The Pharmacist

6/24/2019 - Monocle Journal

The short-term effects of amphetamine and methylphenidate on the body include sharpness of vision, a feeling of euphoria, increased confidence, improved alert ness and deep focus. Common side effects include irritability, a loss of appetite, restlessness, obsessiveness, trouble sleeping and a dry mouth. Amphetamine and methylphenidate are potent central nervous system stimulants and are widely used to treat individuals, mostly children, diagnosed with attention deficit hyper-activity disorder (ADHD), primarily through the use of prescription medications such as Ritalin, Adderall and Concerta.

Although there is little to no data regarding the prevalence of ADHD among South Africans, the Attention Deficit and Hyperactivity Support Group of Southern Africa (ADHASA) suggests that as many as 1 in 10 children could be affected by the disorder. In the US, the ratio is similar at around 11%, with 3.5 million children currently being treated with the use of central nervous system stimulants, mostly in the form of Adderall, while in South Africa, Ritalin and Concerta are preferred, with the latter promoted as a slow release dose. But while ADHD is commonly associated with children, the truth is, these powerful prescription drugs are more regularly being sought out by adults, both legally and illegally. Figures show that in recent years, adults were the fastest growing group using ADHD medication, with 16 million Adderall prescriptions being given to individuals between the ages of 20 and 39 in the US in 2012.

Universities are primary contributors to the increase in use of these drugs among older users, with students utilising the boost in concentration and mental sharpness to their advantage when cramming for tests and when under pressure to achieve tight deadlines. With this surge in demand, a black market around the distribution of these pills has sprung up on campuses around the world. According to one study, the unprescribed use of ADHD medication has become so ubiquitous among students that it has earned the accolade of being the second most used illicit substance on campus, only after marijuana.

So valuable have these “study aids” become – as they are often colloquially referred to – that their street value ranges from anywhere between $10 and $20 per 10mg pill, or the equivalent of up to R240 each.

While we still know little about ADHD, a recent study by the Kennedy Krieger Institute has shown that there are noticeable physiological differences in the brain scans of those diagnosed with the disorder and those without. When testing a sample of nearly 100 children aged between nine and ten years old, none of whom were yet being medicated for the disorder, the study found that among those diagnosed with ADHD, there were significant differences in the cerebral cortex area known to be related to cognitive and behaviour control, compared to the undiagnosed control sample.

What we do know is that these drugs do work to increase the concentration levels of those with ADHD, while also curbing what are deemed disruptive behaviours in certain settings, such as in the classroom. What we do not really know is whether it is sustainable as a long-term solution. It is difficult to determine how a drug with behaviour and personality changing properties can be used for long periods. Does there not come a time when the patient must ask, “What happens if I stop taking it? Will I be the same person?” If one acts and thinks completely differently when on the drug, which is often taken every day by those prescribed it, there may be a case for such questions. The same may be said for the ever-increasing popularity of anti-depression and anti-anxiety medications that are being shelled out by pharmacists at an alarming rate, not to mention the ever-growing opioid epidemic sweeping the US and many other parts of the world.

What this says of the state of our society is distressing. The proliferation of these drugs seems to highlight the enormous pressures that exist in our daily lives and the fierceness of today’s competitive landscape, as well as the predatory nature of pharmaceutical conglomerates that take advantage of these circumstances for their own profit. From as early as primary school, we are putting children on powerful behaviour-altering drugs in fear of them falling behind or acting up. In high school, exam results have become so important to securing a university placement that one bad month can potentially shatter tertiary education dreams. At university, the competition has become so intense that students are turning to the black market for mind-altering medications to try get ahead. And in the workplace, many adults have started to self-medicate to cope with the unending torrent of work that lands on their desks each day, failing which they may lose the livelihood that supports them and their families.

Faced with these extreme life and work pressures, we have become a pill-popping society obsessed with finding a quick fix – and big pharma has welcomed this phenomenon with open arms, manufacturing and marketing their offerings on a grand scale in response to every new syndrome, deficiency and disorder we seem to give ourselves. On the other side of the table, be it lecturers, employers or parents, those in a position of leadership need to recognise how and when these pressures become detrimental to individuals. These authorities need to take care to foster an environment of healthy competition rather than a space that facilitates destructive rivalries, as the latter, more often than not, only serves to bring out the worst in those who fight to survive in such circumstances.


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