Links
JMU Counseling Center: https://www.jmu.edu/counselingctr/
Transcript
0:02 Intro: Hi there! Welcome to Well Dukes, brought to you by The Well. Each week, you’ll hear conversations from a variety of JMU staff and students that we hope challenges what you know, think, and do in regard to your own health and helps you be Well Dukes.
0:22 Jordan: Hey there everyone, welcome to another episode of the well, Dukes podcast. I'm Jordan.
0:27 Mikayla: And I’m Mikayla.
0:28 Jordan: And this episode today is all about prescription stimulants. On today's episode, our guests are Mindy Koon and Renee Crosswhite. Mindy has experience working with college students and drug misuse. And Renee is a psychiatric nurse practitioner at the Counseling Center here at JMU.
0:46 Mikayla: Yeah, so they define what prescription drug misuse is, why college age students are more likely to misuse, and what are common side effects of using prescription stimulants, both for people that are prescribed and for those who use but are not prescribed that medication. They do also discuss what happens when someone combines alcohol and stimulants, including in some cases, those interactions resulting in alcohol poisoning and death.
1:11 Jordan: And by stimulants, we're talking about drugs that may be referred to as speed or uppers. The most common pharmaceutical and prescription names are dexedrine, which is a dextroamphetamine. Adderall, which is most commonly known for college students. And that's a dextroamphetamine-amphetamine combination pill. And Concerta or Ritalin, which is a methylphenidate.
1:34 Mikayla: All right, well let’s get started.
[Musical Interlude]
1:39 Mindy: Well, Dukes. Thanks for joining us today. My name is Mindy Koon. And I'm happy to be speaking today with the wonderful Renee Crosswhite from the University Counseling Center. You know, I think I'm going to let Renee introduce herself. So Renee, I'd like to pass it over to you if you could share with our listeners a little about the work you do on campus.
2:01 Renee: Sure. Hi, everyone. I'm Renee Crosswhite. I am a psychiatric nurse practitioner in the Counseling Center. I am in my fifth year with the counseling center. So I mostly prescribe medicines, sometimes I do a little counseling also. But I usually leave that to the counselors and my main role is prescriptions and assessment. So that's basically what I do.
2:29 Mindy: I so look forward to hearing about your knowledge today and just the experiences you've had on our campus. And today, we'd really like to focus on prescription stimulants and take a closer look at that. Renee, as someone committed to college student health and wellness, why do you think this is an important topic?
2:53 Renee: It's an important topic because of the current abuse in the country that's going on that I was reading research recently, where one in four to one in five students abuse stimulant medication during their college career. And that is an astonishing statistic to me that there's that much abuse going on throughout campuses nationwide. So it's definitely a problem that we need to talk about.
3:23 Mindy: Yeah, and prescription stimulants, for 18 to 25 year olds, this is one of the most commonly misused substances, which I think we'll probably dig into later. And I think that's surprising for folks because they might think of other types of prescription medications being more commonly used for 18 to 25 year olds, but prescription stimulants are the top ranking one annually on surveys.
3:53 Renee: Yeah, we've talked about this, um, you think opiates a lot of times because it's in the media so much right now. But I think a little older age group, probably, that is the case. But in college age students, it is stimulants, the number one, and access is part of that reason, I think.
4:17 Mindy: Yeah, I think access is definitely part of that bad reason. And one of the surveys I know I look to with data like this is the National Survey of Drug Use and Health. And annually, once again, prescription stimulants really come up at the top of the list for 18 to 25 year olds for misuse. And I think there's a lot of reasons probably for that other than access, does anything come to mind for you?
4:49 Renee: Yeah, the, exactly, physiologically what it does in your body, a lot of people seek that because of what's going on in their life. I think that students are trying to stay up and exam weeks happen and people have Adderall available. And it's easy to say, yeah, I've got to study, I've got to pull an all nighter, it would be easy to take somebody's Adderall and, and try to help me with this and this one time to get through it. So, then, there you go. That's the first time and then it gets easier after that to do it again. Yeah, it's just that that starts up a chain reaction often.
5:35 Mindy: Yeah, certainly that stimulant, that extra brain activity certainly has appealing aspects, I think for students, and thinking about prescription stimulants... What conditions do they help folks with who have these prescribed to them?
