Dr. Sujith Ramachandran: Is Adderall Overprescribed?

Mar 21

Opioid addiction—and resulting overdoses and deaths—get a lot of headlines and rightly so. But addiction to, misuse of, and overdoses involving prescription stimulants have increased exponentially, with relatively little discussion. Researcher Dr. Sujith Ramachandran notes that all prescription drugs have the potential for misuse, but says misdiagnosis of ADHD and overprescription of stimulants greatly increase the likelihood of abuse of stimulants. As an assistant professor in the School of Pharmacy at the University of Mississippi and assistant director of the Center for Pharmaceutical Marketing & Management, Sujith’s research involves healthcare policy, quality measures, and prescription drug abuse.

In this episode of The Mayo Lab Podcast, Sujith and David discuss the widespread—but under-discussed—issue of addiction to prescription stimulants and getting to the root of the culture of over-prescription.

“The co-occurrence of opiods and stimulants at the moment of overdose has increased exponentially.”

- Dr. Sujith Ramachandran

Dr. Sujith Ramachandran is an Assistant Professor of Pharmacy Administration and an Assistant Director for the Center for Pharmaceutical Marketing & Management at the University of Mississippi School of Pharmacy. His research interests include healthcare quality, prescription drug abuse, and economics of care. In his research, Sujith aims to build high-quality healthcare systems that improve not only patient outcomes but the values of each patient. In his prescription drug abuse research, Sujith investigates the safety of opioid prescription among older adults.

Sujith earned both his Master's and Doctorate from the University of Mississippi School of Pharmacy.

Watch the podcast on YouTube:

David Magee: Sometimes I think that because when someone dies of an opioid overdose, it gains a lot of attention and the death is heartbreaking and it is. But when we lose people to death, it gains a lot of attention. Sometimes though, people can be losing their joy and be struggling with addiction to other drugs, not just opiates and that's the way it is with stimulants. Like Adderall, for example, or Vyvanse, both of which I had sadly a real personal story with where I became Lee addicted to prescription Adderall and then Vyvanse, I misused them, didn't follow doctor's instruction. And I did not dive an overdose, but I can tell you that I ruined my life and a lot of people's lives around me. And so as we see that epidemic really increasing across the country, I think on The Mayo Lab Podcast, it's such a critical story to delve into because stimulants, for example, are one of the most prescribed drugs for young people in this country.
Alexis Lee: They are. And I hear people talking about it all the time of Adderall and different types of stimulants. And so I'm excited to have this conversation because I don't think it lives just on a college campus. I don't think it starts just on a college campus. And that's what we're here to talk about today.
Magee: I think on this day, honestly, when I had students all over the country, high school or colleges or universities, when I'm asking them in casual conversations about the drugs that are misused the most, there's the obvious alcohol and marijuana, but stimulants right at the top and increasingly it's moved right next to maybe if not, I had a student tell me one time, they say, "Hey, if I go misuse alcohol, my parents can smell it on my breath. If I'm jacked up on some Adderall, somebody else's Adderall, they don't even know. They do not know." So we decided, part of what we do on The Mayo Lab Podcast is bring in some researchers, bring in voices to really help us understand, because these aren't our ideas. It's about bringing in the information where the facts are the facts are the facts so that parents and students and others in communities can make the best decisions for their lives going forward. So we think we found just the perfect guest to talk about stimulants and other prescription drugs and how they are misused in some of the impacts of that.
Lee: I think we have found the perfect guest. Dr. Sujith Ramachandran, is an assistant professor of pharmacy administration and assistant director for the Center of Pharmaceutical Marketing and Management at the University of Mississippi School of Pharmacy. And we're so excited to have him here. Did I get your name right?
Dr. Ramachandran: You absolutely got it right. And if it is easier, my students call me Dr. Ram, and that is much easier to say than my full name. And that's okay with me.
Magee: Dr. Ramm, that's a good one. I love that. And so help us understand, well, first of all, how did you get involved in how stimulants are misused and the impact? Tell us about your background with that.
