In 2009, a 23-year-old New Orleans Saints placekicker was desperate totake something that would keep him awake for a long night drive fromDallas to New Orleans.
He took a half-pill of Adderall, and washedit down with a Red Bull. He made it to New Orleans just fine - kind ofwired, he recalled.
A few days later, he was drug-tested by theNFL, 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.
Threeyears later, the Adderall-related drug suspensions keep on coming,including the latest - prominent Tampa Bay cornerback Eric Wrightsuspended four games Monday and claiming Adderall use as the reason.More than a dozen NFL players have either blamed their 2012 drugsuspensions on Adderall or been connected to the drug by others.
Thewidespread use of Adderall in general highlights the complicated taskthe NFL - and Major League Baseball - face in regulating a powerfulprescription drug that the leagues exempt as medicine for players whoneed it and classify as a performance-enhancer for those who don't.
Thedrug itself is misunderstood. There is a counter-intuitive aspect tohow Adderall works. It is a stimulant, but it has a calming effect onthose who use it to treat attention deficit hyperactivity disorder(ADHD) by basically balancing out chemicals in the brain.
Forthose who don't need the drug, Adderall acts as a powerful stimulant -an alertness aid for students in an all-night study session, apick-me-up for those wishing to extend the party, or, in the case of anathlete looking to gain an edge, an energy boost when they need it.
"It'sa stimulant," NFL senior vice president of labor law and policy AdolphBirch says. "When taken in a non-medically-indicated, non-therapeuticuse, it's a stimulant that can combat fatigue and feelings of fatigue ona playing field."
Addingsome intrigue in the NFL is that under current league policy playerscan blame any positive drug test on Adderall - even if it was for a morestigmatizing substance such as steroids - while knowing that the leagueis prohibited from releasing information to the contrary.
Themystery in recent months is why have there been so many players drawingdrug suspensions and admitting to using Adderall, which is commonlyprescribed to children and young adults for treatment of ADHD, which ischaracterized by inattentiveness, over-activity and impulsive behavior.
Adderall,a brand name, is classified as a psychostimulant, related to otherstimulants such as methamphetamine and cocaine. It is illegal without aprescription 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.
Athletesin other leagues can use Adderall by being granted therapeutic useexemptions, but the leagues say it is a misconception that any playerwith a prescription qualifies for an exemption. The pro leagues and theNCAA have a process to determine whether an exemption is warranted.
"Theprocess in the NFL for obtaining a therapeutic use exemption on anydrug I would say is extremely rigorous, and the number of persons whoobtain 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.
Becauseprofessional sports leagues have made allowances for those who aredeemed to be in need of Adderall, and the privacy concerns tied tomedical issues, there is a lot of uncertainty about how to react to whatseems to be growing use of the drug in some sports.
In MajorLeague Baseball, the percentage of players among 40-man rosters who weregranted therapeutic use exemptions skyrocketed from 28 in 2006 to 103in 2007, the year after MLB banned amphetamines like Adderall. Thatnumber has remained about the same since. In 2011 it was 105.
Soroughly 9% of major league players are granted exemptions for drugstreating them for ADHD. By comparison, a study commissioned by theNational Institute of Mental Health in 2006 found that 4.4% of adultsages 14 to 44 in the U.S. experienced symptoms of ADHD.
"To havedoubled the population prevalence of a disorder is staggering," saysUniversity of Wisconsin psychiatrist Eric Heiligenstein. "Obviously,that's weird."
Ben Vitiello, a research psychiatrist with theNIMH, says that 4.4% figure cited in the 2006 study is probably stillaccurate, but says it's simplistic to claim baseball's ADHD prevalenceis double the general population, because baseball's numbers reflectonly 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'sRob Manfred, executive vice president for labor relations and humanresources, says the percentage differences are understandable.
