Why Are ADHD Medicines Controlled Substances?

If you’re taking medicine for ADHD, what you’re taking likely is a controlled substance. That means that the federal government regulates how the drug is made, prescribed, and dispensed.

There are also extra security measures to guard against abuse.

“This affects the way you get and fill your prescription at the pharmacy,” says Norman P. Tamaka, a consultant pharmacist and health care risk manager.

But do you know why?

Controlled Substances: What You Need to Know

The Controlled Substances Act has been in place since 1970. It governs the making and distribution of medications.

Medications fall into one of five categories, called “schedules,” based on their safety, risk for abuse, and accepted medical use.

The majority of ADHD stimulant medications, such as Adderall (dextroamphetamine-amphetamine), Ritalin (methylphenidate), and Vyvanse (lisdexamfetamine), fall into the Schedule II category. They're legal, but they’re considered dangerous because of their high risk of abuse and dependence. Other Schedule II drugs include painkillers like OxyContin and Vicodin.

Why Most ADHD Drugs Are Considered Schedule II

“Like with other stimulants, it’s possible to become dependent on or abuse ADHD medications,” says Lenard Adler, MD, a professor of psychiatry at NYU Langone Medical Center.

Research suggests a growing number of people without ADHD are taking the drugs illegally. To know why, it’s important to know why the drugs are used for ADHD.

Although the exact reason for ADHD isn’t known, experts believe brain signal problems -- how different parts communicate with each other -- are part of the cause. Studies show that certain spots, such as the area just behind your forehead, called the prefrontal cortex, are less active for people with ADHD.

These medications work by stimulating these areas so they receive more signals. So when people who don’t have ADHD take these drugs, they have more activity in the part of their brain that controls behavior and thought.

“It can make you more alert and increase your concentration and metabolism,” Tomaka says.

Since even people without ADHD can get the boost from the medications, they take the drugs illegally to try to do better at school or work, or to feel more alert and focused. Abuse of ADHD medication is increasingly common among college students.

But that’s not the only reason some take it.

“These stimulants can also cause a feeling of euphoria,” Tomaka says. When crushed and snorted or injected, they can lead to a “high” that’s similar to cocaine. This can lead to a psychological and physical dependence on these ADHD drugs.

People who become dependent can have withdrawal symptoms like feeling tired, feeling depressed, or having unusual sleep patterns if they stop taking it.

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What Does This Mean for You?

If you’re prescribed a stimulant drug for ADHD, it’s important that you take it as directed.

“With the appropriate monitoring, the risk of abuse or dependency in people who have ADHD is limited,” Adler says.

Many prescriptions are written on a 30-day basis, which means you have to check in with your doctor every month.

If you’re concerned about your risk of addiction to your ADHD medication, speak with your doctor. He may want to prescribe an extended-release version of your drug. Because this form of the medication is released into the bloodstream over time, it may reduce the risk of abuse.

You should also be aware of signs of abuse, such as:

Because of their schedule, you can’t just refill your prescription, and your doctor can’t phone in a prescription unless it’s an emergency.

“You have to obtain a new and signed prescription from your doctor for each prescription,” Tomaka says. This may mean seeing your doctor monthly. Doctors can also issue prescriptions through a secure electronic prescribing system, which is regulated by the Drug Enforcement Administration (DEA).

If you have trouble filling your prescription, talk with your doctor and pharmacist.

Is There Anything Can I Take Instead?

While all stimulant ADHD medications fall into the Schedule II category, there are nonstimulant drugs that aren’t controlled substances, such as Strattera (atomoxetine), Kapvay (clonidine ER), and Intuniv (guanfacine ER).

Because they aren’t stimulants, there’s a lower risk of abuse and dependency. But nonstimulant drugs are considered less effective for ADHD than the stimulants.

Talk with your doctor to see if a nonstimulant option is a good choice for you.

WebMD Feature Reviewed by Smitha Bhandari, MD on February 12, 2016

Sources

SOURCES:

Lenard Adler, MD, professor of psychiatry and child and adolescent psychiatry, NYU Langone Medical Center.

Norman P. Tamaka, consultant pharmacist and healthcare risk manager; spokesperson, American Pharmacists Association.

FDA: “Controlled Substances Act.”

Drug Enforcement Administration: “Drug Schedules.”

Sahakian, B. The Lancet Psychiatry, April 2015.

Morton, W. The Primary Care Companion to the Journal of Clinical Psychiatry, October 2000.

Cleveland Clinic: “Attention Deficit Hyperactivity Disorder: Nonstimulant Therapy (Strattera) & Other ADHD Drugs.”

Cornell University Law School Legal Information Institute: “U.S. Code, Title 21, Chapter 13.”

Drug Enforcement Administration: “Electronic Prescriptions for Controlled Substances.”

U.S. Government Accountability Office: “Controlled Substances Quota.”

National Institute on Drug Abuse: “Drug Facts: Stimulant ADHD Medications: Methylphenidate and Amphetamines.”

Medscape: “FDA Approves Extended-Release Clonidine for Pediatric ADHD.”

Medscape: “Once-Daily Guanfacine Approved to Treat ADHD.”

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