5:58 Jordan: Yes, typically, we prescribe stimulant medication for Attention Deficit/ Hyperactivity Disorder, or attention deficit disorder, which is mostly just not the hyperactivity part. So much, it's focusing, concentration more. But usually, those are the main two things that we use stimulants for. They are also used in narcolepsy. And that is rare. That is not seen very frequently. So yeah, it's occasionally used for narcolepsy. And sometimes, in severe depression, where people are just unmotivated and can't get out of bed, you'll occasionally use a little bit of a stimulant with those people. But the majority is ADD and ADHD, those are the two things that we mainly treat. Most of the time, the majority of people that are prescribed stimulants have been diagnosed under 18 years of age. So the majority of people start and try this medicine before they get to college. But what I see in practice, sometimes, is students don't like the way they feel if they truly have ADHD on the medicine, because they all have side effects. So they've taken this for a while, and they didn't like it, they took it through high school, and they managed, and they get to college. And they think, well, I don't have to take this any longer, I think I can manage. And a lot of times those students can with the first year and sometimes the second year with the gen ed's. And then a lot of times I'm seeing them, we don't typically treat ADHD in the Counseling Center. But sometimes if I'm working with anxiety, or depression or, or those things, then we see, we get that better. And then we realize it's the ADHD, untreated, that's really causing even more problems, that's causing the depression because you can't study and you can't focus and you can't concentrate. So that's what happens a lot of times, and then they'll often have to get back on medicine, and I've been able to be out off of them for a couple of years. So I see that sometimes. And those are students who truly have tried to do without medicine and don't want to get back on it. But then they realize just to be successful at the end, I'm gonna have to do this for a few more years. So that happens too.
8:33 Mindy: That is just really fascinating. I mean, thinking about the different conditions this could be prescribed for but also knowing that ADD and ADHD are really the primary focuses. Well, really to help a student focus and have that-- not just a student, anybody would be on these medications-- to, to have that focus. And you can see why someone might want to not take them thinking that they'll be able to overcome some of those pieces. Could you share a little bit of what are some of those side effects that someone may experience from taking these medications that they don't maybe really appreciate?
9:14 Renee: Yeah, yes, one of the main ones, um, and sometimes for some people, this is a positive, but for a lot of people that decrease in appetite is a negative. And sometimes, for some people, that never really goes away. And a lot of these medicines are long acting, so they'll work for 10 to 12 hours. And if you just really aren't... Nothing tastes good and you're not really hungry for that long. So a lot of times people just don't like that. And sometimes the decreased appetite leads to headaches. So then you've got the low blood sugar and you're feeling weak. And you get a headache, you just it's kind of like a snowball effect and where it goes on top of each other, and sometimes they also cause insomnia in certain people, especially with college age students having irregular schedules and sleep patterns. They get up later if they don't have classes early in the morning sometimes. So they end up taking their medicine later. Because a lot of times when people are prescribed stimulants, they don't want to take it before they've eaten. So they'll wait a couple hours to eat, they'll sleep late, wait a couple of hours to eat. So then they're taking it by noon or a little bit later. So if you've got a 10 to 12 hour medicine, then you're going to be midnight before you could even probably get to sleep. So that's a problem. When they think, “Oh, you know, I need to get up tomorrow. I know I'm gonna get up tomorrow and do better. But I can't sleep.” So yeah, it's just it just gets into a cycle there. And with some people not having the food and not being able to eat then you start having GI distress and stomach aches and stomach pains. And there... Yeah, a lot of side effects with these medicines for some people.
11:06 Mindy: Yeah, definitely sounds like it. And sleep can be such a vital component of doing well in anyone's life, but especially for students.
11:15 Renee: Right? If you're not sleeping, and you're not getting proper nutrition, it-- Yeah, it's hard to learn. You're just even if you spend the time and the material, you're not, you're not able to take it in and memorization is just not as good. So you start doing, yeah, academics, it shows over time if you don't get proper nutrition and sleep.
