At a Stanford Blyth Fund event last year, a hedge fund employee told the audience, “If you want to do well on Wall Street, you have to have an edge. Anyone in the room, what’s your edge?” Ross David*, a sophomore studying computer science, recalled that a student in the audience said the fact that he takes economics and computer science classes at Stanford should be an edge in and of itself.
“That’s not an edge. Everyone has that,” David recalls the speaker replying. “Adderall — now that’s an edge.”
The use of prescription stimulant drugs like Adderall for cognitive enhancement is a major topic of discussion on college campuses across the country, and Stanford is no exception. A survey released by the Partnership for Drug-Free Kids and published in late 2014 reported that one in five college students abuses prescription stimulants at least once in their lifetime.
As part of an investigation into stimulant use and the culture surrounding it at Stanford, The Daily surveyed students on the use and distribution of stimulants on campus; the survey was distributed via email. Out of nearly 400 survey participants, three percent indicated that they had been prescribed stimulant drugs; approximately two-thirds of those with prescriptions indicated that they had distributed stimulants as well. Another three percent, comprised of both individuals who had been prescribed stimulant drugs and those who had not, indicated that they had distributed a controlled stimulant drug. Ten percent said that they had used stimulants for cognitive enhancement without or beyond prescriptions, while 45 percent confirmed knowing others who had done the same.
The Daily’s investigation into stimulant use at Stanford has tracked students’ motivations for experimenting with stimulants, the impacts of such a culture on health and the mechanics and ethics of the stimulant market.
Getting an Edge
David, the student who related the dialogue between the student and the speaker at the Blyth Fund event, was galvanized by the hedge fund employee’s reference to Adderall. Hailing from a small “suburb within a suburb,” David found that the caliber of students at Stanford was qualitatively different from those he had worked alongside with back during his high school days. He decided that he needed an edge.
I am a really big fan of trying to push what I can do as a person both physically and mentally,” David said. “I like putting myself in extreme situations. It’s really difficult to differentiate yourself even if you put in the thousand hours that you have to put in.”
”To get past the top 10 or 15 percent of students here, either your brain has to be wired differently, or you have to do something else,” he added.
David independently researched stimulants and nootropics, a class of smart drugs used as cognitive enhancers, poring over scientific papers and experimenting with different drug cocktails and dosages and eventually settling upon a strict regimen. He takes caffeine on Mondays (pills, not coffee — it’s more efficient that way, he says); modafinil, a prescription drug that promotes wakefulness to treat narcolepsy, or phenylpiracetam and choline, other nootropics, on Tuesdays; caffeine again on Wednesdays, modafinil or phenylpiracetam and choline on Thursdays; and phenylpiracetam and choline on Fridays. He takes the weekends off.
Stanford’s Counseling and Psychological Services (CAPS) director Ron Albucher emphasized the culture of achievement as precipitating out-of-prescription use of stimulants.
”You want an edge. You’re now in a large group of students who have similar abilities as you, compared to your high school experience when you were at the top of your class,” Albucher said. “You’re putting the pressure on yourself…to be successful, so there’s a lot of appeal to use stimulants.”
Lisa Park*, a current junior at Stanford who sells stimulants on campus, noted that most students buy just a few pills at a time, with the most common use cases including studying all day, pulling all-nighters and taking exams — most sellers run out of their supplies close to finals week, Park explained.
A Lifestyle Choice
Some students say that taking stimulants — both without and with prescription — is simply another way to stay healthy.
David believes that stimulants makes him a healthier person, both mentally and physically. He finds that his increased efficiency not only allows him to take on sizeable course-loads, but also enables him to pursue interests outside school while maintaining an active social life — all the while getting eight to 10 hours of sleep a night.
A current freshman at Stanford with an intended computer science major, John Tyler* called his use of stimulants and nootropics “a lifestyle to enhance performance.” He began experimenting with the drugs after coming across new research on smart drugs, which paired well with his experiences at neuroscience competitions.