Dr. Ramachandran: So the story here is actually quite a little, it was accidental because I like to call myself an accidental academic. I was not going to be in academia for the longest time. But as I was finishing my PhD, I realized that I enjoyed doing this work more than anything else out there. And that is almost also how my interest in stimulant research started because my original interest was in mental health and substance use. I was specifically thinking about needle exchange clinics, heroin use. And I realized that to do the work that I wanted to do as part of this was much more taxing and resource intensive as a grad student and I did not have those efforts. So my kind advisors help redirect me to identifying prescription stimulants. And I have really discovered the fact that this is a huge problem and it's not being talked about on the level that we see other substance use or even opioids. So I've ended up refocusing most of my efforts here because I have recognized the scale and the importance of the problem.
Magee: I'm so thankful for that work because as I said on our introduction, people die from opioid use. And it's very sad and it's unfortunate. I've lost a son to it. It was extremely sad and extremely unfortunate. But what I always talk about is what I call the walking dead. They're still alive and they're still with us, but substances have just reached in and changed how their brain works, how they're functioning daily. And I feel like, honestly, from getting into schools and universities and even in the adult population, I see an absolute crisis of stimulant abuse and overprescription misuse. And then we even get into the counterfeit drugs that just barely seems on the radar. First of all, when you get into the research, I mean, what do we know about this? Do we think they're being over-prescribed? For instance.
Dr. Ramachandran: Can I answer something else before please before I say this because I think you made a really good point. When we think about opioids, the first thing we think about is all of the overdoses and the death numbers that are on CDC, every news website, we recognize the epidemic, it's all over the media. People don't think of stimulants resulting in the same thing, and that's actually incorrect. Because a growing proportion, and today, a majority of opioid related overdose deaths also have stimulants. So there are studies out there that have looked at were stimulants present in the bloodstream at the time of an overdose. And the co-occurrence of opioids and stimulants at the moment of overdose has increased exponentially. In fact, if you will let me do this for a second. I want to show just how much this has increased in the past three-year period between 2015 and 2017.
Three year period, like 2000, sorry, a four-year period between 2015 and 2019, opioid overdose deaths increased from about 30,000 to 50,000 in this country, a big overdose. But stimulant overdose deaths, where a stimulant was present at the time of the overdose increased from just over 5,000 to over 15,000. That's three times the number, but who's talking about it? And our first reaction to thinking stimulants are being over-prescribed is that walking dead phenomenon, which I think is absolutely accurate, don't get me wrong. But there are an increasing number of overdoses, ER visits and hospital admissions happening because of prescription stimulants that are not being talked about. The number of stimulant related emergency room visits between the same 2015 and 2019 four year periods has quadrupled. But that does not make headlines as much as opioid overdose, as resulting in deaths.
Magee: In at that same time period, we've seen a drastic increase in the amount of, say, Adderall and Vyvance prescriptions written. I'm not here to pick on those drugs, what I tell everybody, I say, "Look, I mean drugs that come to market in this country, they come for good reason because they're needed." The issue we face is, we're talking about over-prescription and misuse. And look, I'm not the expert here. How do I know if we face overprescription here or not? What I do know is that, in recent years, we've had a drastic rise in the number of stimulant prescriptions written to young people, and therefore we can expect to see more use simply because there's more in the marketplace.
Dr. Ramachandran: Absolutely. Every stimulant prescription has what prescribers usually assess called abuse liability associated with it. Every time you write a prescription, you assess that liability and you want to make sure that the person you're prescribing those medications to knows how to use it and how not to use it. And just writing a prescription can have a liability, but providing appropriate education and appropriate follow up, you can minimize that liability. But as we write more and more of those prescriptions, we increase the risk that they get diverted or they get used in ways that are not medical, if you will.
Magee: And do we even fully understand what goes on with a young person? So I was with a high school student recently and he walked me through, he said, "I really can relate to what you talked about, me, dealing with Adderall misuse because I went through the same thing." He said, "The problem is, I got a doctor's prescription in high school I didn't like it, it was very strong, but my parents wanted me on this medication because my grades always went up, they did." But he said, "It impacted me so that," he said, "I didn't like how it felt when the medication wore off. So I began to use a lot of marijuana to try to help me come off of the stimulant because I couldn't even get to bed." And I just don't know that this story of what's happening to young minds and how the impact can have a ripple effect. I'm just not sure we understand that. So what type of research have you done so far in this area and what areas are you looking into?
