Up All Night With New Study Aids

A year ago, David Green, a student at Harvard University, famously told the Washington Post: "In all honesty, I haven't written a paper without Ritalin since my junior year in high school." Since then, "Vitamin R", "R-Ball", or "Viagra for the brain" has been an open secret. But although the academic-performance enhancer is well established in U.S. and East Coast Canadian universities, Ritalin and its twin, Dexedrine, are only just becoming mainstream in B.C.

Chris Wren is a 19-year-old second-year student at UVic. He was diagnosed with ADHD halfway through Grade 11 and has been taking prescription Dexedrine (dextroamphetamine) ever since. In university, he started taking extra medication to help him study. Last year, he was getting 55 percent in Economics 100 after missing half of the classes and all of the labs. The night before the exam, he took one pill, stayed up all night, and read the entire textbook and study guide. He got 90 percent on the exam. "I could never have done this without Dex," he says by phone from Victoria. "Once you try it, it's unbelievable. It's amazing."

It's not just the slackers who are fans. Julia Portsmouth (not her real name) is a second-year science student at Queen's University with a straight-A average. She started getting Ritalin (methylphenidate) from her boyfriend's roommate in her first year to help her get through the exam period. "The material becomes so interesting, you don't want to move, go to the bathroom, eat, anything," she says during an interview in a Vancouver café. "And you remember all of it." About half of the people she knows take Ritalin or Dexedrine to get through exams: "They're the people who want to do really well and want to keep scholarships or get into grad school."

Wren's friends caught on that he had a prescription and started to ask him for it. At first, he gave it away, then people started offering him money. He sold it for $1 per pill, then $2, then $5, and finally, $10. Throughout the year, he sold Dex to seven out of the 28 people on his residence floor. Of his 100 or so acquaintances on campus, five have prescriptions for Ritalin or Dex, about 50 have used them, and around 30 use them regularly. Most try it once, realize the benefits, then rely on it for the exam crunch times. "It's cheap; it's amazing value for what you get."

And it's easy to get. Most students don't bother even trying to get a prescription. One student at UVic says she knows several people who "give it out like candy".

Dr. Patricia Mirwaldt is head of student health services at UBC. She says she has seen a huge spike in requests for Ritalin and Dexedrine over the past five years. People learn about it from friends and the Internet, she says on the phone from her office, and they come in to the clinic to get a study aid. Most leave empty-handed. But with an abundance of prescriptions, students simply turn to their friends.

Wren says the reason Ritalin and Dexedrine requests are on the rise is that the drugs work--and for everyone. After his experience with the economics exam, Wren realized that with Dexedrine, "I could focus better than people without ADHD who don't have prescriptions. I do need it, but only to an extent. I really believe it gives me an unfair advantage. I can concentrate 10 times better than someone else."

Derryck Smith agrees with Wren's theory. "Ritalin is very effective at helping people to concentrate, focus, and be alert, and the effect is not specific to those with ADHD."

Smith is head of the department of psychiatry and psychiatrist-in-chief at B.C.'s Children's Hospital, as well as head of the division of child psychiatry at UBC, and he is widely recognized as the province's leading expert on ADHD.

"Methylphenidate has been used in warfare to improve performance, to help soldiers stay focused and alert for long periods of time," Smith says in his hospital office. "In this sense, it can very much be characterized as a performance-enhancing drug."

But he cautions that Ritalin and Dexedrine are drugs intended to treat patients with impairment. "If the patient is functioning normally on a daily basis, there is no need for medication or prescription. The physician's job is to treat the patient with a medical diagnosis, not to prescribe medication to enhance performance."

The five-fold increase in B.C. in prescriptions for Ritalin in the late 1990s created a situation where some argued that B.C. had the highest prescription rates for that drug in the world. In response, the College of Physicians and Surgeons of B.C. placed Ritalin on the "triplicate prescription list". That meant that every time a doctor issued a prescription, one copy stayed on file at the office, one copy went to the College of Physicians and Surgeons, and one went to the pharmacist.

According to a Freedom of Information request to B.C.'s PharmaNet--a network that links all the pharmacies in the province and one of the most comprehensive databases in North America--last year doctors in B.C. prescribed 72,286 prescriptions of methylphenidate (Ritalin) alone. However, the college announced in fall 2004 in the College Quarterly that Ritalin would be taken off the triplicate-prescription list because there was no evidence that it was being prescribed improperly. It found that the increase in prescriptions was due to heightened awareness of ADHD.

