%. Accompanied by about 80% use of antacids and PPIs by late residency.

In residency you will learn that you are much better off if you are able to go to sleep on a dime when you find a free hour or two between pages -- they come too infrequently -- so the last thing you want is a stimulant on board. Which is why residents seem eternally tired.
Click to expand...

Just out of curiosity, would you care to elaborate on the 80% using antacids and PPIs? I mean, I know the connection between heartburn and coffee/soda, but would prescription stimulants such as adderall lead to acid reflux?
 
I was talking about caffeine. Again, I suggested prescription stimulant use in residency is far less common than is being suggested in this thread. It probably happens, but it's pretty unusual in my personal experience. When you find time to sleep in residency, you need to be able to go to sleep. Being on any strong stimulant will waste these windows of opportunity. It's not like you get many weekends off to catch up.
 
The main problem that I have with stimulant (Adderall, Ritalin, etc.) use is that most people who take it plan to stop during clerkship years/residency. They really only want the effects to get high preclinical grades and then a high Step I.

I think this just sets them up for failure since they might get the more competitive residency, but they are not capable of doing that work. I think these people on ADHD meds are in for a rude awakening if they think they can just stop abruptly after Step I.
 
To the people arguing abuse being higher at higher ranked schools:

I got to a "lower" tier school. Theres no way that only 20% of my class uses adderall. Without much effort last year, I found a handful of people selling it and an enormous amount of students using it. Those were only the people who were open about discussing it. At my school its definitely closer to 40-50%
 
Anigma07 said:
The main problem that I have with stimulant (Adderall, Ritalin, etc.) use is that most people who take it plan to stop during clerkship years/residency. They really only want the effects to get high preclinical grades and then a high Step I.

I think this just sets them up for failure since they might get the more competitive residency, but they are not capable of doing that work. I think these people on ADHD meds are in for a rude awakening if they think they can just stop abruptly after Step I.
Click to expand...

Not really.

A common misconception is that stimulants make you 'smarter.' This is empirically false. They simply allow you keep the intelligence you have focused on a given task.

Studying for long periods is very boring for most and therefore can make a lot of people seem like they have ADD. In short, stimulants like adderall make studying much less boring (if that makes sense).

Most of us signed up because we enjoy practicing medicine and therefore don't need a stimulant because the work itself is stimulating.
 
I did not say they are less intelligent off of the drug (although that argument can be made) ...I said they are not capable of doing the work. Doing well in medical school and practice is more related to your work ethic than your intelligence. People who use adderall only for a short period of time as a way to study (not those with a disease that need treatment for life) do not have the work ethic and discipline to sit down and study the material.

The idea that the work is just stimulating is also ridiculous...very few students in my class find studying biochemistry for the third time "stimulating." I had a class mate who tried to get off ADHD meds and could not last two days. It's fine if you plan on taking the drug your whole life. If not, good luck, you and your future patients will need it.
 
Anigma07 said:
The main problem that I have with stimulant (Adderall, Ritalin, etc.) use is that most people who take it plan to stop during clerkship years/residency. They really only want the effects to get high preclinical grades and then a high Step I.

I think this just sets them up for failure since they might get the more competitive residency, but they are not capable of doing that work. I think these people on ADHD meds are in for a rude awakening if they think they can just stop abruptly after Step I.
Click to expand...

This couldnt be further from the truth. They will be fine and they will not abruptly stop after step 1 because, as physicians, they know not to abruptly stop any long-term drug. Ween it off over a period of time and things will be fine.
 
Anigma07 said:
I did not say they are less intelligent off of the drug (although that argument can be made) ...I said they are not capable of doing the work. Doing well in medical school and practice is more related to your work ethic than your intelligence. People who use adderall only for a short period of time as a way to study (not those with a disease that need treatment for life) do not have the work ethic and discipline to sit down and study the material.

The idea that the work is just stimulating is also ridiculous...very few students in my class find studying biochemistry for the third time "stimulating." I had a class mate who tried to get off ADHD meds and could not last two days. It's fine if you plan on taking the drug your whole life. If not, good luck, you and your future patients will need it.
Click to expand...

I am not talking about biochem. I am talking about 3rd year and beyond.

Why would you do something that is not interesting, not stimulating and boring? I'd find a new career if I found that concept ridiculous. It sounds like a miserable 30-40 years ahead for you.

I am not interested in debating the merits of ADHD meds for med students with you. Most med students don't fit the DSM criteria for ADHD, but then again a lot of meds are used for off label purposes. I am not a psychiatrist nor aspire to become one.

I am guessing you are pre-clinical?
 
link2swim06 said:
I am not talking about biochem. I am talking about 3rd year and beyond.

Why would you do something that is not interesting, not stimulating and boring? I'd find a new career if I found that concept ridiculous. It sounds like a miserable 30-40 years ahead for you.

I am not interested in debating the merits of ADHD meds for med students with you. Most med students don't fit the DSM criteria for ADHD, but then again a lot of meds are used for off label purposes. I am not a psychiatrist nor aspire to become one.

I am guessing you are pre-clinical?
Click to expand...

Do you even read comments before replying to them? I am assuming that you are on ADHD meds and in denial over the fact that your interest in medicine is held up by drug use. As I mentioned, most of the students I know taking stimulants do so in their preclinical years and they plan on coming off during clerkship and residency.