11:39 Mindy: Yeah, absolutely. And as you talked about some of those side effects, I could almost imagine someone hearing those and thinking, that could be reasons why someone may want to misuse a prescription stimulant. And just for our listeners, I'd like to share, like, what prescription drug misuse is: that would be using a prescription drug and a manner or in a dose that is not prescribed. Using another person's prescription drug, even if maybe you're using it for a reason that may be medical, that's not a medication prescribed for that person. So that would be described as misuse, and then using a prescription medication for the purpose of getting high or euphoria. So those are kind of the three areas that can be considered prescription drug misuse. What would someone's experience be like if they took a prescription stimulant without having a medical need for it?
12:43 Renee: Right, these medicines change the brain chemistry along with other other chemicals in the body, but the brain is mainly affected. So in ADD and ADHD, there are certain chemicals that are lacking in synapses in the brain. So that's what causes people to have issues with focus and concentration. Those, those chemicals aren't staying there long enough. So they just don't have them available. And so they can't focus. But somebody that doesn't have that and has enough of the chemicals available, then you're just providing excess ,that means an excess of chemicals in the brain. So you've got, you know, not the proper amount. So then you get symptoms like really excitability, restlessness, it can impair your memory over time, especially if you take these and you don't have the ADD or ADHD, it's really it just ramps everything up. It kind of does that to some degree, systematically. Even with people that have ADHD, they're going to have increased heart rate, increased blood pressure, just because of what it's doing in the body. But they don't have the problem in the brain that somebody that's not diagnosed with this does. And that's one way you can tell for sure. If you give... if you have a misdiagnosis and somebody takes it and they're like, “Whoa, I was just going 90 I couldn't stop. I was all over the place.” And that's what it feels like when you don't have ADD and ADHD. With ADD and ADHD, it’s going to help your concentration and focus. But if you don't have it, it's not going to help that, it's just going to make you really alert. Really restless. Really. Yeah. Just think of speed. It's just speeding everything up. Everything in your body is going to accelerate basically.
14:45 Mindy: Yeah, just like overstimulation in general for folks, which might make it harder because I could imagine, you know, someone may want to miss us to be able to stay up and study or something like that. But if they're having these effects that could actually be almost counterproductive.
15:03 Renee: Yeah, it can impair learning, actually.
15:08 Mindy: I think that is… that is really good to know and consider for folks thinking about these medications and that it might be an answer, or possibly help with academics. [Renee: Right, right.] I would like to also ask about one of the pieces of misuse is taking a medication in a manner other than its prescribed. So certainly there are folks that crush up prescription stimulants and snort, sniff it, snort it, whatever the term is that folks would like to use. And I'm wondering how that might change someone's experience with these medications.
16:01 Renee: Right, this is interesting, because I have previously worked in substance abuse, with substance abuse people in inpatient facilities too and outpatient facilities. So I've seen a lot. So it's very interesting. For the medicine, most of the stimulants that are the majority of stimulants now, are time released. So they're extended release medicine, and they're made in a way that they're meant to enter your body slowly, 10 to 12 hours most of the time, so that you get effects with taking one pill, and often you're not having to multiple dose daily. That's the benefit of the longer acting stimulants. And I would say 95%, that's what is I have them prescribed, instead of immediate releases is extended release. So when you crush these medicines, you're getting all of that daily dosage in your system at one time, and it can't be metabolized. So it's harder work on your liver, which does the-- metabolizes it and and you're getting more into your system than what should be and so your heart's going to go faster than it normally would, abrupt blood pressure is going to be more elevated, your temperature often will go up. And to dangerous levels. People have heart attacks and strokes that abuse stimulant medications in this way. So yeah, it can be -- cause heart arrhythmia as they can cause death in severe cases. So yeah, it's really, really dangerous. And people just do not are not aware of the dangers of this. It's scary when I hear that.
17:50 Mindy: Yeah, well, I think it's easy to think like this is a medication that was made by a pharmaceutical company. So there's that belief that maybe it's safe for that reason. And obviously, just based on all you-- just described, that this really is something that could potentially cause an overdose for someone and require a medical intervention. If not worse.
18:11 Renee: Right. What comes into the emergency room often? Yeah, if it's not illicit stimulant, if you it can cause the same thing is going on the streets and buying cocaine. Yeah. Crushing, crushing Adderall long acting, yeah, together. It's just you're getting way too much medicine in your system at once.
