While most people are familiar with ADHD prescription stimulants such as Adderall or Ritalin, fewer patients are knowledgeable about Vyvanse, another prescription-only amphetamine. While marketed as a safer alternative to other medications with higher potential for abuse, there are still some significant concerns about Vyvanse that you should be aware of.
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Everything You Need to Know about Vyvanse Misuse, Abuse and Dependence
First Things First – What Is Vyvanse?
Vyvanse is the brand name of the prescription medication lisdexamfetamine dimesylate. Because it is a powerful amphetamine-class drug, it is classified in the United States as a Schedule II controlled substance. Vyvanse is typically prescribed for a number of conditions, including:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Binge eating disorders
- Asperger syndrome
- Chronic fatigue syndrome
- Oppositional defiant disorder
When taken for legitimate reasons and as directed, Vyvanse is a safe and effective medication. Not only does it reduce the “core” symptoms of ADHD – hyperactivity, impulsivity, inattention – it also improves a number of functional outcomes, including:
- Academic performance
- Antisocial behavior
- Non-medical drug misuse
- Social function
- Use of services – Examples: unemployment, public assistance, health programs, bankruptcy, etc.
In addition, in children with ADHD, Vyvanse use promotes a gain of 4.5 IQ points
Finally, lifetime ADHD therapy involving Vyvanse that commences during childhood has been found to reduce the chances of the patient developing an addictive disorder as an adult.
Although Vyvanse has legitimate medical uses, it is also diverted for recreational purposes and for supposed cognitive and athletic performance enhancement.
The problem arises when Vyvanse is misused in non-medically, in a manner not recommended by the prescribing physician. In fact, it has become common practice among Vyvanse abusers to fake the symptoms of ADHD in order to obtain a fraudulent prescription.
Vyvanse Statistics in America
According to the Centers for Disease Control and Prevention, ADHD is a very prevalent condition in the United States, affecting 11 % of American children between the ages of 4 and 17, and 8% of adults aged 18-44. Moreover, ADHD rates are rising sharply – in 1997, less than 7% of children were affected.
Because of this, the use of Vyvanse and other prescription stimulants is also rising. In 1990, roughly 600,000 US children were prescribed stimulants as treatment for their ADHD. However, a generation later, in 2013, the number of children being given prescription stimulants had ballooned to 3.5 million.
While far behind industry-leader Adderall, Vyvanse is growing in popularity. For example, in 2013, Vyvanse accounted for approximately $1.25 billion in sales for Shire, its parent company. But it is estimated that for 2017, spiked to $2.1 billion.
Medications That Are Similar to Vyvanse
Of course, Vyvanse draws comparisons with better-known ADHD medications like Adderall.
Vyvanse versus Adderall:
- Vyvanse is 100% pure d-amphetamine, while Adderall is composed of 4 d- and l-amphetamines. D- amphetamine is more effective at reducing hyperactivity and impulsiveness. L-amphetamine is better at improving concentration but may lead to increased anxiety.
- Adderall comes in both immediate-release and extended-release formulations, while Vyvanse is only available in a delayed-release formulation that is inactive until broken down by digestion.
- Whereas Adderall can be misused by crushing the tablets and then either snorting or injecting, this is not an option with Vyvanse.
- Overall, Vyvanse is considered to have less abuse potential than Adderall. However, when chronically abused at higher-than-prescribed dosages, it is still possible to get high, and dependence and addiction become increasingly likely.
Compared to Adderall, Ritalin, Concerta, and especially their generics, Vyvanse is far more expensive. According to Drugs.com, here are the cash prices for 100 tablets of each medication:
- Adderall – $646
- Adderall XR – $752
- Concerta – $1145-$1316
- Ritalin – $77-$149
- Generic methylphenidate – $66-$458
- Vyvanse – $1035
Right now, there are no generic formulations of Vyvanse, and their patent does not expire until 2023. However, several companies have already applied for permission to release generic versions of lisdexamfetamine dimesylate of upon that expiration:
- Amneal Pharmaceuticals
- Roxane Laboratories
- Sandoz, a subsidiary of Novartis
- Mylan Pharmaceuticals, a subsidiary of Mylan
Vyvanse Dosages, Onset of Action, and Duration of Effects
Vyvanse comes in two different formulations – capsules or chewable tablets, and seven dosages – 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, and 70 mg. The chewable tablets, typically prescribed for children, do not come in the 70 mg dosage.
