Looming in the background of America’s devastating opioid epidemic is what many experts believe to be a hidden crisis, one which has the potential to impact greater numbers of college students than misuse and abuse of opiates.

Data from government surveys on drug use show that stimulant use is climbing and in some cases, has outpaced opioid use. While increased misuse and abuse of prescription stimulants has gone largely unnoticed in the general population, EVERFI’s prescription drug prevention course data found three times as many students reported misusing stimulants compared to opioids (17% versus 5%, respectively). This is in spite of the fact that far fewer college students have ever been prescribed a stimulant (22%) compared to those who have ever been prescribed an opioid (62%).

Among the many factors contributing to this growing concern on campus is the belief that stimulants are a “safe” drug. By law, drugs prescribed to treat ADHD are controlled substances, in the same class as cocaine and methamphetamine. Yet perceived risk of harmfulness of amphetamine use among 19-year olds declined by 25% between 2001 and 2016. While drugs like Ritalin and Adderall don’t hold the same potential for addiction and overdose that opioids do, the issue isn’t as cut and dry as many, especially students, would like to believe. Contributing to the misperception of safety is the assumption that prescription stimulants affect everyone in the same way, regardless of whether or not they are diagnosed with ADHD. All in all, what does seem to be clear is that a growing number of college students believe these drugs somehow hold the answer to surviving in today’s hyper-competitive academic environment.

Correcting these misperceptions starts by understanding what the research tells us about the effect that stimulants have on those diagnosed with ADHD versus those who are not. In one review of more than 40 studies spanning 30 years, there was some evidence to suggest that people without ADHD had slight improvements in concentration and rote memory when taking stimulants. However, these improvements did not translate into enhanced learning or improved complex memory (Arria, 2010; Lakhan & Kirchgessner, 2012), both of which are required for standardized tests.

Further insights have been provided by research in the field of neuroscience, which has grown exponentially over the past 10-12 years as a result of the availability of enhanced brain scanning technology. For example, a recent brain imaging study found that the brain structures of children with ADHD differ in small but significant ways from those of  children without ADHD. This supports findings from previous neuropsychological studies of ADHD children and adults that found “impairments in many cognitive areas including selective attention, memory, reaction time, information processing speed, and executive control function such as set-shifting, and working memory.” This research has contributed to greater recognition of ADHD as a true disorder, rather than a motivational deficit or character failing.

Knowing this, how do drugs like Adderall and Ritalin impact those who don’t have ADHD? For those diagnosed with ADHD, the increased dopamine levels that result from a prescribed stimulant will compensate for deficits in cognitive functioning, but will not enhance that individual’s performance. Those without deficits are likely to experience a dopamine “overload”, which can lead to a number of potentially dangerous side effects but few, if any, improvements in academic performance. Just last month, researchers at the University of Rhode Island and Brown University, identified that Adderall has little impact on cognitive performance in healthy college students. Similarly, research done by Amelia Arria in 2010 found that students who engaged in non-medical use of prescription stimulants showed no increases in GPA and gained no advantage over those who abstained from use. There is also a significant placebo effect with ADHD drugs, where individuals feel more focused because they tell themselves that‘s supposed to be the case.

Beyond the misperceptions about the effectiveness of using ADHD medication to enhance learning, there are numerous health risks that come with using any medication outside of a physician’s care. At high doses, prescription stimulants can lead to a dangerously high body temperature, an irregular heartbeat, heart failure, and seizures, all of which can be avoided when under the care of a medical professional. A 2016 study in the Journal of Clinical Psychiatry found that Adderall use among young adults who didn’t have ADHD jumped 67% in recent years and that emergency room visits related to these medications rose 156%. And while Narcan can reverse an opioid overdose, there is no “rescue drug” for those who overdose on stimulants.

Prescription medicines play a critical role in healthcare. Advances in drug discovery and development help millions of people live longer and healthier lives. But any medication, when misused, can also cause harm. Campus professionals must advocate for the responsible use of all prescription medications in order to avoid stigmatizing those who use them safely and legally. At the same time, dispelling the myths about prescription stimulants as a “safe” and “effective” way to gain a competitive advantage is an important component of a thoughtful, diversified, and evidence-informed approach to reduce the likelihood of misuse and abuse of all substances.