18:37 Mindy: Yeah, I really appreciate you taking the time to explain the extended release, and why that would be an extra reason as to the strong impact it could have for someone using it in that way. I know we've talked about just general side effects and what could happen, you know, with that direct route to the brain with snorting, essentially. Are there any other types of harm someone could experience from misuse of these substances?
19:10 Renee: Yeah, one of the main things is, if you do, if you abuse a stimulant very long, what happens is you permanently change your brain chemistry. And you have a pleasure center, that when you're around family, when you're around friends, your brain releases a chemical called dopamine, which is a pleasure center, which makes you experience joy and happiness with those interactions, with things that you enjoy doing. Like exercise, or you get endorphins, you get those things. Well, when you have so much of this chemical available from a medicine, it's giving you excess dopamine. So that's when you feel pleasure and that becomes the only time you feel pleasure. So what happens is you permanently change your brain to where when you have those interactions, if you're not using that medication to excess, then you don't feel joy, you don't feel happiness, you don't feel pleasure, you just, you're very flat with all those interactions. So it's really sad to see how that changes and how long and it can never come back. They can come back eventually in some people, but sometimes it never comes back. And it's just, it's really sad that people can actually permanently change the chemistry of their brain where they just do not feel happiness with day to day life and interactions.
20:42 Mindy: Yeah, I think that's a really important consideration and understanding how dopamine is created, and how, you know, all drugs essentially, can have an impact on those dopamine levels and cause the body to stop producing as much for normal activities, that would also release a lot of dopamine.
21:05 Renee: Well, and another scary statistic with college students is often drugs or those drugs are abused with central nervous system depressants in combination. So you're combining alcohol and the stimulants to stay awake. So the stimulant what it does, eventually, it will impair judgment. And because you get too much of it at one time, so you say you've crushed or taken an excess amount of Adderall or Concerta or whatever medicine it is combined with alcohol. So alcohol normally is a Central Nervous System depressant that’s slowing everything down. So your brain and your body's getting all these mixed messages. And then the stimulant alters your judgment to where you do not realize how much you've drank. So it's keeping you awake, you're drinking longer, but normally, you would pass out with as much alcohol as you’ve had, and you start throwing up. Um, so a lot of times you say alcohol poisoning, in addition to stimulant abuse, because people have just stayed away and kept drinking, and kept drinking. And, yeah, we see that a lot in the emergency room, and they'll have sky high alcohol levels, and still be awake. And you get the blood work. And you're like, how is this person even breathing? And their heart rate is like 300. It's just like, your heart is beating so fast. It's Yeah, it's really scary.
22:32 Mindy: Yeah, combining a variety of drugs together can certainly produce just catastrophic effects. And I think alcohol is one of those substances that can be mixed with others and cause some potential difficulties for folks.
22:47 Renee: And I think that's a combination that you see often is stimulant abuse, combined with alcohol in college populations. Yeah. And that comes into the emergency room a lot.
23:00 Mindy: Yeah, I could see how that would be the case, and someone might not piece together, especially with that extended release, that those things could possibly be potentially problematic.
23:12 Renee: Right? And then eventually, if the stimulant wore off, and you've got all this alcohol in your system that's not metabolized, what's gonna happen is you're going to go to sleep, and you're not going to wake up. So yeah, that because you've got alcohol poisoning, you didn't realize it. So it's a really dangerous combination to do that, that starts out as people think it's going to be a fun evening, because I'm going to be awake. So I'm taking the stimulant and I'm gonna get the party longer and enjoy all this longer, but it's really dangerous.
23:43 Mindy: Yeah, definitely sounds like it. Gosh, I think that could be a whole other podcast episode, talking about interactions of substances with alcohol, because I know that's something that definitely comes up in a variety of educational aspects of the work that certainly we do here in The Well. Well, just to kind of pull everything together, what is something that you would like our listeners to take away from our conversation today?
24:12 Renee: That when you take a medicine that is not prescribed, and you do not have a diagnosis for, and you have not been medically assessed for, you're taking a risk with your health. You don't know your interactions with that medicine, you don't know, you've not been screened. So you just it's really, really risky and unsafe to do that. Also, we screen for a lot of addiction possibilities and there will be people that take this pill for the first time they become addicted and go on to have problematic behaviors. Nobody takes one the first time thinking I'm going to be that person. But that happens. So you're taking a risk that this is going to change your life that way as well. So I would just be very, very careful and just never take medicine that's not prescribed for you in the manner that is prescribed and the dosage that is prescribed.
