Adderall misuse: A pharmacist's perspective with Tom Viola

In this episode, pharmacology expert Tom Viola, RPh, CCP, breaks down what hygienists should know about Adderall, one of the most commonly used—and misused—stimulant medications.

Viola explains how Adderall works, why recreational use remains a concern, and the clinical signs hygienists may observe during treatment. From xerostomia and bruxism to elevated pulse and blood pressure, he outlines the oral and systemic effects that should prompt closer evaluation, careful documentation, and consistent vital sign monitoring.

Transcript

Andrew:
Welcome back, listeners, to Fast Facts: Ask the Expert. I’m joined today by Tom Viola. Tom, thank you for being here.

Tom:
Thank you so much for having me, Andrew. It’s always a pleasure.

Andrew:
I’ve got another drug I want to talk about — one that seems especially common among college students and young adults. When I was growing up, this was a medication people viewed as relatively safe. I want to talk about Adderall: who’s using it now, whether recreational use is still common, what it does to the body, all of that. So what can you tell us?

Tom:
Adderall is one of those drugs people both use and misuse because it’s the same medication coming from the same bottle. You get a prescription for Adderall or Concerta for ADHD or narcolepsy, and you take it as prescribed several days a week. But on the days you don’t “need” it, some individuals crush or alter the tablet to release the full dose at once—snorting it, smoking it, or injecting it.

So you're paying one copay for two very different uses: legitimate medical therapy and illicit stimulant use.

Pharmacologically, Adderall (dextroamphetamine) and Concerta (methylphenidate) produce classic stimulant effects: pale skin, increased body temperature, runny nose, dilated pupils, and weight loss. You also see elevated blood pressure and pulse—things we can detect easily if we consistently take vitals.

Oral signs include xerostomia, periodontal disease, and especially bruxism related to stimulant effects.

Andrew:
If someone has ADHD, does the drug work differently for them compared to someone misusing it?

Tom:
Not when the drug is taken illicitly. These medications are designed as extended-release systems. When someone crushes or opens the tablets to bypass that system, they get one large, rapid stimulant dose. That produces the same erratic effects whether you have ADHD or not.

Andrew:
Is overdose an issue with Adderall?

Tom:
Absolutely. Overdose risk increases when Adderall is combined with other stimulants, which is common. People often drink multiple energy drinks, misuse albuterol inhalers, or use marijuana to “come down”—all of which can further raise blood pressure and pulse.

This combination increases the risk of hypertensive crisis, stroke, and heart attack, even in young users who don’t perceive themselves as medically vulnerable.

That’s why vitals are essential in dental settings: they tell us who may be at risk before an emergency occurs.

Andrew:
Such a great point. Tom, thanks again for joining us. If someone wants to reach you, where can they find you?

Tom:
You can find me at TomViola.com or on social media at Pharmacology Declassified.

Andrew:
Thanks so much, Tom, and thank you all for listening to Fast Facts: Ask the Expert.