Dr. Ramachandran: You are right and that this is a very complex area between societal, parent pressures, educational pressures, and how these medications are used. My research has primarily focused on the fact that there are an increasing number of prescriptions being written for these medications. But if you talk to the prescribers writing these prescriptions, often they say, "I feel the need to write these prescriptions because these kids are coming to me telling me problems that the only way I know to treat it and the thing they expect out of me is a prescription for Adderall." So when we started the project, we said, how do we minimize risk of non-medical use or diversions of prescription stimulants? And the way to minimize that risk was to have fewer prescriptions written that were unnecessary. And the way to write fewer prescriptions was to stop misdiagnosing ADHD.
And that's an important one because ADHD is a very, very complex mental health condition to diagnose. It's one that is most often a primary care provider cannot diagnose accurately, and you need a especially trained psychologist to diagnose ADHD accurately. Anybody that's had a proper ADHD diagnosis knows that it's a two to three hour process where they take multiple assessments and a battery of instruments before that ADHD can be accurately diagnosed. So if you go to the small town family doctor in your hometown and he writes you a prescription after seeing you for 15 minutes, I question the validity on that diagnosis.
Magee: Right. Because let's take grades as an example. Let's take grades as an example. All of us humans are created differently. So we laugh on here sometimes I say, "Look, don't hire me to be your algebra teacher." Because my brain does real numbers very well, I could get through stacks of paper. I do creative things well, I don't do algebra well, I just wasn't created so that my mind can look at algebra equations and see the unknown. I deal with real people. I can see you, I can touch you, I can almost see your algorithm or someone's algorithm of who they are, but I can't see that unknown. So I think about young people, but they will get better grades. So if that is our sole objective, it's easy I guess to walk into this doctor's office and say, hey, for me, it was I walked in and they said, "What's going on with you?" And I said, "Hey, for the first time, I can't finish a book I've got on deadline."
Now, there were a lot of underlying reasons for that, but I walk out with an Adderall prescription, which begin to turn my life upside down because I don't think I was really even a candidate for it. So it all goes poorly. How might we communicate with physicians? I mean, what's our way through in solving that? I mean, we're having this conversation, which we hope parents are listening to, but as you look about in the field, because there has been this obsession over the opiates for very good reason. But here is a dramatic problem just that has fully blossomed across this country.
Dr. Ramachandran: I think healthcare practitioners are under a lot of pressure to give the patients what they want. So that's part of the problem. I think what this podcast is doing, is great in that it changes the conversation and the culture. There is nothing I hate more than everybody has a little ADHD culture. I think that not only does it potentially harm people, it actually takes away and minimizes the problems of people that actually have ADHD.
Lee: It's almost like it's cool to have ADHD.
Dr. Ramachandran: Yeah. I mean, I get distracted between Instagram or Facebook and messages and email too, but that does not mean I have ADHD. And having discipline in how you use your devices and technology is different from having ADHD. And as part of my dissertation, I realized this quickly because I had to interview students with and without ADHD. My interviews of students with ADHD would take two hours and we would sometimes not get to the question. Because these students, I remember one particular example where a student did not take their meds that day because of some other reasons, and I knew immediately they had ADHD as opposed to the, hey, everybody has a little ADHD culture that I think we are at sometimes today.
Magee: Well, when I go look at, and we've talked on this podcast before and in an upcoming episode, we'll deal with it, Lee, we talk a lot about sleep. You like to sleep a lot. I like to sleep a lot. And look, I'm not a scientist, but I'm a journalist, so by trade I can get into Google and go. So I look up sleep deprivation symptoms and people will hear me talk about this often. Way at the top of the chart is sleep deprivation often closely mimic symptoms of ADHD. You can't focus, you can't look at... And so I think about all these students out there and studies also show, oh, by the way, they're sleep deprived. And so maybe there's some correlation yet our solution is giving maybe many that don't qualify, as you say, they haven't been through these battery attests.