Vyvanse is taken once a day, and effects are felt within two hours. The duration of effects can be between 12 and 14 hours.
What Are the Side Effects of Vyvanse?
Even when taken exactly as directed, Vyvanse, as an amphetamine, can trigger a number of adverse physical and psychological side effects, including:
- High blood pressure
- Alternately, abnormally low blood pressure, leading to dizziness and fainting
- Raynaud’s phenomenon – decreased blood flow to the extremities
- Rapid heartbeat
- Reduced seizure threshold
- Muscular tics
- Erectile dysfunction
- Too-frequent/unwanted erections
- Priapism – prolonged, painful erections
- Profuse sweating
- Blurred vision
- Nasal congestion
- Excessive teeth-grinding
- Dry mouth
- Faster and deeper breathing
- Abdominal pain
- Loss of appetite
- Weight loss
- Difficulty in urinating
- Mood swings
- Overactive libido
- Obsessive behavior
Why Do People Abuse Vyvanse?
Although the abuse potential for Vyvanse is less than that of other ADHD medications, it can still nonetheless be abused or misused non-medically. At sufficiently high doses, Vyvanse can increase the user’s energy and create a euphoric feeling of well-being.
All prescription ADHD stimulants are popular as illicit study aids. Misuse is highest among high school and college students, who take Vyvanse illicitly for its supposed cognition-enhancing effects.
- task-oriented motivation
- goal-directed behavior
Vyvanse is also misused by athletes, because it increases:
- muscle strength
- reaction time
Use by athletes is somewhat risky, however, because amphetamines are banned by the anti-doping commissions of organized sports at every level. Also, at higher doses, they can impair athletic performance by elevating body temperature and accelerating muscle breakdown.
One of the biggest factors in the development of Vyvanse dependence and addiction is how rapidly a user can become amphetamine-tolerant. Needing higher doses to feel Vyvanse’s effects, the user soon becomes dependent on the drug, and will experience painful withdrawal symptoms whenever it is not available.
Symptoms of Vyvanse Withdrawal
Almost 90% of chronic, heavy abusers will experience withdrawal symptoms within 24 hours of discontinuation. These symptoms can last up to four weeks, with the biggest “crash” occurring within the first week. While not particularly dangerous, Vyvanse withdrawal can be profoundly uncomfortable, and may push the person back into resumed abuse:
- Severe anxiety
- Irresistible drug cravings
- Deep depression
- Loss of motivation
- Sleep disturbances – either insomnia or excessive sleepiness
- Pronounced fatigue
Statistics about ADHD Drug Abuse
- 15% of 8th-grader students report that it is “easy” to obtain ADHD drugs for nonmedical use.
- But by the 10th grade, the percentage climbed sharply, to 28.5%, and by the 12th grade, it reaches 47%.
- 40% of US teens think prescription drug misuse is “safe”.
- 29% of teens think prescription drug addiction is impossible.
- Annually, 36% of first-year college students are offered ADHD medications illicitly, and more than 13% take the actions.
- Sophomores – over 38% are offered, and nearly 18% use.
- Juniors – more than 41% are offered, over 21% use.
- Seniors – 32% are offered, 16% use.
- Over the four years of college, 62% of students are offered Vyvanse other stimulants illicitly, and 31% will accept the offer.
- Compared to other age groups, college students are at doubled risk of ADHD drug abuse
- 40% of students who misuse Vyvanse and other prescription stimulants will do so during midterms and finals.
- Over 90% of students taking ADHD meds got them by faking symptoms.
