AaronY
11-30-2012, 11:13 AM
Do pro sports leagues have an Adderall problem?
David Leon Moore and Jim Corbett, USA TODAY SportsShare12 Comment
For athletes who need it, Adderall is a medicine. For those who don't, it can be a performance enhancer. For pro sports leagues, policing who needs it and who doesn't is far from simple.
(Photo: Marcio Jose Sanchez, AP)
STORY HIGHLIGHTS
Saints kicker Garrett Hartley's Adderall admission in 2009 just the beginning of NFL suspensions
In Major League Baseball, percentage of players approved for Adderall runs above national average
Leagues say process for players to receive exemptions to use drug requires more than a prescription
3:04AM EST November 28. 2012 - 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."
MORE: Tampa Bay's Wright latest to admit Adderall use
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.
MORE: Did Seahawk accidentally 'drink' Adderall?
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.
New Orleans Saints kicker Garrett Hartley (5) admitted in 2009 that he had taken a half-pill of Adderall so he could make a long night drive from Dallas to New Orleans. Hartley was suspended by the NFL after he tested positive days later, just the first in what has been a rash of Adderall-related suspensions in the NFL.(Photo: Matt Stamey, US Presswire)
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.
MORE: Adderall boom has unintended side effects
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."
http://www.usatoday.com/story/sports/nfl/2012/11/27/adderall-in-pro-sports/1730431/
David Leon Moore and Jim Corbett, USA TODAY SportsShare12 Comment
For athletes who need it, Adderall is a medicine. For those who don't, it can be a performance enhancer. For pro sports leagues, policing who needs it and who doesn't is far from simple.
(Photo: Marcio Jose Sanchez, AP)
STORY HIGHLIGHTS
Saints kicker Garrett Hartley's Adderall admission in 2009 just the beginning of NFL suspensions
In Major League Baseball, percentage of players approved for Adderall runs above national average
Leagues say process for players to receive exemptions to use drug requires more than a prescription
3:04AM EST November 28. 2012 - 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."
MORE: Tampa Bay's Wright latest to admit Adderall use
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.
MORE: Did Seahawk accidentally 'drink' Adderall?
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.
New Orleans Saints kicker Garrett Hartley (5) admitted in 2009 that he had taken a half-pill of Adderall so he could make a long night drive from Dallas to New Orleans. Hartley was suspended by the NFL after he tested positive days later, just the first in what has been a rash of Adderall-related suspensions in the NFL.(Photo: Matt Stamey, US Presswire)
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.
MORE: Adderall boom has unintended side effects
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."
http://www.usatoday.com/story/sports/nfl/2012/11/27/adderall-in-pro-sports/1730431/