25:13 Mindy: Yeah, I think like you said, sometimes it's a very unlikely risk, but the potential, there's a potential possibility.
25:22 Renee: Yeah. And I never, I never saw anybody in the emergency room coming in for treatment that said, “Oh, yeah, when I took it the first time, I thought this was gonna happen,” you know, it's just you never know. Yeah. So…
25:34 Mindy: Yeah, there's a lot of variability for what folks could experience. And I would say that, I think that's an important consideration for individuals.
25:45 Renee: Because the same with stimulants, I will say before we end with stimulants, also, it takes more and more and more. So what often happens is, over time, you're taking more and more to get the same effects. And so then a lot of people will progress to non-prescription drugs to cocaine and those street things to get because they're getting more of a stimulant effect. So over time, you may think that you're never going to do that. But it happens in people with good jobs, doing well. You know, it's not just people that you see on the street, and you think that people are using meth, and that's gonna, that's the people I'm talking about. But it's successful people. I've seen people, professionals, you know, with these problems, so you just never know.
26:34 Mindy: Absolutely. substance use disorders can affect anybody. It's really choices someone makes not a lifestyle that they have, or an identity that they have. [Renee: For sure.] Well, Rene, thank you so much for joining me today. I really enjoyed our conversation, and I appreciate you being able to just share this information with our listeners.
26:56 Renee: Well, thank you for having me.
26:58 Mindy: You’re very welcome.
[Musical Interlude]
27:03 Jordan: Man, that was a really good episode, I-- super informative. And I even myself learned a few things that I didn't know.
27:11 Mikayla: Yeah, same. I was very surprised when Renee mentioned that sometimes Adderall can be prescribed for folks that suffer with narcolepsy, as well as severe depression. That was new to me, even though that's not always the case, something new. And I feel like I always knew the concept of you don't mix uppers with alcohol or uppers and downers, but I guess I never truly understood the full impact of someone can be fully awake, and then they fall asleep and they don't wake back up. So I knew the concept of it. But having Renee walk us through exactly why that's happening was really informative for me.
27:47 Jordan: Yeah, like talking about how it's, you know, the body is trying to metabolize it and having those high amounts. Yeah, for sure. One thing, I just think it's important that we also add to this conversation when talking about prescription stimulants, especially if it's someone who is taking prescription stimulants that's not prescribed to them, or they're misusing those prescription stimulants are potential legal issues that could happen. So the crime of drug possession occurs when a person possesses any controlled substance without a valid prescription. So that's meaning taking the medication without being prescribed. Adderall is a Schedule II drug and under Virginia law, possession of a Schedule II controlled substance could be charged as a class five felony, which may result in paying a fine jail time or imprisonment. So there are potential legal issues if someone is caught with a prescription that is not theirs. But there is also the crime of distributing prescription stimulants. So the crime of drug sale or distribution occurs when a person sells, provides, gifts away, delivers, or distributes a controlled substance. So that means if someone has medically prescribed Adderall, and they distribute by selling or giving away their pills to a friend or roommate, they can be charged with a felony conviction resulting in possible imprisonment and really steep fines. So that's just something we also want to add on that yes, there are the potential health risks and potential dangers for your body if you're taking a medication that is not prescribed to you or taking it away, that's not prescribed. But also there is still that legal part that someone could be charged with if they are caught in possession of a medication or if they are caught distributing their medication to someone else.
29:42 Mikayla: Yeah, and if you are concerned about the role that prescription stimulants may be playing in your life, we do want to encourage you to seek resources at the JMU Counseling Center to talk with someone and really just walk through your options and be able to speak with somebody about how this substance may be impacting your life.
30:00 Jordan: Yeah, and once again, if you want to learn more just about The Well and the resources that we love sharing with students follow us on Instagram @JMUWellDukes or you can always shoot us an email at at welldukes@jmu.edu. And if you're listening to this for HTH 100 credit the passcode is “dosage.” So remember, be well, Dukes.