A topic in medicine can be extremely interesting but having to memorize every pathway for one molecule is just tedious work that builds your discipline. Like I said, if it is a disorder that a person has and they plan on taking treatment for life then there is no problem. People that are only taking drugs as a "shortcut" and not for treatment do not build up the work ethic they need and their life/practice/patients are going to suffer.
 
Anigma07 said:
Do you even read comments before replying to them? I am assuming that you are on ADHD meds and in denial over the fact that your interest in medicine is held up by drug use. As I mentioned, most of the students I know taking stimulants do so in their preclinical years and they plan on coming off during clerkship and residency.

A topic in medicine can be extremely interesting but having to memorize every pathway for one molecule is just tedious work that builds your discipline. Like I said, if it is a disorder that a person has and they plan on taking treatment for life then there is no problem. People that are only taking drugs as a "shortcut" and not for treatment do not build up the work ethic they need and their life/practice/patients are going to suffer.
Click to expand...

Your assumption is wrong. I use to drink a metric ton of energy drinks M1/M2 year but now as a M3 no longer need them. I know a lot of people who have came off adderall since starting rotations with no problems.

You aren't getting my point. M1/M2 doesn't teach you work ethic for M3 year and beyond as you imply. The day to day activities are vastly different. You will see in a few years what I mean.
 
link2swim06 said:
Your assumption is wrong. I use to drink a metric ton of energy drinks M1/M2 year but now as a M3 no longer need them. I know a lot of people who have came off adderall since starting rotations with no problems.

You aren't getting my point. M1/M2 doesn't teach you work ethic for M3 year and beyond as you imply. The day to day activities are vastly different. You will see in a few years what I mean.
Click to expand...

Energy drinks (caffeine) are different than amphetamines. It is not just studying that adderall effects but brain chemistry and overall well-being. I think you should read up a bit on side effects of amphetamine use (the NYT published a front page article last week on this issue). If there was the impression of looking down on these people, that is not the case-- they are victims of drug addiction and dependance.

This is a longer discussion than can be done on a message forum. I would suggest reading up on amphetamine use and long-term side effects before being so accepting of students using it-- these are drugs that can ruin someones life.
 
Last edited:
Anigma07 said:
Do you even read comments before replying to them? I am assuming that you are on ADHD meds and in denial over the fact that your interest in medicine is held up by drug use. As I mentioned, most of the students I know taking stimulants do so in their preclinical years and they plan on coming off during clerkship and residency.

A topic in medicine can be extremely interesting but having to memorize every pathway for one molecule is just tedious work that builds your discipline. Like I said, if it is a disorder that a person has and they plan on taking treatment for life then there is no problem. People that are only taking drugs as a "shortcut" and not for treatment do not build up the work ethic they need and their life/practice/patients are going to suffer.
Click to expand...

Stimulants may be a shortcut, but the argument that people using them in preclinical years will not be able to handle clinical years is pretty baseless. I don't think adderall would be all that helpful on the wards anyway aside from the ability to stay up for long periods of time.

Leonidis I said:
not trying to make this a racial thread but anyone have any idea why white students have a 9-fold increase in odds for stimulant use compared to asian students? is it just differences in access to the stimulants?
Click to expand...

4683983353_4034b32926.jpg
 
Leonidis I said:
not trying to make this a racial thread but anyone have any idea why white students have a 9-fold increase in odds for stimulant use compared to asian students? is it just differences in access to the stimulants?
Click to expand...

Who knows:
- Access
- Culture and Willingness to report
- Culture and Work ethic
- Genetics and Intelligence
 
Is M1/M2 really that hard that you need amphetamines to get through or perform optimally? To answer my own question: no way. I mean if you have legitimate ADHD that's certainly one thing, but the average student does not need to resort to amphetamines to do well in my opinion, and I've never really understood the attraction to these drugs. Are people just not confident enough in their own abilities?

And you can't really compare amphetamine to caffeine - completely different drugs, completely different mechanisms of action, completely different long term outcomes.

It's not my place to tell people how they should act. People are adults and can make adult decisions, but these drugs are not benign and not really necessary for most people in my opinion.
 
SoundofSilver said:
Is M1/M2 really that hard that you need amphetamines to get through or perform optimally? To answer my own question: no way. I mean if you have legitimate ADHD that's certainly one thing, but the average student does not need to resort to amphetamines to do well in my opinion, and I've never really understood the attraction to these drugs. Are people just not confident enough in their own abilities?

And you can't really compare amphetamine to caffeine - completely different drugs, completely different mechanisms of action, completely different long term outcomes.

It's not my place to tell people how they should act. People are adults and can make adult decisions, but these drugs are not benign and not really necessary for most people in my opinion.
Click to expand...

Agreed.
 
In med school everyone is on something/uses something; anything from coffee to amphetamines to even having the exam lol.
I drink coffee everyday [1-2 cups] and maybe toss in an energy drink during finals. I did however do last semester without a single energy drink :D lol.
But I think there is a difference between using a drug to perform versus using a drug to give you that extra edge. Ex. students who dont study until 1-2 weeks before the test, pop some pills to focus those 2 weeks versus a student who studies everyday/ keeps up with the work and pops a pill before the test to help them focus. All in all things like amphetamines can't make you "smart".
 
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