On the patio of the Sunset Tower Hotel overlooking the Hollywood Hills, on the kind of sun-blinded afternoon Raymond Chandler made famous, Amanda F.* and I are eating. Well, one of us is eating. And it's not Amanda. "I took my Adderall about an hour before I got here," says the television producer as she picks at her crab salad. "If I hadn't taken it, I would have inhaled the table."
Amanda has been diagnosed with adult Attention Deficit Disorder (ADD or ADHD), for which Adderall, an amphetamine that paradoxically allows ADD patients to slow down and concentrate, is an accepted treatment. But for her there's a notable and seductive side effect: For a body that has fluctuated between a size 14 and a size 2, Adderall — along with yoga and chain-smoking — has helped her maintain a size 6.
"I can see you have a healthy attitude toward food," Amanda says, stopping me as my fork hovers midway between plate and mouth. My pants feel curiously tight. "But let me ask you this: If you could take a drug that has almost no noticeable side effects and lose all the weight you want, wouldn't you do it? That's what Adderall's like for me. And for a lot of women. It's a godsend."
And apparently God, or at least the local pharmacy, is sending it out to the weight-obsessed in the entertainment industry, where the difference between a size 4 and a size 8 may mean a difference between working and not.
"When a high-profile celeb suddenly drops a lot of weight, the rumors start that she's on A," notes Kym Douglas, who co-wrote “The Black Book of Hollywood Diet Secrets" (Plume). "It isn't a secret among people like the top stylists and makeup artists who work with celebrities." Indeed, several wispy young starlets have been rumored to have prescriptions for the drug.
Since 2002, the number of prescriptions for all amphetamine-based drugs used to treat ADD — including Concerta and Strattera — have skyrocketed. Sales for Adderall XR (extended release) have more than doubled in the past five years, from 4.2 million in 2002 to 9.5 million in 2007, according to IMS Health, a health-care information company. And online, Adderall ranks right up there with Viagra in most-hawked pharmaceuticals on the Internet; indeed, type in the words "Adderall abuse" and you're likely to be directed to a site that sells the stuff.
Just why Adderall helps people with ADD is a little unclear. But scientists believe that sufferers have some imbalance of three chemicals in the brain dopamine, norepinephrine, and serotonin — and that Adderall helps by inhibiting the reuptake of these chemicals so they remain in the synapses longer, says Paul Thompson, professor of neurology and director of a neuroimaging lab at UCLA David Geffen School of Medicine. For the most part, Adderall is used exactly the way it is prescribed — to increase concentration among those with ADD. But there is a tempting yet dangerous side effect to all stimulants: They stimulate the dopamine — or pleasure — center of the brain, which causes a feeling of euphoria and a loss of appetite. So it's no great surprise that the young and beautiful, many of whom have grown up bumming their friends' Adderall to increase their mental edge at exam time, do not necessarily want to give it up when studying is no longer the issue.
Alex Geana is a 29-year-old New Yorker transplanted from L.A. and the author of an upcoming book on pill-popping culture called "Side Step Me" (BookSurge). When he was growing up in the suburban L.A. area, Adderall "was just part of the mix," he says. "Kids got it for their schoolwork, but a lot of the girls were doing it to be pretty. I remember one of my friends was always like, 'I can clean my room and really concentrate ... and I don't want to eat.'"
Charles Sophy is not at all surprised by the prevalence of Adderall use for weight loss. In addition to being the medical director for the L.A. County Department of Children and Family Services, Sophy is a psychiatrist with many celebrity clients. "I've had several young patients come in looking for Adderall prescriptions," he says. Some, he says, are using it for weight loss, while claiming they need it for their ADD. "These slim girls come in saying, 'I need medication, and it has to be Adderall.' And I'll say, 'Why not Strattera?'" Sophy continues. "Well, that's the game. A drug like Strattera [which is also used to treat ADD] won't give them the high and won't give them the appetite suppression. So they'll have all these reasons why they need Adderall and only Adderall."
Doled out like candy
Tamara*, a junior editor at a magazine in L.A., knows how the game is played. She will take Adderall because it makes her feel "intensely creative," she says. "I can sit down at my computer and just write, write, write when I'm on it." But in her college days, she relied on it for weight management too. "Everyone told me I looked sickly, but sitting down and not having stomach rolls never gets old," she explains. She is already svelte, but if she gained a few pounds, "I'd definitely use Adderall right before a bikini vacation." Not having a prescription is a nonissue. "I have friends who have the script and dole it out like candy. It's insane," she says. "Some sell them for $5 to $10 a pill. But mostly I get them for free. I don't know how many pills their doctors give them on a monthly basis, but I've always been surprised at the generosity."