And so number one, it's not almost fair to those who really are suffering because it's throwing everybody in this pool. And number two, it could change important personality characteristics of a young person or an adult who doesn't even have the actual symptoms. It may be a byproduct of other things, as you say, distraction, lack of sleep or so many other things.
Lee: And it's, let's be honest, it's not cool to talk about sleep. It's not cool to say, "Hey, I went to bed." I told Magee this today, I went to bed at seven o'clock one night last week. It's not cool to have that conversation [inaudible 00:15:26].
Magee: It's pretty cool around me.
Lee: Especially for teens, it's not their first thing because they have all these devices, they have these things they want to do. Cultures telling them this success looks like X, Y, Z. It's almost as if stimulants are what they think is that golden key to success, whether that be grades, finishing a paper, finishing a book, in Magee's case. It's almost like that's an excuse for them.
Dr. Ramachandran: Mm-hmm. It's a hyper-competitive environment we live in today. I teach in the pharmacy school and I see students that are incredibly smart, that are stressed out because they're afraid of the students loan they're taking. They're afraid of not making it through all As. And these are incredibly smart kids, they're smarter than I was when I was in college. And amount of stress they take, I feel for them. And then they feel the need to cope unhealthily using Adderall or stimulant sometimes. And then when you add that onto the everybody has a little ADHD culture. The leap to, oh my God, I think I have ADHA, so instead of just buying Adderall from my neighbor in the other dorm, why don't I just go to the doctor, get a prescription that my insurance or my dad will help pay for? And now I have a whole month's supply that I don't have to go buying from my neighbor. And that's where we get to the misdiagnosis problem.
Magee: And we've seen such a rapid rise that the stats I've seen on how many prescriptions of stimulants we had say 20 years ago? I mean it's threefold, fourfold up, and it's pretty dramatic. And you think that was the... It's either a case of we are over-prescribing or the entire culture had ADHD all along and we didn't know. But then if that were the case, that would be normal anyway. And why do any of us need it? If we all have it, why don't we just take it off the shelf?
Dr. Ramachandran: Yeah. ADHD is what a scientist would call a bimodal condition, as in there is a lot of underdiagnosis of ADHD because of the stigma with mental health, the stigma with not performing well in the classroom. But there is also overdiagnosis because of the hyper-competitive pressured environment that academics usually work in. So that bimodal condition leads to both problems. So any conversation we have around this today should not be invalidating people that actually have the problem, but also recognize that misdiagnosis and overdiagnosis with over-prescribing of Adderall is a real problem in combination with that.
Magee: And one of the challenges we run into when you have over-prescribing is it floods to the marketplace, then when you have misuse, it's traded around. Well then when we go through periods like earlier this year, where there's an actual shortage, there is an actual shortage of people who need it, can't get it. The demand is so high on other factors. It's kind of the world as we've seen since COVID where things just happened and we get in short supply. Well in this instance was Adderall. And what happens is, then it's in use and people turn to the street what they're getting, if they're buying it from friends nowadays, they've been desensitized to think it's okay to misuse it. But now then when they go try to misuse it and buy it outside of their own doctor's prescription, more often than not, these days it's a counterfeit pill.
And so they're not even getting Adderall, they're getting something made with substances that may also very likely have fentanyl in it, which could be highly addictive and or deadly. And I have encountered that not just a few times in the past year, for example. So that's this overdiagnosis culture and how it's like the domino. It's like once it starts, one falls, the rest of them begin to fall and you have a much bigger problem. Some of your work has also centered around opioids. What type of work have you done there?
Dr. Ramachandran: Around opioids, we've done a good bit of work in older adults. Some of this work was led by Dr. Yang at the School of Pharmacy who's championed safety of opioid use for chronic pain. Because opioids, like chronic pain also have people that actually need the medication and actually need it for their functionality, need it for their quality of life. But overuse is dangerous and so is also inadequate or improper tapering of opioid use. So patients may be on opioid use for a long term, but then they get tapered off because of all this media buzz around and the increasing policing of prescribers. And the tapering itself causes adverse reactions where we've entered this word where we've got to find the balance. Overuse is bad, underuse or under prescribing is also bad, and we need to find the balance for the best of the patient.
