Pubdate: Sun, 19 May 2002
Source: Union Leader (NH)
Copyright: 2002 The Union Leader Corp.
Author: Shawne K. Wickham
Bookmark: (Youth)


Here's something else for parents to worry about. Youngsters have found a 
way to get high that's cheap, easy to hide, and readily available: Ritalin 
and other stimulant-type medications used to treat attention deficit 
hyperactivity disorder.

And here in New Hampshire, which leads the nation in per capita consumption 
of methylphenidate (the compound found in Ritalin), the drug may be more 
accessible than you think.

Just ask 20-year-old Beth Clay of Plymouth, a first-year childhood studies 
major at Plymouth State College. She said abuse of Ritalin was "pretty 
prevalent" when she was in high school.

"I would say I could walk into Plymouth Regional High School, a school of 
900 students, and I could easily get 100 pills if I asked the right people 
at any given day."

"Manchester West, I could walk in and get 1,000," she said.

Clay knows firsthand how critical a drug Ritalin is for those with ADHD; 
her two brothers have been diagnosed with the disorder and the drug helped 
them to concentrate on their studies and excel in school. She's had her own 
struggles with attention deficit, and has learned behavior modification 
tricks that can help her without medication, she said.

But Clay said some youngsters who take Ritalin for ADHD squirrel away extra 
pills to sell in school, sometimes skipping medication on weekends. "They 
will take an extra pill or two and sell it for $5 apiece," she said. "It's 
very profitable."

Clay once had a high school classmate steal her brother's bottle of Ritalin 
from her home while they were working on a class project together. She said 
she knows students who don't have ADHD and who take one Ritalin pill to 
help them focus on a project or cram for an exam, and she said she doesn't 
think that's dangerous. "It's when you're at a party or at school, and you 
buy five pills for 20 bucks and then you take 80 milligrams or 100 
milligrams of Ritalin. It's when the dosages are beyond what's acceptable."

She's seen the effects of that: "The symptoms of almost an overdose kick 
in. The person gets very hyper, hyper-sensitive, hyper-alert, with very 
intense mood swings. It's pretty crazy."

Precautions At School

In New Hampshire, administrative rules of the state Department of Education 
require prescription medications to be transported to schools by parents or 
guardians, kept locked up, and dispensed only by school nurses or 
principals, according to Katherine Rannie, the school health services 
consultant for the department.

"The thrust of that is we don't want medication stolen or otherwise taken, 
and Ritalin is certainly a drug that's been subject to that in New 
Hampshire," she said.

Still, Rannie said, she receives several reports a year from schools that 
Ritalin has been stolen, either from the school nurse's office or from a 

Rannie said the rule isn't always strictly followed. "Some schools don't 
enforce it as well as they should, but once they realize how important it 
is, and get examples like that, they tend to crack down," she said.

Dr. R. Joffree Barrnett, a child psychiatrist at the Anna Philbrook Center 
in Concord, said youth drug use is closely tied to access. "With 
adolescents, unlike adults, they don't have a continuous monetary supply so 
they can't develop a drug of choice, or even a regular habit of a drug. So 
they constantly have to be opportunistic about it, and they take what's 
available and they experiment widely."

"So the prototypic pattern of most adolescents is that the stuff that is 
plentiful they'll use a lot of, but they'll sample around with lots of 
different things."

The more available Ritalin-type drugs are, they more likely it is that they 
can become the drugs of opportunity for adolescents, Barrnett said.

It's About the Access

Dr. Mark McGovern, an associate professor in the department of psychiatry 
at Dartmouth Medical School, is a consultant for the state's Division of 
Alcohol and Drug Abuse Prevention and Recovery.

McGovern describes youngsters using Ritalin to get high as "trading up from 
what's under the kitchen sink." "People alter themselves with what they can 
get a hold of," he said.

The youngest children might experiment with "huffing" household products, 
or sneak liquor at home. Middle schoolers might then think about 
experimenting with Ritalin if they can get it easily.

"I think it's something about the access, and if a typical kid that's on 
this substance might be 10 or 11 or 12 -- that's when they might get first 
diagnosed and first started --that might be the kind of thing you'd see."

He's heard of youngsters who pocket their own Ritalin pills during the week 
"and then use it on the weekends, with alcohol and other drugs as part of 
the whole party scene."

