Over the Counter Prozac Continued: Should we Consider Over the Counter Adderall too?

When I read the post about Prozac potentially being sold over the counter, I immediately commented about what seems to me a pretty interesting problem: the overuse and over-prescription of attention deficit hyperactivity disorder (ADHD) medicine, such as Adderall and Ritalin. I found myself struggling to decide whether I thought these kinds of medications should be made available over the counter, and I’m still not sure what side of the fence I fall on. I spent a few minutes looking online for related articles, and I came across a fairly persuasive article entitled “Scientists Back Brain Drugs for Healthy People.” The article can be found here: http://hosted.ap.org/dynamic/stories/M/MED_BRAIN_PILLS?SITE=NCKIN&SECTION=HOME&TEMPLATE=DEFAULT.

The article explains that there are a growing number of professionals, including authors, ethics experts, and doctors, that are publicly arguing that “brain drugs,” like Ritalin, should be made available to the public. There are a number of arguments made in the article, a few of which I’ll mention here. For example, one argument suggests that taking a drug to improve brain function is functionally no different than getting a good night’s sleep or eating healthily. And the benefit is tangible: these drugs would allow people to multitask better and boost memory. Most importantly: the side effects are minimal. Another argument is that because these drugs do not have significant side effects, they function really as an improved version of caffeine, and there’s no ban on caffeine.

I’m not sure I buy this last argument. I think the devil is in the details and I think comparing prescription “brain” drugs to caffeine found in coffee or soft drinks is a little disingenuous. The way and amount that these drugs alter the brain is so significantly more than we see with caffeine that I think the comparison is a little moot. I may be making assumptions, but I personally feel this comparison is trying to equate apples and oranges. Adderall and caffeine may overlap in some ways or even fall into the same category, but there is a distinct difference.

I think the most interesting ethical argument is whether we should make these drugs ore widely available simply because a lot of people are already taking advantage of them and using them. The article cites that at some colleges, students who have used these drugs are as high as 25%. I know from my own experience as an undergrad and here in law school, that MANY students have been taking advantage of Adderall and Ritalin despite not having ADD or ADHD. I’ve asked some of my friends whom I know do not suffer from ADD how they managed to get a prescription, and the response is usually very similar: they simply tell the doctor they have a hard time focusing, or that they can’t manage multiple things at one time, and poof! Prescription. And I wonder if this is like this everywhere, because I know people from different parts of the country who all have basically the same story. More concerning, is the fact that once diagnosed, people seem to be able to get more meds with relative ease, which I believe is why people are now buying and selling Adderall and the other meds “illegally.”

So is the fact that this is has become almost a common practice reason enough to make these drugs available to everyone? I do not think so. While it is a completely different issue, I think the way sports (struggle) to handle steroids sheds some light on this problem as well. Even though many people use banned substances, the NFL isn’t about to let steroids and other banned enhancements become sanctioned. The idea is to keep the field as natural and fair as possible. And when people violate the rules, it is an unfortunate consequence. But penalties seek to deter infractions, and at least by keeping substances illegal, it makes access to them more difficult. While it is ENTIRELY unrealistic to assess “penalties” for this kind of drug use, I think imposing some restraints on their access is prudent and at least keeps the problem from expanding at an exponential rate. Shouldn’t we seek to keep our brains as “natural” as possible and not encourage stimulate use/abuse?

Importantly, even the pro-drug corner believes that more research needs to be done before such a drastic step is taken. The supporters want more research to be done into the use, benefits, and risks of the drugs. I think we need to know more before we make a significant judgment call like allowing these to be sold over the counter. Supporters also believe that doctors need to develop policies for the use of such drugs, and legislatures need to rethink the issues. All of these suggestions I do agree with. Opening up the drugs to more scrutiny would be a better way to assess their potential pros and cons.

However, I do not think that this would eliminate the most critical concern with drugs like these: that people would either feel coerced into taking them, or that the drugs would get abused. It is easy to imagine the scenario where “everyone’s doing it,” and therefore, to compete in (very competitive) workplaces or schools, people almost have to resort to such enhancements simply to keep the playing field level. Opening access to these drugs, even if they don’t have serious side effects, to the public would cause an explosion in the use of such drugs, and I think that many people who would not have sought or needed these drugs in the past would be forced to take them or would at least heavily consider it.