Ritalin -- Prescriptions Don't Seem to Matter for Some

From the WebMD Archives

May 9, 2000 -- High school and college students have taken on a dangeroushabit. They're partying with Ritalin prescribed to their peers. And reports arethat parents are also popping the drug -- sometimes using their own kids'supplies -- hoping it's the perfect weight-loss, high-energy boost. Experts addthat this phenomenon doesn't only occur with Ritalin -- other prescriptiondrugs are being abused as well. Do they realize the risks?

Ritalin is most frequently prescribed for treatment of attention deficithyperactivity disorder (ADHD), which is thought to affect as many as 5% ofschool-aged kids in the U.S. The hallmarks of ADHD are lack of concentration,restlessness, and frequent frustration. The drug has always been controversial.However, recreational use and abuse of Ritalin is a growing trend that the DrugEnforcement Administration (DEA) and other watchdog groups have noticed.

Recently, 15 middle-school students in the Chicago suburbs were disciplinedfor selling or abusing the drug. The DEA lists Ritalin as one of its "drugsof concern." As with other controlled, prescription substances, Ritalin has"high potential for abuse ... that may lead to severe psychological orphysical dependence," Rogene Waite, a DEA spokesperson, tells WebMD.

A report from the DEA identifies Ritalin as one of the top 10 controlleddrugs most frequently reported stolen. It's sold on the street as "VitaminR" and "R-Ball." In many cities, Ritalin abuse has moved from theclub scene and now is available to younger adolescents in other socialsituations, many of which are billed as "no alcohol" events, PaulUlrich, a Chicago-based DEA spokesman, tells WebMD.

One national school survey conducted by the Institute of Social Research atthe University of Michigan shows that in 1997, almost 3% of high school seniorswere using Ritalin without a doctor's order, up from 1% the previous year.Another survey shows 7% of all Indiana high school students used Ritalin fornon-medical reasons, and 2.5% reported using it on at least a monthlybasis.

Also, since 1990, there has been a sixfold increase in the number ofestimated drug abuse emergency room visits associated with the use of Ritalin,according to the Department of Health and Human Services.

Like similar drugs, high doses of Ritalin cause rapid heart rate, high bloodpressure, nervousness, and insomnia. "In teenagers and adults, it acts morelike speed," Jeffrey Bernstein, MD, an emergency room physician at JacksonMemorial Hospital/University of Miami, tells WebMD. "There are also thecomplications you get from high blood pressure and rapid heart rate, like heartattacks, strokes. There's something called 'amphetamine psychosis' ... peoplewho take it continuously for a long time have hallucinations," he says.

Typical-dosage Ritalin is slow acting, but when many pills are crushed andsnorted or injected, the high comes quicker, says Bernstein. Danger comes intwo ways -- the drug is psychologically addicting, and injecting thecrushed-pill form is "fraught with complications," says Bernstein.

A good amount of the pill is talc and doesn't get absorbed by the body. Thiscan cause blood clots in the lungs, brain, and heart. The drug can also causebacteria to infect and destroy the heart valves. "All can be lifethreatening," Bernstein tells WebMD.

Parents are also getting involved -- either in acquiring the drug or abusingit themselves, drug abuse officials say.

There have been reports of parents obtaining Ritalin "for theirkids," paid for by Medicaid, only to turn around and sell the pills to drugdealers. Such scams have been uncovered in seven states.

Parents who abuse their children's medication are nothing new. Also, the DEAhas received numerous reports of students who gave, sold, traded, and/or abusedtheir own Ritalin medication or that of a sibling, friend, or classmate. Schoolnurses, principals, and teachers have reportedly been involved in stealing thedrug -- even from children's supplies at school.

Says Bernstein, "[Ritalin abuse] is not a new phenomenon. This has beenaround at least since the '60s. The phenomenon of parents using Ritalin asspeed, that's been going on since I was a kid."

Ritalin abuse is "way underreported," says Bernstein. "I thinkmost physicians have a fairly high level of suspicion ... when a child needs itmore often, when it accidentally got flushed down the toilet or whatever. ...We have drug seekers coming into the [emergency room] all the time, they'velost their prescription, the dog ate my prescription, they'll say anything fordrugs ... including Ritalin.

"When I was in medical school, there were a large number of medicalstudents who used Ritalin when they studied," Bernstein tells WebMD. "Iknow a lot of college kids now are abusing it as a study aid. People use it tostay up later. People use it so they will be more awake and function betterduring the day. And some people just like the way it makes them feel."

As a weight-loss drug, Ritalin is a bust, he says. "It will kill yourappetite at least temporarily, but there's no evidence that it does in the longterm. You become accustomed to it and eat anyway."

Rarely will you catch ADHD patients abusing Ritalin, Karen Hochman, MD,assistant professor of child and adolescent psychiatry at Emory UniversitySchool of Medicine in Atlanta, tells WebMD.

"In fact, the thinking is that it may prevent that by treating the coredeficit of the disorder -- which is inattention, hyperactivity, andimpulsivity. Kids have more school success, more social success ... they don'tget into as much behavioral trouble, they have less substance abuseoverall," says Hochman.

Other kids are sometimes the biggest risk to ADHD kids, Hochman adds."They may try and extort [the drug] out of them ... you have to be carefulwho you tell you're on this."

"As a stimulant compound, the risk of abuse has always been there,"Katherine Cunningham, PhD, tells WebMD. "It certainly is not in the samecategory as ecstasy, cocaine, methamphetamine, which have very prominenteffects. ... It seems we would have heard more about it than the whispers we'rehearing now." Cunningham is a pharmacologist at the University of TexasMedical Branch in Galveston.

More studies of the issue are needed, James Perrin, MD, tells WebMD."Abuse is talked about to a degree, but I wish there were better data. Alot of people can give individual stories here and there, but I'm not aware ofany good data on this." Perrin, who is director of pediatrics at HarvardMedical School/Massachusetts General Hospital for Children in Boston, helpedwrite recently released guidelines for physicians prescribing Ritalin forADHD.

As a street drug, Ritalin does have a few advantages, says Perrin. "Ithas relatively few side effects compared to some things teenagers use. So inthat sense, a lot of middle-class teenagers think they will not only get high,but it might help them do better on a statistics test. There is a variety ofreasons why at least on an anecdotal basis we know this has been a fashionabledrug to try, but there is very little evidence in terms of scope."

Tracking the trend has been Thomas Clark, a research associate with Healthand Addictions Research in Boston. While he's still compiling data from arecent survey, Clark suspects Ritalin use will be in the range of about 5% of12th graders. "You always see higher use in most drug categories in ages 18to 25. The trend tends to go up in young adults," says Clark.

"The under-25 age group are probably the ones abusing[Ritalin]."

Vital Information:

  • Federal agencies report Ritalin, a prescription drug used to treatattention deficit hyperactivity disorder, is becoming more popular as arecreational drug. It's one of the top 10 controlled prescription drugsreported stolen and has a high potential for abuse.
  • Reports show parents are abusing the drug as well as teens. One expertnotes legitimate Ritalin users usually are not abusers.
  • Doctors add it's important to be careful who knows about a child receivingRitalin by prescription, since others may try to gain access to the drugthrough the young patient.