Ritalin Alert: As Abuse Rates Climb, Schools Are Scrutinized
by Katy AbelNew Study on Drug's Illicit Use Sparks Concern
The reports trickling out of rural towns, urban centers, and affluent suburbs have now become a steady drip: Prescription pills meant to treat ADHD in children are quietly being emptied out of vials and passed from hand to hand, given or sold to fellow students. No one knows how pervasive Ritalin abuse is nationwide, but if preliminary data from a forthcoming Massachusetts public health study is any indication, an alarming number of students are sharing or using Ritalin to get high.
Among the findings from a soon-to-be-published Massachusetts Department of Public Health survey: 13 percent of 6,000 high-school students and 4 percent of middle-school students admitted to an "illicit, unprescribed use" of Ritalin in anonymous, written surveys.
"Ritalin abuse is similar to rates of cocaine abuse," says the study's author, Thomas Clark of Health and Addictions Research in Boston. "It's not 'way down there' on the list with heroin."
Three years ago, high-school students in a focus group told Clark that the stimulant was "great for studying." Teens who crush and snort it liken the drug, intended for the treatment of ADHD, to cocaine. Also known as methylphenidate, Ritalin ranks on the Drug Enforcement Administration's Top 10 list of most-often stolen prescription drugs.
"In our research, prescription drugs were number two after marijuana in terms of drugs kids said they used most readily," adds Clark. "Girls especially felt prescription drugs were cleaner and safer because they'd been manufactured in controlled conditions."
Ironically, the false sense of security claimed by some young users may also explain why government and anti-drug agencies may have been slower to take up the battle against Ritalin abuse. The "war on drugs" has focused resources on combating the abuse of illegal drugs, not those available over the counter or by prescription. In DARE and other anti-drug programs in schools, kids learn about the dangers of cocaine, but not the perils of a legal drug that produces similar effects.
Congress Orders Study
While the Massachusetts numbers on Ritalin abuse seem high, reliable research on the national level is harder to come by. Conflicting studies have prompted Congressman Henry Hyde (R-Ill.) to order the General Accounting Office to investigate the extent of Ritalin diversion and abuse. At present, there is little data to show how - or where - students are getting hold of the drug.
"We know that Ritalin prescriptions are way up and correspondingly, school nursing programs have been cut in most states," says a member of Congressman Hyde's staff. Some researchers theorize that the combination of those factors has created a greater potential for abuse. According to testimony given at a congressional hearing last spring, domestic sales of methylphenidate increased nearly 500 percent from 1991 to 1999 (although prescriptions of the drug have leveled off at about 11 million per year for the past 4 years.)
At the same time that schools are being asked to dispense more prescribed medication to children, the resources to do so remain limited. In 1996, according to the American Nurses Association, 45,000 mostly part-time nurses covered 87,125 school buildings in the United States. Not surprisingly, a DEA investigation that same year found that "most schools did not have a nurse dispensing medication." In the absence of a nurse, the job often falls to school secretaries or teachers, who must dispense meds while juggling many other duties.
While studies to quantify the abuse problem get underway, few who follow the currents of the drug culture underestimate Ritalin's potency and value.
"Occasionally, I've had a street-wise family who'll say to me, 'Do you know what they would be worth on the street?'" recalls Biddeford, Maine, school nurse Nancy Dube.
Little Accountability in Schools
Q: What's the difference between a pharmacy and a school?
A: On any given day, in some communities, a school may have greater quantities of Ritalin on hand that the local drug store does. And while pharmacies are closely regulated and inspected, schools are not.
Despite growing reports of Ritalin abuse among students, the Drug Enforcement Administration's regulations on the safe handling and storage of the drug don't apply to schools.
"Schools for the last 100 years have not been handlers of controlled substances," observes Terence Woodworth, deputy director of DEA's Office of Diversion Control. "As a result, there are no safeguards."
Those sentiments are echoed by Judy Robinson, RN, Ph.D., executive director of the National Association of School Nurses. She notes that while many states have medical and nursing practice laws on the books, "schools tend to act as if they don't know about health laws. We have the laws but nobody to enforce them."
"I have actually observed schools where medications for middle-school students were kept unlocked in a counseling office, and kids were allowed to walk in and take their own meds," she recalls. "They were supposed to check with the secretary, but she didn't actually see them take it."
Last year, congressional efforts to force schools to become more accountable went nowhere. A bill to amend the Safe and Drug-Free Schools Act would have required states to certify that schools have implemented safeguards to prevent the diversion or theft of prescription drugs in return for federal funding under the program. According to a congressional source, the legislation was never considered because debate over reauthorization of the Act focused solely on guns in schools and the need for violence prevention efforts in the wake of the Columbine massacre.
Many parents, however, defend their school's handling of Ritalin and other prescribed medications.
"At my son's schools, it's always been very closely supervised and guarded," observes Kathy G. of Massachusetts, parent of a teenager who takes Ritalin. Still, when her son stays after high school to play sports he often carries a single pill to take on his own. With no nurse on duty to administer the drug, there seems little choice.
"It's part of a larger issue of school health practices," believes Robinson. "People can make gross errors of judgement about health and safety, and kids die."
