Popping an ADHD pill like Adderall or Ritalin to enhance your studying and boost grades might sound tempting. But you could be risking serious (albeit rare) side effects, including heart attack, stroke, and possibly even death, for little, if any, benefit.

Mounting evidence has linked misuse of stimulant medications meant to treat attention deficit hyperactivity disorder (ADHD)—amphetamine and dextroamphetamine (Adderall, Adderall XR, and generics), methylphenidate (Concerta, Methylin, Methylin ER, Metadate, Ritalin, Ritalin SR, Ritalin LA, and generics), atomoxetine (Strattera), and others—to serious harm.

ER Trips on the Rise

In a March 2017 case study published in the Journal of the American College of Cardiology, a healthy 24-year-old student experienced chest tightness and shortness of breath after snorting 90 mg of Adderall before his final exams, and was subsequently treated in the hospital for heart failure. 

And a study published last February in the Journal of Clinical Psychiatry found Adderall use among adults who didn’t have ADHD—most were 18 to 25 years old—jumped 67 percent in recent years. And emergency department visits related to these medications rose 156 percent from 2006 to 2011, driven largely by the spike in adults misusing the drugs. The top reasons for ER trips included suicide attempts, abuse, and the various side effects of the medications.

Worse, people using these drugs as study aids often get them illegally, which can be dangerous. In the Journal of Clinical Psychiatry study, most of the adults misusing the drug did not have a prescription. Instead, they were getting the medications from a friend or relative. That could explain the rise in some of the ER visits, since they were using the medications without the supervision of a doctor.  

"While many people think of prescription opioids when prescription drug abuse is mentioned, non-medical use of stimulants is also very common," says Caleb Alexander, M.D., one of the study's authors and a co-director of the Center for Drug Safety and Effectiveness​ at the Johns Hopkins Bloomberg School of Public Health.

"As with all drugs, stimulants have risks and benefits, and all too often, the balance of these is unfavorable," he adds.

Small Boost, Significant Risks

Wim Riedel, a psychopharmacologist at Maastricht University in the Netherlands, says the small boost these medications might provide isn’t worth the risks. Riedel co-authored a review of 59 studies of methylphenidate, published in the International Journal of Neuropsychopharmacology, that found a small improvement in specific tasks, such as memorizing a set of items, in a controlled setting. But he said that the tiny improvement seen in the lab hasn’t been shown to help in the real-world setting, such as studying for an exam.

And a big problem is that a student would need to take the drug each time he studied, which could lead to dependency and possible withdrawal effects—even after a few doses—when he stops taking it after the exam. “So the net cost-benefit picture just doesn’t look very good,” Riedel says. 

Still, many college students are convinced otherwise. In a July 2017 study in the journal Addictive Behaviors based on survey data collected from more than 6,900 U.S. college students without ADHD, 28 percent of students believed that using stimulants would improve their grades, and another 38 percent said they weren't sure whether the drugs would help them gain an edge. Of the students using stimulants, nearly two-thirds (64 percent) believed the drugs helped them.

Doctors Urge Caution

Recognizing that an increasing number of students without diagnosed ADHD turn to these drugs to gain an edge in the classroom, the American Medical Association announced last year that the drugs are risky, don’t help improve grades, and should be avoided. The AMA's policy also urged physicians not to prescribe stimulants and other so-called "smart drugs" to healthy people seeking to enhance studying.

"While prescription stimulants carry real risks, they do not make people smarter," the AMA said in a statement.

The medical group's recommendations are based on an analysis by their Council on Science and Public Health that looked at available studies of stimulant medications and concluded that the drugs might provide a small mental boost, at best, in people without ADHD. The AMA also said the drugs can pose other dangerous side effects, such as hallucinations and delusional thinking.

Smarter, Safer Study Strategies

If you have persistent difficulty studying or concentrating, instead of using medications, see a doctor to get an accurate diagnosis, because those problems could stem from medical conditions including anemia, thyroid disorders, and infections, and not getting enough sleep.

Certain medications can also cloud thinking. These include certain antibiotics, such as ciprofloxacin (Cipro and generic); antihistamines, such as diphenhydramine (Benadryl Allergy and various PM drugs); antivirals, like acyclovir (Zovirax); cough and congestion medications, such as dextromethorphan (Robitussin and various products) or pseudoephedrine (Sudafed and generic); and tricyclic antidepressants, including amitriptyline (Elavil and generic).

William Graf, M.D., a pediatrician at the University of Connecticut, says young students who ask about ADHD medications should instead boost their focus by trying safer options: Limiting distractions by switching off smartphones, staying off social media, and improving sleep habits in order to get sufficient sleep, especially on the nights before exams. 

Other safer ways to improve studying:
• Stop multitasking. Doing several tasks at once can cause confusion and it can take longer to complete them than tackling them sequentially.
• Address your stress. Studies show that people under stress perform worse than their calmer counterparts. Good relaxation strategies include exercise, meditation, massage, and listening to music. 

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).