In young working women, the drug may not initially be used for weight loss; more often, it's for the lift of getting through a stressful, busy life. "I have this one friend with this hugely busy career, kids, husband," says Amanda. "She's asked for my Adderall a few times just to make it through the day." But then the friend — and countless other women — discover its effect on the appetite. The Neil George Salon in Beverly Hills is popular among young starlets, and co-owner Neil Weisberg hears his share of how-I-dropped-the-pounds chatter. One client who started taking Adderall for ADD became so obsessed with her weight loss that she kept increasing the dose and eventually graduated to street speed ... more, and more, and more. "It wasn't good," Weisberg says. The latest buzz on Adderall is about cheating the time-release delivery system of the XR capsules by grinding and snorting their contents, or parachuting — wrapping a crushed pill in toilet paper and eating it to avoid the nasty taste. The result? A bigger rush and maximum appetite suppression.
Indeed, the weight-loss effects of Adderall have not been lost on some physicians. Fuad Ziai, a pediatric endocrinologist in Oak Lawn, Illinois, made headlines last year when CNN reported that he had prescribed Adderall to hundreds of obese kids; reportedly, 90 percent of his patients lost weight. His rationale? The risk of side effects — headaches, irritability, mood swings, and increased heart rate — was far smaller than the risk of diabetes to the overweight-kid population. The report neglected to mention a detail that might have been used to bolster Ziai's treatment: The formulation now known as Adderall was originally marketed as the weight-loss drug Obetrol. (In a statement to Allure from Shire Pharmaceuticals, the maker of Adderall XR, Matt Cabrey, the company's director of corporate communications, noted that a physician can prescribe Adderall "off-label" — i.e., in whatever way he sees fit — but that a pharmaceutical company cannot promote it for anything other than what the FDA approved it for. Says Cabrey, "Shire does not support the abuse, misuse, or diversion of any prescription medicine and Shire does not promote the use of ADHD medicines for any purpose other than the approved indication as an ADHD treatment.")
Addiction to amphetamines
Adderall is more famously related to crystal meth — both are amphetamines, though with different molecular structures. Where meth can cause brain damage, "Adderall would have to be taken in a very high dose to kill brain cells," says Thompson, who has mapped the effects of methamphetamine on the brain. "Note that the daily dose of Adderall is available in 5-, 10-, 15-, 20-, or 30-milligram doses, and our meth addicts, who lost 1 percent of their brain tissue per year, were taking about 100 times that, or around 3,000 milligrams a day. Of course, people who are taking Adderall for weight loss are probably taking it in higher dosages than they need, which increases the likelihood of addiction."
And therein lies the problem. Amphetamines have a way of creeping up on you. "Young people don't realize that medications like Adderall can be harmful if not prescribed for the appropriate condition," says Sophy. When taken at higher than prescribed dosage, Adderall can be psychologically and physically addictive, and some long-term users need to take increasing amounts to get the same appetite suppression, says Thompson. There are also a number of undesirable side effects: dry mouth, headaches, "fast heartbeat," "trouble sleeping." Many users turn to other drugs, like sleeping pills, Thompson says, to counteract Adderall's stimulant effect.
And then there was the incidence of sudden death. In 2005 Health Canada (the equivalent of our Food and Drug Administration) suspended the sale of Adderall XR after a manufacturer's review submitted to the agency found 20 sudden and heart-related deaths and strokes in adults and children taking prescribed doses since the introduction of Adderall in 1994. (In a statement to Allure, Matt Cabrey, a Shire Pharmaceuticals representative, noted, "Just because a person has an adverse event while taking a medicine, it does not mean the medicine caused the event.") The drug was reinstated later in the year — with much harsher warning labels than we have in the U.S., plus letters to all prescribing doctors informing them of the risks associated with the use of Adderall XR.
Finally, consider this reason for not abusing Adderall: the rebound effect. "If you don't keep taking it," says Amanda, who occasionally runs out of her pills before she can revisit her doctor, "your appetite returns, your motivation is nothing, you're really tired." Moreover, as tolerance for Adderall builds, "there is a concern that those who abuse the drug may need to take more just to maintain their new, lower weight," according to Thompson.
Still, I can't help wondering: If she didn't have the ADD that, in the past, had kept her from holding a job for more than six months when she was unmedicated, would she still take A to keep her weight under control?
Amanda ponders for a moment, then smiles. "Well," she says, "this is Hollywood."