"And other kids who might be at least a little concerned with academic 
performance might use it during the week and then figure they don't need to 
use it as much over the weekend, and use their supply over the weekend in 
more than the usual dose to get some pretty strong effects."

Methylphenidate is classified as a stimulant. But researchers discovered 
that for children and adults with attention deficit and hyperactivity 
disorders, the drug had a reverse effect, McGovern explained. "It kind of 
slows them down and enables them to focus," he said.

However, he said, "At inappropriate doses, it does have the stimulant 
effect . . . It makes them feel the same way it would if you were on an 
amphetamine or a substance like cocaine."

And there are added dangers if youngsters mix the drug with other drugs or 
with alcohol, such as increased risk of impulsive behaviors, including 
aggression, and of suicidality, he said. "These are not good combinations 
of things," he said.

Judy Elliott is a school nurse for elementary schools in Webster and 
Salisbury; she previously worked at Merrimack Valley High School. She said 
there is more control over medications at the younger levels, since parents 
are required to bring the medication to school, and nurses have to dispense 
it and record when it is distributed.

However, in the high schools, she said, "I know for a fact it is a problem."

"As in any situation, you want your child to be more independent and you 
want to trust them, but there are situations where they have found that not 
only can they make money, but for those children who actually use it as a 
quick high, they put demands on their peers to obtain it," she said.

Elliott said most instances she has heard of involved youngsters selling 
their pills to others, but she recalled one case of a teenager saving up 
his own medication and then taking an increased dose for the stimulant 
effects. She said Ritalin abuse might be better hidden than other substance 
abuse problems "because it's a quick fix."

McGovern came to New Hampshire from an area north of Chicago, where he said 
use of Ritalin-type drugs among high schoolers was "almost epidemic."

"I think it was really a very, very popular drug."

A Serious Problem

Is it likely New Hampshire is lagging behind when it comes to 
methylphenidate abuse? Quite the contrary, McGovern believes.

"On most other measures of substances, whether it's alcohol or marijuana or 
heroin, New Hampshire is above the average" in prevalence rates, he said. 
And that means methylphenidate abuse is a serious problem here as well.

McGovern said abuse of prescription drugs is much less understood than 
abuse of illegal drugs or alcohol. "We just seem to know much less about 
that," he said. "It just seems harder to track."

Some are trying, however. For the first time last year, New Hampshire's 
education department added Ritalin to the list of substances students are 
asked about using, in the Youth Risk Behavior Survey sent to high schools 
around the state.

"During your life, how many times have you used amphetamines (also called 
speed or crank, or use of Ritalin not as prescribed) or methamphetamines?" 
the survey asked.

Virginia St. Martin, an education consultant who coordinates the survey for 
the Department of Education, cautioned that only 1,303 students, from 56 
different schools, responded to the 2001 survey, resulting in data that is 
not scientifically weighted. Still, 15.3 percent of those ninth through 
12th graders who responded said they had used such drugs one or more times.

"We need to be concerned about all of it," St. Martin said. "This is a very 
powerful drug."

Sarah Brophy, a Concord psychotherapist who specializes in treating adults 
and children with ADHD said she's heard more lately about youngsters 
abusing legally prescribed medications such as Ritalin. She said she takes 
care to counsel her young clients about the dangers of abusing the medication.

One Possible Answer

Brophy said one change that might limit methylphenidate abuse is the 
availability of newer, long-lasting forms of the drug. The prescription 
drug Concerta, for example, is taken once at home, before school.

"Concerta lasts the whole school day and with most people well into the 
late afternoon. It's been a godsend with regard to that," she said. Experts 
say parents should be watching their youngsters more closely, to make sure 
they're not selling extra pills or abusing the drug themselves.

"I think it's important for parents whose children are using Ritalin by 
prescription to be aware of the quantity and to keep it in a secure place," 
St. Martin said. "It's a challenge for parents managing their children's 
medication, because you also want your child to be independent about it . . 
. but because there is an abuse potential with the drug, the parents need 
to be aware of that."

She said parents also should warn children of the serious legal 
consequences from selling a controlled substance. "They may not understand 
how much trouble they could get into or how serious it is, or that it could 
actually hurt someone else."

And McGovern agreed parents should pay closer attention to their children's 
medication. "You have to be sure. You hate to get into pill counting, but 
you might have to do that," he said.
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