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Focus on the Real Issues
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ADDA Responds to the New York Times!


ADDA has asked Board of Directors Member Celeste A. Jacque, M.D. to respond to a recent article that appeared in the New York Times on behalf of ADDA.  Dr. Jacque is also a key member of ADDA’s College Committee, a group particularly interested and active in issues affecting young adults preparing for and attending institutions of higher learning.  Dr. Jacque is board certified in both Psychiatry and in Child and Adolescent Psychiatry.


Focus on the Real Issues


By Celeste A. Jacque, M.D.


On February 3, 2013, the New York Times published an article entitled, "Drowned in a Stream of Prescriptions.”  The article, chronicling the descent into psychosis and subsequent death of Richard Fee, is extremely sad.  However, the article’s emphasis on another "bad medication” is misleading.  There is no "bad” medication; there is no "bad” food, "bad” books or even "bad” music.  These items, all frequently decried as "bad,” are inanimate objects so may be utilized in inappropriate ways.  They carry no valence, in and of themselves, neither good nor bad.  They do not make decisions nor do they act independently.  When properly used they may lead to significant benefit. 


The stimulants prescribed to Richard Fee have significantly improved the lives of children, adolescents and adults who have been accurately diagnosed with Attention Deficit Hyperactivity Disorder.  Stimulants were not appropriate for Richard, as he did not meet the DSM IV criteria for Attention Deficit Hyperactivity Disorder based upon the information reported in the article and attributed to his parents and friends.  He initially accessed and used the medication illegally as a diversion in college. 


Of course, college students do not have credentials or sufficient training to legally or safely distribute medication to fellow students.  Although this type of activity usually goes undetected, as with any drug exchange, it may lead to severe academic and legal consequences for the distributing student.  It may also lead to significant psychological or physical consequences for the receiving student.  Again, the stimulant did not upset the exchange; the humans involved diverted the medication.


Richard may indeed have become addicted to the "high” of the stimulant medication, as it does, in some instances, cause a "rush” in people who do not have Attention Deficit Hyperactivity Disorder.   But that alone may not have led to his spiral into psychosis.  Richard developed a belief about his ability to function on stimulants and he followed this in a feverish manner.  This belief was not grounded in reality.  Richard’s misuse of stimulants certainly did not improve his grasp of reality, but it may not be the only cause of his delusions. 


Richard’s situation was tragic, both for him and for his family.  Unfortunately, human factors compounded illegal misuse of medication with a medical situation when important observations of bizarre behavior by Richard's family and friends were ignored.  Blaming medication is easy, and the "bad” inanimate object "du jour” makes an easy target in many of our news reports.  Demonizing any inanimate object does not help the public understand or attempt to find solutions to complex issues affecting our young adults. 


Richard's story should not become another issue sensationalized or trivialized until the next "bad” thing is discovered.  It should instead raise important questions about mental health issues in the young during times of transition, appropriate diagnosis and monitoring of treatment when considering the use of potentially abused medications such as stimulants and prescription pain medication and diversion of medication from one student to another.


ADDA’s College Committee has developed and distributed a medication information sheet specifically for students in higher education settings.  In addition to addressing both the potential benefits and possible side effects, the information sheet outlines the ethical and legal responsibilities of taking stimulant medications.  One responsibility that is strongly emphasized is to never give or sell one's medication to another student. 


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