Ritalin Abuse

What are ADHD drugs?

Used to treat attention deficit hyperactivity disorder (ADHD), these medications are all drugs that stimulate the central nervous system. Ritalin (methylphenidate) has long been the leading treatment for ADHD. The drug helps people stay alert and focus on complex tasks, and is also considered to have a calming effect on hyperactive children. (It has also been used to treat narcolepsy.) But when taken by people without ADHD, it can have the opposite effect, stimulating the user and delivering a euphoric high, according to Dr. Amanda Gruber, associate chief of substance abuse in the biological psychiatry laboratory of Harvard-affiliated McLean Hospital.

Other stimulants prescribed for ADHD include Adderall (a combination of dextroamphetamine and amphetamine) and Dexedrine (dextroamphetamine). In 2005, the Food and Drug Administration issued a Public Health Advisory on Adderall. Earlier that year Canada suspended sales of the drug after receiving international reports of sudden death and stroke in patients. Canada later allowed the drug back on the market with a warning not to give it to children with heart abnormalities. Shortly after issuing its advisory, the FDA began to require a black box warning -- its strongest type of caution -- on ADHD drugs containing amphetamines. While the FDA does not feel that immediate changes in approval are warranted, and plans to continue assessing safety data as it becomes available, in 2005 the agency took the additional step of requiring manufacturers to notify patients of adverse health events associated with these drugs -- such as heart attacks, strokes, and psychiatric problems in patients with no history of them. Patients or parents of children taking this drug should talk to their doctors before altering or discontinuing treatment.

A National Institute of Mental Health study published in 1999 concluded that stimulant treatment was superior to therapy and community treatment, but critics have pointed out that the study failed to meet the criteria for a scientific study of medication effectiveness -- that is, there was no control group of untreated children with which to compare the children who took the medication, and no group that was unaware of the treatment. More recent research shows that a combination of medications and therapy may be most effective in treating ADHD.

Why are these medications abused?

Most research to date has found that Ritalin is a safe drug when taken as directed. At the dosages prescribed for treatment of ADHD, Ritalin won't make children feel "high" or lead to addiction. The potential for abuse comes in when people, especially those who don't have ADHD, take Ritalin or other ADHD drugs without a doctor's supervision. Some people -- including teenagers, college students, and adults -- take illicit doses to get high, to lose weight, or just to stay alert for a long meeting or a night of studying. Some swallow too many pills; others crush the tablets into a powder and snort it. In 2007, the FDA approved a new long-acting ADHD stimulant medication called Vyvanse, which may have less potential for abuse.

How dangerous is this type of drug abuse?

Tremors, agitation, a rapid heartbeat, and hypertension are all common side effects of Ritalin misuse. Abusers have also been known to suffer severe psychiatric complications, including psychotic episodes, hallucinations, paranoia, and bizarre behavior. Serious, long-term consequences are relatively rare. Ritalin isn't as addictive as amphetamines or cocaine, but according to the Drug Enforcement Administration, people who abuse Ritalin can still become hooked.

Amphetamine and dextroamphetamine medications like Adderall and Dexedrine can also be addictive and cause similar side effects. According to the National Institutes of Health, people hooked on ADHD drugs run the risk of withdrawal -- in the form of depression and extreme fatigue and weakness -- if they abruptly stop taking them. Gruber notes that these withdrawal symptoms can be more discouraging to the user than the negative side effects of taking the drugs, making it tempting for people to start using again.

How common is ADHD drug abuse?

While the true incidence of abuse is unknown, all signs point to a potentially serious problem. According to a 2005 report by the National Center on Addiction and Substance Abuse at Columbia University, prescription drug abuse among teens more than tripled over 10 years, and nearly 10 percent of 12 to 17-year-olds abuse prescriptions. Prescription drugs are second only to marijuana when it comes to drug abuse for this age group. While prescription drug abuse is on the rise, however, amphetamine use among adolescents has fallen since its peak in the mid 1990s. According to data from the Monitoring the Future survey, funded by the National Institute on Drug Abuse, 1.6 percent of 8th graders, 2.9 percent of 10th graders, and 3.4 percent of 12th graders reported using Ritalin without a prescription..

How is addiction treated?

To date, no medications have been proven useful in treating prescription stimulant addiction, according to the National Institute on Drug Abuse (NIDA). Treatment usually begins with tapering the intake of the drug and treating withdrawal symptoms, if any. Behavioral therapy then follows, often based on approaches proven successful in treating cocaine and methamphetamine addicts. NIDA says that support groups may also be effective during this recovery time.

What can be done to prevent abuse?

If your child has a prescription for Ritalin or another ADHD drug, make sure he or she takes it only as directed. Just as importantly, tell your child to never give pills to friends. You can make things easier by taking the pills out of the youngster's control -- administer the doses yourself, and keep the pills out of reach. If a dose of medication is needed during the school day, it should be administered by the school nurse.

References

Interview with Amanda Gruber, associate chief of substance abuse in the biological psychiatry laboratory at McLean Hospital

Poison centers' experience with methylphenidate abuse in preteens and adolescents. Klein-Schwartz W and J McGrath. March 2003. Volume 42, Number 3: 288-294.

MedlinePlus Drug Information: Dextroamphetamine and Amphetamine, National Institutes of Health, August 2010 http://www.nlm.nih.gov/medlineplus

Attention Deficit Hyperactivity Disorder. National Institute of Mental Health, 2008 http://www.nimh.nih.gov

Bollinger et al. Under the Counter: The Diversion and Abuse of Controlled prescription Drugs in the U.S. National Center on Addiction and Substance Abuse. July 2005 http://www.casacolumbia.org/

National Institute on Drug Abuse. NIDA Info Facts: Stimulant ADHD Medications -- Methylphenidate and Amphetamines. June 2009. http:www.drugabuse.gov

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