Magee: I talked to a cancer patient the other day and they've been undergoing a lot of pain and bone type thing, and they said, "I appreciate all the work you're doing around substance misuse." He said, "I sure wish it wasn't making it so hard to get my painkillers because I'm in my sixties, I've got a difficult case of cancer and I'm having to go in and the doctor's almost afraid to give me those painkillers." So I mean, the education is so important for us to understand where the problems happen, but also where the problems are not.
Dr. Ramachandran: Absolutely. We have been working with the Mississippi Division of Medicaid for the past decade or so. Part of the initiatives at the School of Pharmacy is partnering with the Medicaid division is with education related to opioid prescribing. And we've also been discussing with the Department of Health now to try and expand that, not just to Medicaid doctors, but all doctors around Mississippi to try and communicate what the importance of opioid prescribing is, how to make sure it is used safely, but also that if your patient needs it, you are not the one denying them from it because sometimes you need it for maintaining a quality of life.
Lee: And correct me if I'm wrong, but in your dissertation work, you found there's almost some tools that you found in it to how to help doctors prescribe properly.
Dr. Ramachandran: Yeah. So our dissertation work was focused around how to help family doctors, those family prescribers in small towns that don't have access to a mental health care provider. And we said the best way to help these individuals is to come up with a tool so they can identify who needs to be diverted to a mental healthcare provider before any subsequent intervention can take place. And we had developed as part of that dissertation, an instrument that we call the subtle ADHD malingering screener. It's basically a questionnaire with 10 questions on it that can help identify if the person in front of this doctor is giving responses that don't align with what we typically think of as ADHD. And if they don't align, that doesn't mean this individual was lying, just that this individual may need more detailed evaluation before you write them a script for Adderall.
And that might be for a whole variety of reasons. Part of which we've discussed already is people believing that they have ADHD because of the environment and the structure of their lives. But this instrument is freely available today. And I've had one of the greatest joys in my career is every two to three weeks I get an email from somebody around the world saying, "Can you give me the subtle ADHD malingering screener? And do I have to pay for it?" And I get to tell them, "You don't have to pay for it here, you can have it and you can use it." And we've been continuing to do more research on it. And I think more research is needed of course. But that definitely is one of my joys every time I get an email like that.
Magee: That's incredible. So is that people find you through their website to get this? Or how does this take place?
Dr. Ramachandran: So most of the time when people do find it and send me emails, it's because we published a paper in 2019 in a journal called Assessment talking about our development of this instrument. But the instrument itself is available on my website, drsujithram.com. If you go to the resources section there at the bottom of the web page is a link to this study itself. And the scale is free to use. We recommend caution, we recommend being careful to prescribers when they use instruments like this, but we are not looking to make money out of this. Our goal is to help prescribers and clinicians all over the world. And we've got people from Canada, Australia, Europe, that email me from time to time and tell us how much they've used it and always brings me a little bit of joy.
Magee: And also listeners can visit the mayolab.com where we will have a link to your website and people could then find more information there. It's so interesting because before 1970, and I was born in 1965, I realize I'm the eldest one in this room, and I'm an old guy now, but this is in my realm. And before 1970, the diagnosis of ADHD was rare for school children. I mean, it was almost non-existent. And you have to wonder, Lee, I mean, whatever happened in colleges for admissions, the thing that we got obsessed about in the 80s and 90s and parents are all about what college can you get to? And something flipped to because, frankly, when I was in school, I mean it was okay if you weren't just making straight As. I think there's some stigma that I'm not sure people feel that is okay anymore.
Lee: Yeah. And it's just weird and when we talk about it, a lot of what is the definition of success? And that pressure is getting put on students younger and younger and younger and what we've been talking about, the societal pressure and trying to fit in. And I don't know where things switched and how we got here, that's what we're trying to figure out. But there has been this pressure of success and defining success, what that looks like. Unfortunately, it has been on grades, graduating, what job do you have? House do you live in? Things that maybe don't give you joy. Deep down inside they just give you a title behind your name or a picture.
