In 2009, a 23-year-old New Orleans Saints placekicker was desperate to
take something that would keep him awake for a long night drive from
Dallas to New Orleans.
He took a half-pill of Adderall, and washed
it down with a Red Bull. He made it to New Orleans just fine - kind of
wired, he recalled.
A few days later, he was drug-tested by the
NFL, and the result was positive. The NFL did not reveal the substance,
barred by its collective bargaining agreement from doing so.
But Garrett Hartley went public: the positive test was because of the Adderall.
His case was basically Ground Zero in what has become an avalanche of Adderall news in the NFL.
Three
years later, the Adderall-related drug suspensions keep on coming,
including the latest - prominent Tampa Bay cornerback Eric Wright
suspended four games Monday and claiming Adderall use as the reason.
More than a dozen NFL players have either blamed their 2012 drug
suspensions on Adderall or been connected to the drug by others.
The
widespread use of Adderall in general highlights the complicated task
the NFL - and Major League Baseball - face in regulating a powerful
prescription drug that the leagues exempt as medicine for players who
need it and classify as a performance-enhancer for those who don't.
The
drug itself is misunderstood. There is a counter-intuitive aspect to
how Adderall works. It is a stimulant, but it has a calming effect on
those who use it to treat attention deficit hyperactivity disorder
(ADHD) by basically balancing out chemicals in the brain.
For
those who don't need the drug, Adderall acts as a powerful stimulant -
an alertness aid for students in an all-night study session, a
pick-me-up for those wishing to extend the party, or, in the case of an
athlete looking to gain an edge, an energy boost when they need it.
"It's
a stimulant," NFL senior vice president of labor law and policy Adolph
Birch says. "When taken in a non-medically-indicated, non-therapeutic
use, it's a stimulant that can combat fatigue and feelings of fatigue on
a playing field."
Adding
some intrigue in the NFL is that under current league policy players
can blame any positive drug test on Adderall - even if it was for a more
stigmatizing substance such as steroids - while knowing that the league
is prohibited from releasing information to the contrary.
The
mystery in recent months is why have there been so many players drawing
drug suspensions and admitting to using Adderall, which is commonly
prescribed to children and young adults for treatment of ADHD, which is
characterized by inattentiveness, over-activity and impulsive behavior.
Adderall,
a brand name, is classified as a psychostimulant, related to other
stimulants such as methamphetamine and cocaine. It is illegal without a
prescription and is banned by the NFL, MLB, NBA and the NCAA.
Adderall is banned in the National Hockey League, which currently does not allow medical exemptions.
Athletes
in other leagues can use Adderall by being granted therapeutic use
exemptions, but the leagues say it is a misconception that any player
with a prescription qualifies for an exemption. The pro leagues and the
NCAA have a process to determine whether an exemption is warranted.
"The
process in the NFL for obtaining a therapeutic use exemption on any
drug I would say is extremely rigorous, and the number of persons who
obtain them is very small," Birch says.
League officials, agents and health experts see a combination of possibilities to explain the Adderall trend:
- Players
who have been taking the drug legally for years - since they were in
college or even as children - and don't complete the process for getting
an exemption.
- Players who have long used the drug but have
never gotten a prescription. They - like many other Adderall users,
athletes and non-athletes alike - acquire the drug from friends or
family, who studies show provide up to 75% of prescription drugs that
are used illegally.
- Players who decide to see if they derive any
benefit from Adderall and run the risk of getting caught. Even if they
do get caught (the drug typically stays in the body's system for about
two days), there seems to be little stigma attached to a positive test
for a drug so commonly used by the general public.
Because
professional sports leagues have made allowances for those who are
deemed to be in need of Adderall, and the privacy concerns tied to
medical issues, there is a lot of uncertainty about how to react to what
seems to be growing use of the drug in some sports.
In Major
League Baseball, the percentage of players among 40-man rosters who were
granted therapeutic use exemptions skyrocketed from 28 in 2006 to 103
in 2007, the year after MLB banned amphetamines like Adderall. That
number has remained about the same since. In 2011 it was 105.
So
roughly 9% of major league players are granted exemptions for drugs
treating them for ADHD. By comparison, a study commissioned by the
National Institute of Mental Health in 2006 found that 4.4% of adults
ages 14 to 44 in the U.S. experienced symptoms of ADHD.
"To have
doubled the population prevalence of a disorder is staggering," says
University of Wisconsin psychiatrist Eric Heiligenstein. "Obviously,
that's weird."
Ben Vitiello, a research psychiatrist with the
NIMH, says that 4.4% figure cited in the 2006 study is probably still
accurate, but says it's simplistic to claim baseball's ADHD prevalence
is double the general population, because baseball's numbers reflect
only men - who have a greater prevalence of ADHD than women.