Ritalin had also been put on the list because of its use in a street cocktail called T&R (Talwin or Tylenol plus Ritalin--also called "the poor man's speedball"). But the college found that this diversion (nonprescription) use was not a significant factor.

Ritalin is still regulated in the sense that "if a physician prescribes the drug for a month and the patient comes back in two weeks, they'll probably notice something strange," Smith says.

But it's clear that there is some diversion, and Smith argues that using nonprescription Ritalin to study is somewhat similar to using performance-enhancing drugs for athletic events. He suggests that if this continues, drug screens, like in professional sports, might have to be used.

"However, to put this whole thing in perspective, you must recall that coffee is a stimulant too. We do not seem to get too concerned whether some students are getting an advantage from using coffee."

Excessive use of stimulants like Ritalin, Dexedrine, and even coffee comes as no surprise to Cpl. Scott Rintoul, head of the RCMP's drug awareness service in Vancouver. "Globally, we are in an era of synthetic drugs and an era of stimulants. If you look at the '60s--a time of hippies, peace, and love--the drugs of choice were sedative and hallucinogenic, like marijuana, LSD, and MDMA. Back then, there was some speed, but its purity was 50 percent of what it is now, due to the manufacturing process. Meth now is 100-percent pure. And if you do find LSD now, it's half the potency it was then.

"You can also find Wake-Ups at any gas station or drugstore. And we're seeing energy drinks like Red Bull and Monster everywhere." Red Bull only became legal in Canada a year ago, but in 7-Eleven it takes up four shelves of the fridge, more than milk or juice. In Japan, they sell Red Bull in tiny cans only, "like perfume bottles, but here you get the full 250 ml. The exhaustion from the fast-paced world also leads to a need for more stimulants to keep going."

And it's not just stressed students who use it. Rintoul coaches a midget hockey team and kids come in with energy drinks to every practice and game.

But Rintoul says that what people don't know is that stimulants make people "very anxious and agitated". Last year, Wren sold some of his Dexedrine to a student on his residence floor who used it to see how many nights in a row he could go without sleep. After three nights straight, the student started hallucinating and became ill. He told the residence manager, who took him to the hospital, then reported Wren for selling illicit drugs. Wren was evicted from residence.

Wren says he regrets the incident and no longer sells or gives away his prescription as a result, but he doesn't have much sympathy for the student. "He was an idiot. I mean, why would you want to do that? It's really bad when you take too much." Wren himself only takes his prescription during the school year and stops during all holidays and most weekends. He doesn't like how he becomes jittery and has trouble sleeping.

But the jitters aren't the most serious complication; Rintoul says it's violence. "In the '60s, the risk was apathy, but now we are desperate to succeed: to get through school, do it fast, do it better. So we're self-medicating with stimulants." Rintoul says the extreme anxiety caused by stimulants--including cocaine, meth, and Ritalin--can lead to users becoming twitchy, aggressive, paranoid, and even violent.

Further, Rintoul says we talk about "gateway drugs" of marijuana, cigarettes, and alcohol, but Ritalin and Dexedrine can also quickly lead to more serious drug dependence. Rintoul spoke to the mother of a boy who was prescribed Dexedrine from a young age due to ADHD. "He was so conditioned to being stimulated that after his first hit of meth, he thought he was in heaven." He became addicted during university and left school. According to Rintoul, after living on the streets in the Downtown Eastside for several months, he is now in recovery, living "one day at a time".

The cheapness and abundance of crystal meth form the main reason why the Ritalin phenomenon has hit the West Coast later than the East Coast and the U.S. Crystal meth and ecstasy are far more expensive elsewhere, making Ritalin and Dexedrine the cheapest forms of speed. Here, a single dose of meth tends to be $5 to $10, and ecstasy about the same, but Ritalin can run as much as $10 to $20; in Toronto, street prices for Ritalin are $5 to $7, and in Nova Scotia, a pill is a mere $2.50.

Ritalin is listed as a drug in B.C.'s Controlled Drugs and Substances Act (along with LSD, magic mushrooms, ecstasy, and crystal meth). That said, as of yet, there have been no arrests or convictions of university students taking the drug to study.

But Rintoul urges that more than the legalities, "as a society, we have to take a real look at this whole stimulant culture, and what we're really promoting."