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.”

The Marketplace

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.”

Ethical Considerations