Magee: Dr. Ram, the thing is, and I can tell parents from experience, and I say, look, again, I'm not throwing darts at these drugs. These are when they are needed in assessments and they are used properly, I'm all for them actually. Because they solve a very important problem. So we do not want to create any stigma here of people who have the actual need, who are using them as prescribed. That's the way it should be. In my case, when I use them, and I'm not sure they should have been prescribed. I mean, look, I haven't been on that drug for many years, Adderall and or Vyvanse, and I finished a book in 17 days, and I do not make this up. Last year I finished a book in 17 days and everybody's like, you must have some hyper focus. And I was like, I do naturally.
But what's so interesting is that when I get into populations and sometimes the students, and again, it could be anywhere throughout the country, and this subject comes up about stimulants and non-medical use. I mean, I'm talking like 50% or more of the group is raising their hand in or making eyes with me. I mean, it's that prevalent yet for some reason it's not really scaring parents. But the truth of the matter is, they have a higher tendency, I think statistics show for later developing other substance issues.
Dr. Ramachandran: The issue with substance use and stimulants and ADHD is also super interesting. Three years ago, an international panel of experts came together to release some statements about substance use disorder and ADHD. And they found, they made some statements that children with ADHD have a dramatically higher risk of developing substance use disorder later in their life. But one way to decrease that risk was to properly treat that ADHD with stimulants.
Magee: Okay, interesting.
Dr. Ramachandran: Having ADHD alone can be a risk factor, but having untreated ADHD is an even higher risk factor. So when talking about stimulants using it appropriate, there's the value there. If we don't prescribe stimulants where they are needed, now these kids will have a higher risk of a substance use disorder. But we need to make sure it is only being prescribed for who needs it. And that brings me, if you don't mind me saying this. One more point that I love telling my students, and they're shocked when they hear this is that stimulants don't help if you don't actually have ADHD. And they always don't believe me because, if you take it feels great. It helps you stay awake all night the day before the test and then you study and then you do well.
But stimulants have been repeatedly shown to not have the same effects when you don't have ADHD. The only empirical study on this was published in 2016, and this was done in college students, and they found that the use of stimulants, so if you were not a stimulant user, but you went on to become a stimulant user, your GPA did not change at all.
Magee: Wow.
Dr. Ramachandran: The only people in college whose GPA increased were the people that gave up using stimulants. That is almost counterintuitive because giving up in using stimulants involves lifestyle changes that the students had to do and that actually helped them improve their GPA, not the stimulants itself.
Lee: I want to ask a little question we talked about a little bit earlier of, when you take stimulants and you have this high, you have to, and then you come off of and you want to fix it, the change in that internally, neurologically, however you define it, what does that do to a person?
Dr. Ramachandran: The coming off the stimulant high or whatever you want to call it, is a real problem. When you talk to patients with ADHD, and I think Magee referred to this earlier, they hate that feeling. They hate it, and it is real, that's a real side effect of ADHD. In fact, for people that don't have ADHD that want to use Adderall, even once, they have a substantially higher risk of having ending up in the ER because of heart palpitations or because of increased anxiety. So self-medication is dangerous and one has to be careful with things like that. I'm not saying using it once will make you addicted, but we have to recognize the risks where they are present.
Magee: So that's so fascinating, you're right. So you have this equation, the case you were making that the research and medical information shows that that's why your tool, your diagnostic tool, the bottom line is, if somebody truly has it can help them with a lot of issues. It can help reduce issues they may face, if they're provided a stimulant. If they don't actually have it could introduce a host. So therefore that's why proper diagnosing and using this effectively and not just randomly assigning a little ADHD to everyone, that's why that is so problematic.
Dr. Ramachandran: This whole stimulant as a gateway for other drug use is not uncommon. I won't say it's scientifically proven, there is a lot of debate in the literature about that. But the other use of stimulants among college students is not just for studying, but for partying. Because when you take a stimulant, you can drink more alcohol or use more marijuana, and that is actually incredibly dangerous because you would've passed out after three drinks, now you're drinking five drinks or whatever it takes. And the increase in blood alcohol concentration might cause a really fatal reaction there.