After doing his research (Tyler stressed that doing research was crucial before “doping for academics”), Tyler began taking nootropics and stimulants, including caffeine; modafinil; and nicotine patches to improve working memory.
”Nicotine is a stimulating neurotransmitter,” Albucher said. “One of the reasons that people get addicted to cigarettes is that there is this very gratifying effect of a sharpening focus from the use of nicotine.”
To supplement his use of nootropics and stimulants for times when Tyler is looking to think clearly and creatively, he also induces ketosis.
“If you deprive your body of glucose and eat mainly fats, your body enters a stage called ketosis,” Tyler said. “I’ve found that I’ve had a significant boost in energy and mental clarity when I’m in this state, which I induce by taking something called Medium chain triglyceride (MCT) oil.”
For students with prescriptions for stimulants, the drugs are necessary for maintaining their mental health.
Claire Greene*, a junior symbolic systems major at Stanford, was diagnosed with Attention Deficit Disorder (ADD) in sixth grade and given a prescription for Vyvanse. She stopped taking her medication when she first came to Stanford in the spirit of getting off to a fresh start but soon found it difficult to manage her workload and commitments. She resumed using the drug, on prescription, during the spring quarter of her sophomore year, though her college experience was not made significantly more manageable.
Greene has seen many of her friends use stimulants out of prescription with negative lifestyle consequences.
”The main problem is that not everyone knows what they’re doing, so when things go wrong, it’s scary,” Greene said. “You feel like you can’t say anything about it because what you’re doing isn’t technically legal.”
Albucher echoed the risks of taking the drugs without prescriptions. Stimulants can increase blood pressure and heart rate, for example, but someone using a stimulant with no prescription is not likely to be measuring blood pressure and pulse. The drugs can also lead to dependencies.
“You’re priming your system with an external drug, and you can become dependent on it,” Albucher said. “If you’re using significant doses for a while, you’ll have a crash, and so you may then be withdrawn and depressed.”
Though David dubs himself as “probably one of the top 100 drug users on campus,” no medical institution has ever prescribed him stimulants. His drugs instead come from international online markets; a chemist friend of his helps to verify their authenticity.
Tyler also buys much of his supply online, though he did obtain a prescription for modafinil. He isn’t narcoleptic but said that getting the prescription wasn’t difficult. It wasn’t necessary, either — he says that he could have easily obtained the drugs from a foreign country, but he got a prescription just to be safe.
Albucher noted that the subjective nature of diagnosing narcolepsy and Attention Deficit Hyperactivity Disorder (ADHD) can at times result in unwarranted access to stimulants.
“There are certainly practitioners across the country that are less thorough or have less of a sense of obligation to the patient and would, within the first 15 minutes of a visit, write a prescription for a stimulant,” Albucher said. “The medications are out there.”
While Tyler and David themselves do not buy stimulants at Stanford, they both acknowledged the drugs were bought and sold on campus.>
At the beginning of her sophomore year in high school, Park was diagnosed with ADD and given a regular prescription for Vyvanse, a stimulant similar to Adderall. When she came to Stanford, she was not able to get her prescription filled — CAPS has rigorous standards when it comes to prescribing the drug, according to Albucher. She began shipping the medication from her hometown, but that soon became a hassle.
“I took a break from the medication and really struggled with my classes,” Park said. “There was definitely a fall in my grades from when I was taking it and when I had to stop, which was really hard to cope with.”
Park recently found a friend who always had a supply of stimulants like Vyvanse. She started buying some to use for finals week and, though she gave a friend a few pills, she refrained from selling. But, according to Park, word spreads quickly about who has stimulants available on campus. Park had been contacted so often for the drugs that she eventually began selling. She now takes Vyvanse about twice a week herself.
“From my experience, it’s pretty common for students to buy off other students,” Park said. “There are a few people that have prescriptions or get them from somewhere in bulk, and they sell to the majority of students that buy.”
