When Paul left home to attend the University of Colorado at Boulder, he took his prescription for the drug Adderall along with him. The medication is normally used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), but Paul - who now believes he had been misdiagnosed - no longer used it for that purpose.
Instead, the journalism/business student says he took Adderall only occasionally and with a very specific intent: to help him focus on homework, or to stay up all night cramming for an exam. He also shared the pills with other students who did not have prescriptions, but who wanted Adderall for the same reasons he did.
Fellow students "always wanted my Adderall for studying," says Paul, who asks that his last name not be used. "Certain individuals couldn't study without it. They figured, 'If I study all night on Adderall, I'd better take it for the test, too.' "
Adderall is the amphetamine most widely prescribed to treat ADD/ADHD. As with other amphetamines, regular users of Adderall can soon become dependent on it to get through the day.
Dubbed "kiddie coke," Adderall is being used - and abused - by increasing numbers of high school and college students on campuses across the United States.
Although students often take the drug together - sometimes in study groups - their intent is not recreational. Rather, they use the stimulant in an attempt to enhance their powers of concentration and improve their academic performance.
"It's a performance-enhancing drug," says Punyamurtula Kishore, president and founder of the National Library of Addictions in Brookline, Mass., and a physician at Beth Israel Deaconess Medical Center in Boston. "They start accessing the drug legally, and then they find they can sell it for five or 10 bucks a pill to college kids."
Pressure to earn ever-higher grades appears to be a primary motivation in the Adderall craze, say Dr. Kishore and other experts. In Massachusetts, where parents and school officials often have high expectations for students, more prescriptions are written for Adderall than in any other state.
Often, students begin imbibing while still living at home, and sometimes parents - unaware of the dangers involved - tolerate their misuse of the drug.
"A lot of families look the other way so that kids can stay up and study," says Kishore. "It's a myth that they'll do better on exams ... [But while on the drug] they feel they can conquer the world. Then they come down and crash."
Although Adderall is often perceived as legal since physicians and pharmacists are involved in its dispensing, ultimately it is an illegal drug when used by somebody without a prescription. Campus policies on handling student drug users and dealers vary, but range from a warning with counseling to expulsion.
It's hard to quantify the extent of Adderall abuse among students. Certainly the availability to children of drugs to treat ADD/ADHD has soared in recent years.
In the last 10 years, the number of preschoolers taking ADD/ADHD drugs has tripled; the number of school-age children has multiplied by 20. More than 2 million American children are prescribed drugs for ADD/ADHD. Adderall represents about a quarter of the market.
Statistics on the legitimate use of Adderall, of course, don't reveal anything about patterns of illegitimate use. However, some experts suggest that the fact that the drug is viewed as a legitimate one may enhance its appeal - and its danger - to youthful users.
When Adderall is passed on from family or friends who have prescriptions to those who don't, it has an aura of legality that street drugs don't have. It's pure, which makes it seem safer than unregulated drugs, where users don't know what else it may have been cut with.
But in many states it's a felony to be in possession of drug that has not been prescribed for the person using it. Prosecution, says Robert Goldstein, chief medical officer of Somnia, could be "equally as damning to a student" as addiction. When people see a prescription bottle, they think it's OK - even when it's taken inappropriately, says Dr. Kishore.
Students are more likely to take a single Adderall pill than drink 10 cups of coffee because, at least in the short term, it's "longer acting and has fewer side effects than caffeine," says Dr. Goldstein. "When used appropriately, it lasts an entire day."
For 22-year-old Ben, it helped him concentrate for hours on end at the University of Michigan, his alma mater. Ben (not his real name) restricted his Adderall use to study periods.
After about 20 minutes, the drug would kick in. He says that the ability to concentrate intensely "helped time pass by better. I could read for four hours straight without looking up at the clock."
When Ben describes the widespread use of Adderall at his alma matter, he said many students retained prescriptions from when they were young even though they no longer used the drug themselves. Some had stopped taking Adderall because of headaches or other side effects, yet were willing to going on supplying it to others, either to "help a friend in a crunch," as Ben puts it, or to make some quick cash.
At Ann Arbor, blue pills (10 milligrams) normally sold for $3, and orange pills (20 milligrams) for $5, says Ben. Prices rose as demand exceeded supply during midterms and finals.
Ben, an English major, would frequently take the drug with his peers during study groups in the library. They also met afterward to share a joint to alleviate the inevitable side effects, which include restlessness, dizziness, and insomnia.
Kishore has counseled a number of such clusters - small groups of friends who have taken Adderall together, and become dependent on it together.
Overcoming the dependency is tough, Kishore says, especially for students who were using Adderall specifically to help them stay up to study and who need to learn to approach their studies in a new way. Treatment is normally done on an outpatient basis and involves teaching new coping behaviors and techniques.
Some also hope a new version of the drug could help reduce its misuse among younger students.
In 2001, Shire Pharmaceuticals, the maker of Adderall, introduced Adderall XR, a time-release version. The new version was developed primarily as a convenience, the company says. But because it is taken as a single daily dose, children don't need to bring it to school, thus minimizing "any potential misuse or inappropriate transferring of medicine to individuals without a prescription."
But some experts say that Adderall abuse is still not being taken seriously enough by many parents and adults.
Widespread toleration of Adderall misuse is similar to the blind eye too many adults cast on teenage drinking in the 1980s, says Goldstein.
"People didn't pay attention or take it seriously, before groups like MADD," he says. "[Minors drinking] isn't just bad because they're underage, it's dangerous. If somebody gets in a car, they can injure others and themselves. It's similar to being a parent throwing a party with kids drinking, only to find out you're responsible for the car crash that happens later on."