In the same way that some athletes have taken steroids to become stronger, some Minnesota high-school students are taking unprescribed Adderall to perform better in the classroom and on exams.

This illegal use of the drug is prevalent enough that many students seem to take it for granted. Selling it or giving it away is common practice, they say. Prescribed for attention deficit hyperactivity disorder (ADHD), the medication increases concentration, and many students have come to believe it’s a necessary element to compete with peers for grades and test scores.

Some who don’t take it say its use creates an unfair advantage.

In an informal survey of 256 recent high-school graduates by MinnPost, 22 percent of respondents said they had taken Adderall or Ritalin without a prescription during high school. Roughly 54 percent knew of at least one person who had, and 89 percent said a portion of students were using the drugs unprescribed.

Katie Matthews remembers walking out of the ACT as a junior in high school two years ago with her boyfriend. A group of his friends were bothering him about not taking any Adderall before the test, as they had.

“They just always did it, especially for ACT tests,” the 2011 Eastview High School graduate said. Out of a class of 500 students, Matthews estimated roughly 40 students at her school were regularly taking the drug for homework and tests.

The scope of such Adderall use in high schools is hard to gauge. With more students diagnosed with ADHD each year, the medication is easy to get, students say, and with minimal short-term effects besides “improved” focus, many schools and parents don’t know and can’t tell if students are using it.

Students hope for big payoffs, see few risks

Whether it’s a C-average student looking for ways to keep up or a high achiever looking for a competitive edge, Adderall can be enticing; abuse of the drug increases dramatically before big tests and standardized exams, students said. Of those who have used Adderall, most say they took it to study.

Students reported multiple reasons for using Adderall.

“I technically ‘abuse’ Adderall and Vyvanse, but I view it as a necessary component to stay competitive in today’s environment,” one questionnaire respondent wrote.

“If everyone took Adderall the world would work at 120 percent efficiency,” another respondent said.

MinnPost offered respondents anonymity when filling out the questionnaire, though many students spoke on the record about the extent of Adderall use in their schools.

Hal Pickett, adolescent chemical health specialist and director of the Twin Cities’ Headway Emotional Health Services, said he wouldn’t doubt students would use the drug if they thought it would help them.

“Adderall is a prescription that enhances concentration, so a lot of kids could take it and you won’t notice it at all,” Pickett said. “In fact, it could help them.”

Difficult to tell if someone has taken it

Though Pickett said taking any drug without a prescription could be dangerous, Adderall is one of the safest comparatively, if used in moderation. Although side effects can include appetite suppression, increased irritability, or feeling jittery and anxious, Pickett said it would be difficult to tell if a student had taken it. And it is uncommon for Adderall to cause long-term side effects in users, said Joel Oberstar, chief medical officer of PrairieCare.

Less than 1 percent of the patients seen at Headway have abused Adderall, Pickett said.

Medications such as Adderall and Ritalin keep neurotransmitters like dopamine or adrenaline in the brain for a longer period of time, increasing concentration, said Pete Jensen, a child psychiatrist and co-chair of the Division of Child Psychiatry and Psychology at Mayo Clinic. ADHD sufferers are less able to absorb those neurotransmitters, resulting in symptoms like impulsivity and lack of concentration.

Though use of ADHD medication can be detected with drug testing, a student’s use of the pills doesn’t typically emerge unless there is additional drug use, usually marijuana or cocaine, Jensen said.

Compared to other drugs, there’s not a significant danger that a user will become addicted, Jensen said. Meth, cocaine and marijuana are bigger problem drugs in high school, along with alcohol use.

Normal ways of detecting don’t work

Schools detect student drug use with failing grades and bad behavior. But if students aren’t abusing other drugs and they’re actually doing better in school, the normal ways to detect use don’t work. If counselors see students about Adderall use, it’s because they’re using it negatively to get high or lose weight.

“This could be one of those silent things that the larger community doesn’t know about,” Pickett said. “The kids are getting better grades rather than worse grades.”

And the race for better grades and test scores has created pressure on kids to use Adderall whether they’ve been diagnosed with ADHD or not.

The rate of ADHD diagnosis increased each year by an average of 5.5 percent from 2003 to 2007, according to a survey by the Centers for Disease Control and Prevention. In the Midwest, 10 percent of kids have an ADHD diagnosis, according to a 2009 U.S. Department of Health report.

