As an undergraduate at Ohio State University, JD Bickel listened to his classmates talk about using Adderall. He watched them trade it for money, dinner and favors. He cringed when he saw them take it to help them stay up all night to study for a test. But he didn't realize how serious Adderall abuse was on campus until he got involved in the school's campaign to end prescription drug abuse.
Now a student in OSU's Pharmacy College, Bickel has helped expand the conversation about Adderall on campus by reaching out to fraternities and sororities and groups involved in Student Government, Residence Life, and Student Health.
Bickel found that students were ready and willing to talk about Adderall, a psychostimulant designed to treat Attention Deficit Hyperactivity Disorder that has become popular among high-achieving college students. The groups he approached willingly agreed to incorporate an anti-prescription drug abuse message into their programs.
"I saw that students generally knew that this misuse and abuse was an issue, but may not have ever had their questions about it answered - they didn't have a complete picture," Bickel said. "However, they were willing to discuss it with us. When we gave them the information, it was clear that many of them would at least reconsider their perceptions, and even actions, regarding these practices."
Researchers estimate 30 percent of college students have used Adderall at least once. While students aren't hesitant to talk about the "study drug" that has become an almost routine part of test prep or exam week, school administrators are more reticent. And on the few campuses where administrators have taken aggressive steps to stamp out Adderall abuse, students are behind most of the efforts.
In 2007, Ken Hale, assistant dean for professional and external affairs at OSU's Pharmacy College, began to notice a new trend on campus. Prescription drug abuse was growing into a public health issue. OSU students had started to report seeing their peers abusing Adderall.
Hale and other professors at OSU's Pharmacy college joined forces with students to develop The Generation Rx Initiative, a program that provides educational resources for students to learn about the dangers of prescription drug abuse.
Although OSU administrators initiated Generation Rx, students soon took over the program. Students created the first Generation Rx website, helped develop the first resources for workshops, and have integrated Generation Rx into student organizations and OSU's surrounding community.
"In short, students have been a critical workforce for these efforts, and the Generation Rx Initiative could not function at the level it has without them," Hale said.
This month, Hale and OSU students will host the Collegiate Drug Abuse Prevention Conference, in Columbus, Ohio, along with professors and students from 26 different colleges and universities. The OSU team plans to challenge other schools to create a take-home plan to put a dent in prescription drug abuse on their campuses.
Also in August, Generation Rx will launch an Adderall-specific program called "The Adderall Dilemma." The toolkit includes facts, questions, and skits to help foster discussion among students.
But few schools have responded to Adderall abuse with such extensive programming.
Rather than address the root cause of Adderall abuse, some schools have tried to physically contain the drug's prevalence by choosing not to fulfill prescriptions on campus. Those that do fulfill prescriptions on campus encourage students to lock up their prescriptions in a safe place.
But some worry such restrictions could exacerbate the problem. In a study on Adderall abuse published in 2010, Gregory Eells, associate director of the Gannett Health Service at Cornell University, in Ithaca, N.Y., and Thomas Workman, a professor at the Baylor College of Medicine, in Houston, Texas, suggested such policies might actually increase illegal sales of the drug on campus.
Students come to campus with a vast array of prescriptions-an uncontrollable reality for administrators. But critics say schools can do more than suggest that students exercise caution and turn to campus health services for help.
But schools are unsure about what steps to take. Although administrators know that Adderall abuse exists, hard data is scarce. As a result, the problem is hard to assess.
"Even the simple task of naming and defining the problem has created confusion and a bit of controversy among researchers, practitioners, and students," Eells and Workman concluded.
In September 2011, administrators at Duke University, in Durham, N.C. responded to Adderall abuse by amending the university's honor code. The revised policy deems unauthorized use of prescription medications to enhance academic performance as both cheating and a violation of Duke's drug policy.
Stephen Bryan, director of the Office of Student Conduct at Duke, told Reese News, a University of North Carolina publication, that the effort to crack down on Adderall has been in the works for several years and has mainly been motivated by students.
But Bryan acknowledged the code change was mainly a symbolic gesture to show that the University considers such drug use to be dishonest academic conduct: "We certainly don't plan to drug test every student before an exam. The hope is that students will see that the University has taken a stance, see that this [drug use] is considered cheating and will think twice before doing it."
But Bryan sees no indication that students' behavior has changed as a result of the policy change.
Wesleyan University, in Middletown, Conn., considered altering its honor code to specifically ban Adderall abuse after students asked administrators to address the issue. But administrators declined to make any changes, saying Adderall abuse already falls under the university's non-academic code of conduct.
Because most school conduct policies assume Adderall abuse under the larger context of prescription drug abuse, few schools have stepped up with responses that reflect the drug's unique ability to affect the academic environment as a whole.
Students see the Adderall issue as less about covering policy bases and more about preserving a fair academic playing field. But college administrators may not have an incentive to stop students from using the drug, even though they probably don't condone its abuse. If Adderall boosts students' grades, the elevation of schools' academic standings could be a convenient side effect.
But Eells and other researchers insist claims that Adderall improves grades are false.
"It may extend focus, but it's not a miracle substance," he said. "There is a huge placebo component."
Adderall often gets more attention than is appropriate considering the actual number of students involved, Eells said. At Cornell, the numbers are low, he said. Eells believes schools must consider the actual number of students abusing Adderall before responding.
"The data is an important component," he said. "It determines how much effort schools should put in."
But Natalie Colaneri, a student at Dartmouth College, in Hanover, N.H., believes that students' perceptions about the prevalence of "study drugs," regardless of how much they might be exaggerated, are reason enough for schools to bring more attention to the issue.
"To date, the Dartmouth administration has never once acknowledged study drugs on our campus," Colaneri said in an April post for the college's student newspaper, The Dartmouth. "There are forums and committees for other problems on this campus, and this issue deserves that same attention."
Colaneri believes that addressing the Adderall issue starts with open discussion on campus. Because the misuse of study drugs has negative health consequences for the student body and detrimental ethical consequences for the institution as a whole, the conversation must be collaborative--students, faculty, and college administration together, Colaneri said.
Schools that have remained silent in the Adderall discussion might argue that resources regarding prescription drug abuse are, in fact, available for students. But students will rarely go look for them, said Bickel, the OSU Pharmacy College student. Schools can equip students in the way that they think about the issue by creating a safe space to learn the truth about prescription misuse and abuse, he said: "The best thing that schools and their administrators can do regarding prescription drug abuse, is to simply address it."