Still, Vitiello looks at the 9% prevalence in Major League Baseball and says, "That's a fishy number."
MLB's
Rob Manfred, executive vice president for labor relations and human
resources, says the percentage differences are understandable.
"Our
population doesn't look like the nation," he says. "We are younger. We
are higher income, and there's no question attention is a key part of
what these athletes do. So the idea that we would have a higher
incidence rate than the general rate is really not that surprising."
The
NFL does not release details on how many players hold therapeutic
exemptions, but Birch says, "I can easily say that it's less than the
percentages you would talk about on a national average with respect to
Adderall."
The 'Adderall excuse'
When an NFL player
is suspended for using a banned substance, neither the league nor the
NFLPA identifies what drug triggered the positive test. Birch says the
NFL would like to, for one reason to put an end to the "Adderall excuse"
- players who use some other banned substance and get suspended, and
blame their positive test on Adderall. Because of the NFL's
confidentiality provision, the league does not refute players'
explanations about their drug tests.
"We've been laboring to
change that for years, but the union has not shared our view on that,"
Birch says. "We think it's important for everyone to know what the
substance is."
Erik Burkhardt, Hartley's agent, says he believes
Hartley talking openly about his Adderall use gave other players and
agents the idea to take advantage of the current NFL policy when they
test positive for a banned substance.
Speaking hypothetically,
Burkhardt says, "Some 250-pound hulking linebacker doesn't look like
he's human. Everybody suspects he's on something. And the agent can just
say, 'Oh, he took an Adderall.' It's widely accepted. And it's proven
they won't be looked down upon. I think unfortunately, it's been
exploited."
The NFL believes its approval process thwarts improper
use of Adderall. The league requires the player/patient to apply to an
independent administrator of the NFL Policy on Steroids and Related
Substances before he starts using the drug.
The administrator sends the application to selected specialists who review the player's medical diagnosis.
"The
way our system works, it is difficult to obtain one," the NFL's Birch
says. "There are certainly legitimate uses for Adderall and if people
have a condition that legitimately necessitates it, our doctors and
advisers will give it. But it is a very, very detailed process to obtain
one."
The league's protocol may also explain why some players
have prescriptions for Adderall but lack the required exemption from the
NFL.
MLB also requires a second opinion. The league pays a board
of clinicians to review each player's diagnosis to determine if it meets
the accepted criteria, Manfred says.
Birch points out that an
exact number of positive tests for Adderall is impossible to ascertain,
as the NFL drug testers do not distinguish Adderall from other
amphetamines.
Amphetamines
have several performance-enhancing qualities, experts say. The drugs
can disconnect mental from physical fatigue, allowing an athlete to push
through tiredness. There's also a cognitive enhancement, which can help
in learning playbooks or developing strategy. There's also the effect
of offsetting high travel demands and jet lag for frequent-flying
athletes.
It's use among the public makes it more acceptable.
Studies have shown that Adderall is routinely used without a
prescription by high school and college students.
Former NFL
linebacker Bill Romanowski, an admitted steroid user who now runs a
nutritional supplement company and is an Oakland Raiders TV analyst,
suspects that many high school and college athletes have used Adderall
to gain competitive edges in the classroom and on the football field,
and now they have just brought their drug of choice with them to the
NFL.
"They get to the NFL, and they're like, 'Well, I need an edge. And this is what I used in college and in high school.'"
'Hard time walking away'
Heiligenstein,
the Wisconsin psychiatrist, says Adderall prescription misuse has been
going on for 10 to 15 years and echoes Romanowski's view that it's a
societal trend.
"If someone has misused, they're more likely to
continue misuse," Heiligenstein says. "Many people have a hard time
walking away from it because the drug has such a reinforcing effect.
Many people say, 'Gee, I think I'll just keep doing it. I'm not sure I
can be successful without taking it.'"
Heiligenstein says that
while the misuse of opiates such as Vicodin and Oxycontin is a deadly,
widespread epidemic, Adderall misuse is, he says, "an equally serious
and terrible problem."
He cites potential cardiac issues with
athletes who misuse Adderall, as well as dependency "that leads to much
more serious psychological and physical problems."
NFL agent
Hadley Englehard represents New York Giants running back Andre Brown,
who was suspended in March for a positive test but won an appeal to
overturn the penalty based on a mixup over his exemption. Englehard says
Brown has ADD and has approval to take Adderall.
Englehard says
the league and agents have tried to help players understand all aspects
of the drug program but "at the end of the day, you have to look
yourself in the mirror and know if you're taking something that a doctor
has not prescribed to you, it's illegal and you're going to get
caught."
USA Today