"Ourpopulation doesn't look like the nation," he says. "We are younger. Weare higher income, and there's no question attention is a key part ofwhat these athletes do. So the idea that we would have a higherincidence rate than the general rate is really not that surprising."
TheNFL does not release details on how many players hold therapeuticexemptions, but Birch says, "I can easily say that it's less than thepercentages you would talk about on a national average with respect toAdderall."
The 'Adderall excuse'
When an NFL playeris suspended for using a banned substance, neither the league nor theNFLPA identifies what drug triggered the positive test. Birch says theNFL would like to, for one reason to put an end to the "Adderall excuse"- players who use some other banned substance and get suspended, andblame their positive test on Adderall. Because of the NFL'sconfidentiality provision, the league does not refute players'explanations about their drug tests.
"We've been laboring tochange 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 thesubstance is."
Erik Burkhardt, Hartley's agent, says he believesHartley talking openly about his Adderall use gave other players andagents the idea to take advantage of the current NFL policy when theytest positive for a banned substance.
Speaking hypothetically,Burkhardt says, "Some 250-pound hulking linebacker doesn't look likehe's human. Everybody suspects he's on something. And the agent can justsay, 'Oh, he took an Adderall.' It's widely accepted. And it's proventhey won't be looked down upon. I think unfortunately, it's beenexploited."
The NFL believes its approval process thwarts improperuse of Adderall. The league requires the player/patient to apply to anindependent administrator of the NFL Policy on Steroids and RelatedSubstances before he starts using the drug.
The administrator sends the application to selected specialists who review the player's medical diagnosis.
"Theway our system works, it is difficult to obtain one," the NFL's Birchsays. "There are certainly legitimate uses for Adderall and if peoplehave a condition that legitimately necessitates it, our doctors andadvisers will give it. But it is a very, very detailed process to obtainone."
The league's protocol may also explain why some playershave prescriptions for Adderall but lack the required exemption from theNFL.
MLB also requires a second opinion. The league pays a boardof clinicians to review each player's diagnosis to determine if it meetsthe accepted criteria, Manfred says.
Birch points out that anexact number of positive tests for Adderall is impossible to ascertain,as the NFL drug testers do not distinguish Adderall from otheramphetamines.
Amphetamineshave several performance-enhancing qualities, experts say. The drugscan disconnect mental from physical fatigue, allowing an athlete to pushthrough tiredness. There's also a cognitive enhancement, which can helpin learning playbooks or developing strategy. There's also the effectof offsetting high travel demands and jet lag for frequent-flyingathletes.
It's use among the public makes it more acceptable.Studies have shown that Adderall is routinely used without aprescription by high school and college students.
Former NFLlinebacker Bill Romanowski, an admitted steroid user who now runs anutritional supplement company and is an Oakland Raiders TV analyst,suspects that many high school and college athletes have used Adderallto gain competitive edges in the classroom and on the football field,and now they have just brought their drug of choice with them to theNFL.
"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 beengoing on for 10 to 15 years and echoes Romanowski's view that it's asocietal trend.
"If someone has misused, they're more likely tocontinue misuse," Heiligenstein says. "Many people have a hard timewalking 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 Ican be successful without taking it.'"
Heiligenstein says thatwhile the misuse of opiates such as Vicodin and Oxycontin is a deadly,widespread epidemic, Adderall misuse is, he says, "an equally seriousand terrible problem."
He cites potential cardiac issues withathletes who misuse Adderall, as well as dependency "that leads to muchmore serious psychological and physical problems."
NFL agentHadley Englehard represents New York Giants running back Andre Brown,who was suspended in March for a positive test but won an appeal tooverturn the penalty based on a mixup over his exemption. Englehard saysBrown has ADD and has approval to take Adderall.
Englehard saysthe league and agents have tried to help players understand all aspectsof the drug program but "at the end of the day, you have to lookyourself in the mirror and know if you're taking something that a doctorhas not prescribed to you, it's illegal and you're going to getcaught."