Magee: Yes. That's what we see with a lot of young populations. It's a thing. One goes with the other they see. Also with me, which is very interesting, and this is embarrassing to say, but I'll just speak the truth. I can't explain this, but for whatever reason, because I wasn't a good candidate for it, but I got given it and it hit a spot on my brain. So I began misusing Adderall and then Vyvanse when I tried to move to something else. But a strange phenomenon happened with me that I hear others tell me about, which is I begin to really crave nicotine, and I had not been a nicotine user. Very, very strange and the best I can explain is, so the minute that dose of stimulant hit me, it was going to start coming down. It was a peak and then it would come down, and I feel like there was something in my brain trying to get another stimulant in there to keep it elevated, so to speak.
And so I would crave, and I have a lot of students tell me they encounter the same thing with vaping, where they are craving nicotine to go with it. So I think it just opens such a difficult situation that parents, you have a child and you want them to excel in school. You don't want them to get left behind, so to speak. But then the same time, if you're pushing them on a drug or taking them to the doctor and hoping they'd leave with a prescription that where they haven't been properly assessed, you are really playing with fire. I mean, it is a strong drug that hits the brain. I can remember the exact spot in my brain. I can almost point to it when that prescription stimulant would hit my brain, I can exactly point to the spot where it would just, it was like electricity and I felt like I was on fire. And it's just very real, it's not mild, it is a strong drug that has consequences.
Dr. Ramachandran: Absolutely. Chemically speaking, Adderall is not that different from meth. It's just one chemical mighty away from just meth. So it is different, but the difference may not be as much as most people would think it is.
Lee: Where in your opinion, education, I feel like is where we need to start coming at this conversation. But who needs to be educated? Where does the education start? How can parents, physicians? Where? How? Take that where you-
Dr. Ramachandran: I think education's definitely a big part of this. I think the education needs to be multi-dimensional. High schools and colleges is where I would begin with children themselves. But beyond that, we also need to talk about healthcare providers. We need to talk about faculty, people like me. Because I'll be honest with you, in my college, I give a lot of assignments. I assign a lot of readings and exams. And guess what that does? It adds stress to students and they have unhealthy coping mechanisms. So yes, the students need to be taught to have more healthier coping mechanisms, but you also need to teach me not to add undue stress to my students. And curriculum bloat, meaning every year I want to think of more things I want to teach my students because hey, I'm excited about these things. I want them to learn this and this and this. Every year I add more topics, which becomes harder and harder and harder for them to learn and cope up with.
So I think faculty are definitely one part of this piece. But outside of that, even law enforcement officials. There is a lot of stigma and lack of understanding of what it means to share your Adderall with somebody else. Sharing Adderall is a controlled substance, it's illegal. But students don't recognize it sometimes and law enforcement doesn't recognize it. But law enforcement cracking down on sharing by trying to demonize it is not going to help, it's just going to drive it underground. So there is a variety of issues here and really I think the best thing we can do is let college students and high school students know the risks involved every time they choose to take an Adderall.
Magee: That is so fascinating. You hit on multiple points that just captivated me, but I really appreciate your transparency talking about what we face in the academic world, what students face of this curriculum bloat, for example. "Okay, I keep getting excited about this, but I'm going to add more to them." That's what I see in K through 12 schools. I'm fortunate that I get invited to speak in a lot of K through 12 schools. And when I start talking to students about Adderall, first of all, a lot of them are on it and some of them maybe deserve to be, but some don't. But they're just looking at me or come up afterwards and say, "And what's my choice? I mean, they are piling so much on me. I'm on the swim team, practice goes till late. I've got two hours of homework. I'm supposed to be at the young life meeting in the morning before school. I've got something, they want me to go see my grandparents after in the evening. I've got something on the weekend. I'm up trying to keep up with friends on social media."
