Cramming on Ritalin

y Nancy Dreher
It was three days before
finals, on an evening last
January. A girls’ basketball
game was where the noisy
action was in the southeast
Pennsylvania high school. But
in a quiet hall nearby, an
inconspicuous security camera
was recording a theft in
progress.
The camera was taking pictures
of a junior at the school
sneaking out of the nurse’s
office. In his possession, police
would later charge, were more
than 300 pills of the prescription
drug Ritalin and other
medications. The pills had
been stolen from a locked medicine
cabinet where they were
stored for students authorized
to receive them from the nurse
during the school day.
A connection was drawn
between the pills and final
exams. Ritalin, known generically
as methylphenidate and
widely prescribed to treat
attention deficit hyperactivity
disorder (ADHD), is also used
illegally by people who do not
have ADHD. The drug, a stimulant,
is often abused by people
who believe it helps them
When taken as
prescribed, Ritalin is a
valuable medication.
Taking it as a
study aid or
party drug is a big
health risk.
to focus and stay alert longer
to cram for exams, write a
paper…or party.
A Strong, Potentially
Dangerous Stimulant
Ritalin has made its way
into the hands of those who
don’t need it as medication,
and the results can be disastrous.
When taken according to
a physician’s instructions by
someone who needs it as medicine,
Ritalin has a mild to moderate
stimulating effect. But
when it is ground into powder
and snorted, the drug has a
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Ritalin
and ADHD
Ritalin is the best known of several
drugs used to treat attention deficit
hyperactivity disorder (ADHD). The
medication can have a calming effect
on hyperactive children and a
“focusing” effect on those with
ADHD.
“When taken as prescribed,
Ritalin is a valuable medicine,” says
a statement from the National
Institute on Drug Abuse. “Further,
research funded by the National
Institute of Mental Health has shown
that people with ADHD do not get
addicted to their stimulant medications
at treatment dosages.”
Because Ritalin and other stimulant
medicines have a potential for
abuse, the U.S. Drug Enforcement
Administration (DEA) has placed
stringent controls on their manufacture,
distribution, and prescription.
strong stimulant effect.
“The drug enters the body
much quicker,” says Dr. Eric
Heiligenstein, clinical director
of psychiatry at the University
of Wisconsin’s Health Services.
“At that point, the standard
rationale that Ritalin is a safe
drug is thrown out the door.
When you take it intranasally,
you are basically in uncharted
places in the sense of how it
affects you as an individual—
your cardiac system and nervous
system.”
Used as a party drug,
Ritalin is especially dangerous,
even lethal. In Roanoke,
Virginia, a 19-year-old died
after snorting crushed-up
Ritalin pills at a party one
night in April 1995. He was
in cardiac arrest when taken
to a hospital emergency room,
where he was resuscitated
and then put on life support.
Eighteen hours later, he died.
The U.S. Drug Enforce-
ment Administration (DEA)
has reported deaths in
Mississippi and Virginia
associated with snorting
methylphenidate.
Serious Health Effects
Other bad things can happen
when Ritalin is abused.
Even when taken improperly
in pill form (not snorted),
methylphenidate can have serious
health consequences.
Dr. Heiligenstein recalls the
case earlier this year of a student
who came in after exam
time, complaining of dizziness
and unsteadiness. It took a few
appointments before the student
disclosed he had taken
four times his usual prescribed
dose of Ritalin to help him
study.
“The student was an example
of how a person (who misuses
Ritalin) can get overstimulated,
panicky,” says Dr.
Heiligenstein, describing common
symptoms of abuse. “All
parts of the body are stimulated.
Some people get rapid
heart rates. Some are itchy and
jumpy and on edge. They look
that way too; they look
‘wired.’”
There is the problem, too, of
withdrawal. “Any drug has an
action,” says Dr. Heiligenstein,
“and when use stops, there is
the body’s reaction. There can
be significant irritability, slow-
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ing of thinking, and moods
that tend to be quite variable
and low. People [tend to] think
about the problems associated
with taking the drug, but there
are also substantial problems
once it wears off.”
Dr. William Bailey, head of
the Indiana Prevention
Resource Center at Indiana
University, points out other
complications of abuse. For
example, Ritalin tablets come
in doses of 5 mg to 20 mg of
methylphenidate. To make the
tablets big enough to handle,
additional “inert ingredients”
are added. These ingredients
are inert (inactive) if swallowed,
but they can cause reactions
if snorted or injected
intravenously.
For example, the tablets
contain the hydrochloride salt
of methylphenidate, which
becomes hydrochloric acid
when it comes in contact with
moisture. This reaction does
not cause a problem when
swallowed tablets dissolve in
the stomach, where hydrochloric
acid already exists as an
acid that aids in digestion.
However, when Ritalin is
snorted, this reaction takes
place in the moist nasal passages.
The resulting acid can
damage delicate nasal tissues,
causing sores and nose bleeds,
and even lead to deterioration
of the nasal cartilage.
Problems with Addiction
Abusing Ritalin can also
become addictive—a fact readily
acknowledged by young
people who have been interviewed
about their use. The
DEA has found that abusing
the drug makes a person more
tolerant of it. This means more
of the drug is then necessary to
produce the same effect a
smaller amount once had. The
DEA also refers to “severe psychic
dependence,” creating a
mental state in which a person
believes the drug is vital for
performing important tasks,
such as studying or writing
papers.
The abuse of Ritalin
increased during the 1990s, a
trend that coincided with a
huge rise in the number of prescriptions
written to treat
ADHD. Between 1990 and
1995, the number of prescriptions
for the drug increased by
600 percent, according to the
DEA.
As greater amounts of the
medication are being dispensed,
it has become more
readily available to people
who do not need it as medicine.
Sometimes people who
have prescriptions for the pills
give them away or trade them
for other drugs. Ritalin is also
sold illegally, and—as was the
case in Pennsylvania and in
other places around the country—it
is often stolen. The DEA
reports that methylphenidate
ranks in the top 10 frequently
reported controlled pharmaceuticals
stolen from licensed
handlers.
The theft of drugs can obviously
have legal consequences.
The student in the Pennsylvania
school, for example,
was charged with burglary,
criminal trespass, receiving
stolen property, and theft—
and he was expelled from
school.
Even giving away the
drugs is against the law.
Dr. Heiligenstein believes in
spreading the clear message
that methylphenidate is a controlled
substance, and its possession
and use are restricted
by law. “You don’t share
pills,” he says. “Your medicine
is your responsibility.” ✦
Rx
Abuse
Abuse
Ritalin is hardly the only prescription drug with a reputation
for abuse. A 2001 report issued by the National
Institute on Drug Abuse stated that an estimated 4 million
people ages 12 and older used prescription drugs for
nonmedical reasons in 1999.
Three classes of prescription drugs are most commonly
abused:
• opioids, most often prescribed to treat pain
• central nervous system depressants, used to
treat anxiety and sleep disorders
• stimulants (which include methylphenidates),
prescribed to treat ADHD and the sleep disorder
narcolepsy
The report said data indicate that the most dramatic
increase in new users of prescription drugs for nonmedical
purposes occurred in the 12- to 17-year-old and
18- to 25-year-old age groups.
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