- 90% of collegians taking ADHD drugs without a valid prescription are considered “heavy” drinkers and frequently engage in binge-drinking behaviors.
- College students misusing ADHD medications illicitly are:
The Connection between ADHD and Substance Abuse
For those people who DO legitimately struggle with ADHD, it’s important to consider that, across-the-board, they have high rates of substance use and dependence:
- Cigarettes – DOUBLED likelihood of lifetime use and nearly TRIPLED likelihood of dependence
- Alcohol – Almost DOUBLED risk of dependence/abuse
- Marijuana – A use disorder risk that is 1.5 times higher
- Cocaine – Twice as likely to be dependent on or abuse cocaine
Overall, people with ADHD have a risk of developing a substance use disorder that is two-and-a-half times greater than those without the condition.
Why is this the case?
First, many people with emotional disorders attempt to self-medicate to ease the symptoms of their condition. This is especially true with ADHD sufferers.
Second, people with ADHD often have impaired executive functioning and exhibit poor judgment, which can lead to substance experimentation and eventually, regular use.
Third, some researchers believe that there is a biological connection between ADHD and substance abuse. In other words, there may be a shared genetic vulnerability between the disorders.
It is important to keep each of these factors in mind with ADHD patients who are prescribed Vyvanse, because of the specific habit-forming properties of their medication. If a person habitually self-medicates with higher-than-prescribed dosages, they can quickly develop a tolerance that soon progresses to dependence and addiction.
What Are Some of the Dangers of Vyvanse Overdose?
As with any amphetamine, people who use Vyvanse can develop a tolerance – a reduction in effectiveness of the drug, meaning the person has to take ever-increasing dosages in order to realize the same effects. Drug-tolerant users have been known to take up to 100 times the maximum recommended daily dose.
A Vyvanse overdose is a medical emergency. Severe overdose symptoms include:
- Psychosis – up to 15% NEVER completely recover
- Bleeding in the brain
- Collapse of the circulatory system
- Insufficient blood flow from the heart
- Fluid in the lungs
- High blood pressure in the pulmonary arteries
- Kidney failure
- Carbon dioxide imbalance
- Abnormal blood potassium levels
- Dangerously high body temperature
- Muscle breakdown
Treatment for Vyvanse Addiction
For other habit-forming substances, there are medications that can help ease cravings and alleviate withdrawal symptoms, but there are no such pharmacological options to support recovery from Vyvanse addiction.
The lack of an effective medication makes the other steps in the rehab process that much more important. Successful recovery will require time and effort as the addiction is addressed on multiple levels:
- Vyvanse detox – This is medically-supervised withdrawal. In a safe, round-the-clock monitored therapeutic environment, the patient’s body purges itself of drugs. This is a necessary process, because only when the person is free from their physical dependence can they be clearheaded enough to receive the positive messages of recovery.
- Intake and assessment – This information will be used to create an individualized treatment plan. Depending upon the specific rehab program, a combination of any or all of these techniques may be utilized
- Individual psychotherapy
- Cognitive Behavioral Therapy
- Peer group counseling
- Trauma processing
- Stress reduction
- Coping skills
- Effective communication
- Conflict resolution
- Trigger avoidance
- Relapse prevention
- 12-Step meetings
- Concurrent treatment of any co-occurring conditions
- Nutritional support
- Music/Art/Poetry therapy
- Equine or Pet therapy
- Long-term aftercare and support
What’s the Bottom Line about Vyvanse?
Vyvanse is an approved first-line treatment for ADHD and binge-eating disorder. As a delayed-release medication, it has a lower abuse potential than other prescription stimulants, but “lower” does not mean that it cannot be abused recreationally.
On the contrary, amphetamine-based medications rapidly and directly affect the brain. And because Vyvanse tolerance and dependence can develop so quickly, anyone prescribed this drug needs to have a frank discussion with their doctor about any factors that could increase the risk of misuse.
And if any potential problems are identified, then alternate medications and other possible interventions and strategies should be explored.