Sunday, May 6, 2001

Lauren was 13 when she began pilfering her brothers Ritalin pills, crushing a few at a time and snorting them. It wasnt really like taking drugs, she says, because lots of other teen-agers she knew either had prescriptions for the pills or knew someone who would share his or her supply.”I would take one pill in themorning, then snort one or two pills when I came home from school,” says Lauren, a Montgomery County girl, now 17, who would not allow her last name to be used.

“Every once in a while, I´d take a whole bunch at once.”

The Ritalin made Lauren´s heart race, but it also made her alert and focused and improved her grades, she says.

“A lot of kids are on Ritalin,” says Lauren, who eventually moved on to other prescription drugs, alcohol and marijuana. “Parents are under the impression that they need a lot of it. I knew in the back of my mind drugs were bad, but then again, if it had been prescribed for me or my friends, what was the big deal?”

Ritalin (methylphenidate) is the drug commonly prescribed for children and adults to deal with attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). The drug´s popularity has experienced a 500 percent increase in the past decade, says Terry Woodworth, deputy director of diversion control for the Drug Enforcement Administration. With nearly 11 million prescriptions written for Ritalin annually, Ritalin has become a cheap, easily available stimulant at high schools and colleges nationwide.

“I would say Ritalin use is endemic among kids using drugs,” says Sally Eller, a social worker and the coordinator of the Phoenix II Alternative School in Gaithersburg. “It is always there and always easy to get. I call it ‘middle school cocaine´ because it is often the first drug kids get introduced to. Kids who do drugs do not worry whether something is bad for you.”

The typical prescribed dose of Ritalin is 5 or 10 milligrams. High doses of Ritalin, such as several pills at once, have the same side effects and abuse potential as other stimulants to the central nervous system, Mr. Woodworth says. Those side effects include agitation, euphoria, hypertension and increased heart rate.

Dr. Lawrence Diller, a behavioral pediatrician and the author of the book “Running on Ritalin,” says euphoria occurs because of rapid escalation of brain drug levels when the drug is snorted. That sort of effect does not happen when Ritalin is taken orally, he says.

Because the euphoria is similar to a cocaine-induced one, the withdrawal effects also are similar.

“I liked the high,” says Justin, a 16-year-old student who, along with Lauren, attends Phoenix II. “It is speed. It made me pay attention in school. I didn´t have to sleep. When you are high, you feel really good, but then you feel really bad. You start thinking crazy thoughts, becoming paranoid.”

At one point, Justin says, he was taking Ritalin every day.

“I had friends who were prescribed,” he says. “They would give me a handful. I could pop 10 pills and stay up for days. My friend once had 300 pills; he crushed them all up and did it for three days.”

It is tough to track how widespread Ritalin abuse is. There have not been a plethora of hospital emergency room admissions, overdoses or arrests for selling Ritalin as with other drugs such as narcotics, Mr. Woodworth says.

However, the DEA is concerned enough to label Ritalin as a Schedule II drug, one to watch for high abuse potential.

With so many young people legitimately being prescribed the drug, it is tough to tell what is being done with it, Dr. Diller says.

“Once a doctor gives , it is impossible to track how it is being used,” he says.

Legally, it also is tough to track who is misusing Ritalin because the drug is manufactured in a lab and so many teens have prescriptions for it that it is hard to track who is obtaining it illegally, Mr. Woodworth says.

At the local level, jurisdictions such as Montgomery and Fairfax counties do not track Ritalin sales or arrests because they are rare categories. Even at the school level, the official evidence is anecdotal.

“I know that kids across the country are crushing it up and snorting it,” says Clarence Jones, coordinator of the Safe and Drug Free Schools program in Fairfax County. “I have heard about it, but not a lot. I think I remember someone getting in trouble for selling it about five or six years ago.”

Because the drug is plentiful, it often is given away, which makes tracking distribution or catching someone in the act of selling it even more difficult.

“If someone is selling it, it is maybe 50 cents or $1 a pill,” Justin says. “To pay anything more would be a rip-off. You might as well give it way.”

However, some hard statistics do exist:

• From 1990 to 1995, Ritalin was stolen from pharmacies nearly 2,000 times, putting it among the 10 most frequently stolen prescription drugs from pharmacies, according to the DEA. In 1998, there were 376 reported thefts.

• Last fall, Rep. Henry J. Hyde, Illinois Republican, asked the General Accounting Office to undertake a study of Ritalin abuse in schools. Mr. Hyde also asked the GAO to support legislation requiring states to certify guidelines for Ritalin use on school property.

“We need to know whether or not proper safeguards exist to curb its illegal use,” he said.

• A 1997 study at Indiana University of 44,232 high school students included a question on nonmedical use of Ritalin. Nearly 7 percent of respondents reported using Ritalin recreationally within the previous year, and 2.5 percent said they used it monthly or more often.

• A 1998 study published in the Journal of Developmental Behavioral Pediatrics surveyed 161 children who were prescribed Ritalin. Sixteen percent of the children said they had been approached during school hours to sell, trade or give their medication away. Nearly half said stimulants were stored unlocked, and 10 percent said they were permitted to carry their own medication at school.

Ritalin abuse may be even more widespread at colleges, where students are less supervised and have greater pressures to stay awake to study or party.

Dr. Eric Heiligenstein, medical director of psychiatry at the University of Wisconsin, examined Ritalin use on the Wisconsin campus. He asked 100 students who had prescriptions for the drug about their own usage. He says one in five students admitted misusing the drug by increasing the dosage without permission, obtaining early refills or giving pills away to friends.

“Colleges are probably ground zero for distribution,” Dr. Heiligenstein says. “One of the things that impressed us in our study was the social norm of this that giving away a prescription drug is no big deal. But it is a losing battle to convince kids not to do this. It also trivializes the drug for the people who do need it.”

The advocacy group Chadd Children and Adults With Attention Deficit Hyperactivity Disorder is also concerned that abuse of the drug may blur the view of ADHD as a serious disorder.

“There is no data that indicates the widespread misuse of Ritalin,” says Matt Cohen, a past president of Chadd. “Any time someone misuses a medication, it is a cause for concern.”

Dr. Heiligenstein and Dr. Diller both say the medical community needs to do its part by being more judicious in its prescription writing. At the University of Wisconsin, for instance, Dr. Heiligenstein has made it harder for students to claim they “lost” their prescriptions.

“We are getting standardized procedures for how prescriptions are handled,” he says. “You can only lose your prescription one time. We have put in standardized guidelines for diagnosing ADHD. Our standards are as high as can be, but they are not unfair. We need to cut down on kids saying, ‘I´m doing poorly in school. Can you write me a prescription?´”

Overdiagnosis may be at the heart of the abuse problem, Mr. Woodworth says.

“There is no diagnostic test to say whether a child has ADHD,” he says. “It is really in the eyes of the beholder to say what is normal and what isn´t normal. Most of the diagnoses in this country are done by pediatricians. In other countries, it is primarily psychiatrists. If the criteria was more designed, then the likelihood for more accurate diagnosis would result in less diversion.”

Copyright © 2021 The Washington Times, LLC. Click here for reprint permission.

Please read our comment policy before commenting.

Click to Read More and View Comments

Click to Hide