I mean, this is what all the students are telling me. We've not just had curriculum bloat, I think we've had lifestyle bloat. Where we look at young people and expect them to just be this amazing miracle of earth. I would've fallen out with exhaustion. But when you are on a stimulant, let's be honest, if you were given one that you don't really need, it will keep, I mean, it is a stimulant. It will crank up your adrenaline, you will get moving, you will, it will keep you moving.
Dr. Ramachandran: We need to let kids be kids sometimes. We just need to let kids be kids. If everything that a kid does needs to be something that goes on their CV that's going cost long term harm. Going to Harvard or Yale or MIT or wherever you want to go is not going to fix. And I think most parents also need to recognize that. I've met a lot of students in my research that say their parents want them to go to the doctor, get diagnosed with ADHD or get a prescription so that their sibling can have some of that Adderall too. And their sibling can't get a prescription on their own, so the kid has to go get the diagnosis to do this. And I think there is pressure from parents and society as well.
Lee: It's so frustrating. I think that's why we're having this conversation of we weren't built to always be performing and we weren't built to always be performing for someone else. At the end of the day, these kids, this isn't what they want. This is not what makes them happy inside. And they think it is though, to make their parents happy is going to make them happy. And it's just not at the end of the day and it's going to break kids sooner and sooner. And I think it's just heartbreaking.
Magee: Well, I think the You're exactly right. And I can tell you, for me, I remember looking across at my daughter when I was really taking a high dosage of, at that time, Vyvanse and I shouldn't have even been prescribed in the first place, though I take some responsibility for that. But I remember looking across at my daughter one day and saying, "I don't know if I feel anything anymore and I'm not sure if I will ever feel anything again," because it had literally sapped my emotional reaction to things. And so sometimes I think of young people and it breaks my heart to think if, many are over-prescribed and they're just walking around as having their empathy and how they can emotionally connect with others and other things. And it feels like it's not what we really want to be about and it's not what we want our children to be about. And it's a conversation that we just need to have beyond today. I mean, I think culturally we just have to look at what are we even aiming for?
Dr. Ramachandran: Yeah. The conversation around mental health becomes much more prominent when you add all those stressors to a kid's expectations. So if the expectations are high, even things that may not have been a problem start rising to the level of problem in the face of that stress. And then we start fixing them by adding medication or by diagnosing problems that should not have been diagnosed, when in reality maybe we could have solved it by changing our expectations or letting kids be kids sometimes.
Magee: Yeah. Letting children be children, letting kids be kids that is fantastic advice. Dr. Sujith Ramachandran, we hope they will check out your website. Dr. Ram. You can learn more at themayolab.com about he and his work, and you can find that great tool that you've created. Hopefully maybe we'll get healthcare providers just beyond all over the world reaching out for that.
Dr. Ramachandran: I hope so. We've always hoped that this is something that can have used and that can actually help provide us out there. So if they are finding that it helps, I'm here for it.
Magee: All right, Dr. Ram, thanks for joining us on The Mayo Lab Podcast.
Dr. Ramachandran: Thank you. It's been a pleasure being here. I appreciate you guys having
Magee: Me. All right, thank you.
Lee: Thank you for joining us on this episode of The Mayo Lab Podcast. The Mayo Lab Podcast is produced by Dr. Natasha Jeter, Dr. Meagan Rosenthal, David Magee, Alexis Lee, and Slade Lewis. This podcast was recorded at Broadcast Studio in Oxford, Mississippi. The show was mixed and mastered by Clay Jones, and our original music was composed by Slade Lewis. The Mayo Lab Podcast is brought to you by The William Magee Institute for Student Wellbeing. For more information on The Mayo Lab, head over to themayolab.com and follow us on social media @TheMayoLab. If you enjoyed listening to The Mayo Lab Podcast with David Magee, we need your help. Tell others about it, and we'd love for you to subscribe, rate, and give us a review on iTunes, Spotify, or wherever you are listening to this podcast. This podcast represents the opinions of David Magee and guests of the show. This podcast is not intended to be a substitute for the medical advice of a licensed counselor or physician. The listener should consult with their mental health professional in any matters relating to his or her health, or the health of a child.