The most common price Park has seen at Stanford is about $8 to $12 per each 20-milligram pill of Adderall. This price is much higher than a typical prescription market price of around $45 for 60 pills of the same concentration, just 75 cents per pill.
Park’s own inability to get her Vyvanse prescription at Stanford reflects the rigor of the prescription process followed by CAPS.
“We really want to be thorough and not over-prescribe,” Albucher said. “We’ve tried to balance being thorough in an evaluation and not putting up too many barriers for students…We’re trying to find a happy medium.”
In order to get a prescription stimulant through CAPS, students must go through a number of steps that detail their medical history. Each student is asked for previous records of treatment, copies of neuropsych testing, a form detailing their attention difficulties and a reference from someone who knew the student (preferably when the student was much younger, around ages six to eight) to give some historical context.
Albucher explained that it is less likely for someone coming into college to have just recently developed attention problems; as ADD and similar disorders are understood, they tend to start in childhood and persist. Albucher did mention that CAPS acknowledges that there are always outliers.
“There are exceptions where people never got diagnosed correctly or on time in the first place,” Albucher said. “Especially in a lot of cases here, in a typical grade school setting, people can use their smarts to compensate for the lack of attention.”
Discussions about stimulant use on college campuses often touch upon the ethics of out-of-prescription access and distribution.
“I know many people (including good friends that I respect a lot) on this campus who sell their prescription stimulant drugs, and it has always really bothered me,” wrote an anonymous survey respondent. “I think it's a real problem.”
Some believe that people using nootropics or using stimulants without prescriptions have an unfair advantage over their classmates. That argument doesn’t hold sway over David; his own weekly supply costs him no more than a few cups of coffee.
“I don’t think it’s an unfair advantage because it’s not inaccessible to most people. The cost barrier is pretty low,” David said. “Anyone who wants this edge can go and get it right now. The point of an edge is that it’s an untapped market. People aren’t using it...Why wouldn’t you do it? Who doesn’t want to be smarter?”
Tyler views the choice to use stimulants as one that can be made rationally. As long as people are aware of what they’re doing and they know that they could be incurring a biological cost, he explained, it should be up to them to decide whether or not to consume the drugs.
While David firmly believes that the drugs have done nothing but help him, he acknowledges that abusing even mild stimulants — like caffeine and L-theanine, both of which are found in tea — can have dangerous consequences.
During David’s freshman year, many of his friends saw him experimenting with stimulants and wanted to take the drugs themselves. One friend in particular began using the caffeine and L-theanine cocktail to catch up on his work, depriving himself of sleep in the process. His crash was drawn out over several days, according to David, and his friend struggled to make up for lost time.
Ever since then, David swore off distributing stimulants to others. He likened the use of these drugs to the consumption of alcohol — people either drink themselves into drunken stupors or stay away from the drug entirely, he said. Just as, in his experience, most people fail to drink responsibly, they fail to consume stimulants responsibly as well.
“There’s a very subtle distinction between wanting to stand out and needing to,” David said.
As for himself, David believes that he doesn’t need the drugs — he believes he could manage his workload without them, though going drug-free might require him to sacrifice, for example, his social life. For David, efficiency is key. It is efficiency that will help him leave his mark on the world. He estimated that in any given generation, about 1,000 people at most do something so impactful that it gets recorded in a history book.
“I don’t want to go down a standard path,” David said. “I want to be one of those 1,000 people. If I want to do that, I need to optimize my life. And drugs are one way of optimizing.”
Correction: An earlier version of this article introduced modafinil and Provigil as distinct drugs; modafinil is the generic drug, and Provigil is a particular brand of it.
*Editor’s note: Names of the interviewed students were changed to protect their identities.
Akshay Agrawal, Pascale Elisabeth Eenkema van Dijk and Namita Nabar contributed to this report.
Contact Susannah Meyer at smeyer7 'at' stanford.edu.