Most prescriptions written by primary-care doctors

The majority of prescriptions for psychiatric medications are prescribed by primary-care doctors instead of psychiatrists, who are more experienced with the medication, Oberstar said. As a result, he said, more psychiatric medications could be available to students who don’t need them. According to a study by Michigan State University economic researcher Todd Elder, 900,000 children in the U.S. could have received an ADHD diagnosis in error.

But many physicians are becoming more wary of the medication and their lack of knowledge about an ADHD diagnosis, and are less likely to prescribe it, Mayo’s Jensen said.

“It’s being passed around and it shouldn’t be,” Jensen said. “What all doctors are trying to do, is say, ‘Look, I’m prescribing this for this reason and this reason only, and I need to trust you.’ “

With more of their peers diagnosed with ADHD, students say it’s easy to get pills from friends or family members.

“People do whatever they can to get it,” Hopkins High School student Sarah Ungerman said. “People want it bad. I take it for my ADD and people ask me all the time if they can buy it.”

Some question its ability to help much

While students agree Adderall is easy to get, their opinions on actually using it differ. Among students interviewed who didn’t use it, some thought using it gave students an unfair advantage while others doubted it would help that much.

While waiting for a physics quiz to begin last year as a senior at Wayzata High School, Marissa Berglund said, she overheard a girl talking about how her Adderall dealer hadn’t come through for her that morning. The girl said she was nervous about taking the test without Adderall, saying she couldn’t focus without it.

“If you aren’t prepared for the test, just being able to focus isn’t going to help you that much,” Berglund said looking back at the moment. “You need to have studied in order to do well.”

But not everyone agrees.

“It’s totally unfair,” Haley DeParde, a student at South High School in Minneapolis, said. “It’s a boost they don’t deserve.”

Not aware of schools doing much about it

Berglund estimated roughly 10 percent of her class of 900 students were using Adderall. She assumes the school doesn’t know.

Estimates of Adderall abuse among high schoolers vary widely.

“It’s kept pretty quiet if they do,” she said. Berglund said a wellness class she took briefly mentioned Adderall use, but that the most she knew about it came out of a year-in-review current-events page added to her yearbook by the publisher.

Only 15 of the 256 respondents to the MinnPost questionnaire said they had heard of a program to address unprescribed Adderall or Ritalin use in their high schools.

In a dozen calls to high-school officials in the Twin Cities area, none had heard of students using unprescribed Adderall for tests in their school.

“Most of our students make healthy choices when it comes to drug and alcohol use,” Minnetonka High School Chemical Health Counselor Nancy Olson-Engebreth said.

“I wouldn’t have any idea,” said Richard Cash, Bloomington Gifted and Talented Programs director, adding that he doesn’t deal with student health issues. “I don’t know if I’d want to know.”

With no students coming forward about the problem or students getting caught, Bloomington Jefferson Chemical Health Counselor Kristin Wetzel said the achieving side of unperscribed Adderall use isn’t an issue she’s thought to look for. In the two years she’s worked at the high school, she said she’s only heard of students using the drug to get high. When those students get caught, it’s usually because of behavioral issues.

After reflecting on national trends and statistics about prescription drug abuse however, Wetzel said it might be something she needs to be educating parents about.

Prescription drug use is a national issue

Prescription drug use has become a huge issue nationwide, according to the U.S. Drug Enforcement Agency. While ADHD medications aren’t as much of a concern as drugs like the painkiller Oxycodone for the agency, Adderall is still one of the top five diverted prescription drugs – or drugs that are abused or sold illegally.

“They might be off the radar because they’re kids who are high achievers,” Wetzel said. “They’re not kids with behavior issues, so it’s hard to get to.”

Yet with a larger supply of prescription drugs at home, Wetzel said she wouldn’t be surprised if more students were using it unprescribed.

“Even from last year it seems like a more accessible drug,” she added. “And it’s not just here. It’s the result of a community and society where there is a bigger supply of prescription drugs out there.”

This article was produced in partnership with students at the University of Minnesota School of Journalism and Mass Communication, and funded in part with a grant from the Ethics and Excellence in Journalism Foundation.