In the bathroom of a suburban elementary school outside Peterborough, Ontario, a 13- year-old boy offers to sell a quick high to some 10- and 12-year olds. His drug of choice: Ritalin, the prescription drug widely used to treat hyperactivity in children.
In a small town outside Athens, Ga., 282 Ritalin pills suddenly disappear from a medical cart kept in a locked closet of the middle school.
Outside Chicago, two teens report being regularly harassed and pressured by classmates to hand over their daily dose of the drug. They've now changed schools.
As use of the controversial stimulant skyrockets in the treatment of attention deficit hyperactivity disorder (ADHD) - it has increased by as much as 700 percent since 1990 - so has its abuse.
In public schools and private universities across North America, Ritalin is increasingly the drug of choice for thousands of young people, from 10-year-old grade-schoolers dabbling with a first illicit high to graduate students in need of an all-night push to finish a term paper.
The extent of the abuse varies widely from community to community, but the growing recognition of the problem comes at the same time as a heated debate in the scientific community over whether a child's use of the drug works as a gateway to future substance abuse, or protects them from it.
Also known as methylphenidate, Ritalin is in the Drug Enforcement Administration's (DEA's) Top 10 list of most often stolen prescription drugs. It's widely available on college campuses, as well as in high school cafeterias. Kids are popping, snorting, even dissolving and injecting Ritalin, putting it in the same drug class as cocaine.
"Virtually every data source available confirms ... the widespread theft, diversion, and abuse of Ritalin, and drugs like it, within public schools throughout the country," says Rep. Henry Hyde (R) of Illinois. "It seems clear from the data that children are using these drugs illicitly, and that this use is increasing."
The extent of the abuse varies widely. One national study found that only 3 percent of high schoolers reported illicit Ritalin use in the last year. Another found the number was as high as 7 percent.
At the same time, a DEA study of Wisconsin, South Carolina, and Indiana found that about 30 to 50 percent of teens in drug-treatment centers said they had used methylphenidate to get high, although not as their primary drug of abuse.
As a result of the conflicting data, Mr. Hyde has called on the Government Accounting Office to investigate the extent of the diversion and abuse. He's also calling for legislation that would require states to have guidelines for the handling of prescription drugs on school premises.
Lock those medicine cabinets
The DEA is currently putting together pamphlets that contain such guidelines, along with educational materials about the drug. "Our concern is that once that medication is given to children, it's actually taken by the individual that it's prescribed for," says Gretchen Feussner, the DEA's Ritalin expert. "And once it's in a school, it should be secured in a place other than in a drawer or a teacher's desk."
In some schools, as many as 20 percent of the students take the medication regularly during the school day. A 1996 survey by the DEA found more methylphenidate is on hand in many of those schools, where it's completely unregulated, than in the strictly controlled local pharmacy. Most of those schools also don't have full-time nurses on hand to dispense the medication.
That has helped make the drug more readily available to kids than some illegal substances. And it's a key reason experts are particularly worried about its abundance. Ritalin is interchangeable with amphetamine and methamphetamine, and all of them produce much the same effect as cocaine.
"Cocaine is shorter acting, so it has more of a punch: People tend to prefer cocaine when they're sophisticated," says Dr. Peter Breggin, a leading critic of the use of Ritalin. "But before they get to that stage, they'll use Ritalin."
The National Institutes of Mental Health (NIMH) estimates that as many as 6 million American children suffer from ADHD. That's between 3 and 5 percent. If untreated, NIMH says the disorder can lead to serious problems later in life.
In the largest clinical study of its kind, researchers concluded that Ritalin can help 82 to 85 percent of the children who receive the drug. But other studies have raised questions about its long-term impact on substance abuse.
One family's story
In Newport Beach, Calif., Martha Fluor has first-hand experience with Ritalin abuse. Her teenage son, who'd been diagnosed with ADHD and on Ritalin since he was seven, suddenly started to lose weight and have trouble sleeping.
It turns out he was taking his medication more than he should have. In fact, he was grinding it up and snorting it to get high.
"He never had those symptoms when he was taking it as prescribed," says Ms. Fluor, who's also a school board member at the Newport Mesa Unified District.
Her son ultimately got into a host of illegal drugs as well. He ended up in treatment. He's now in his early twenties, off all drugs, including Ritalin.
Fluor says that when he took the drug responsibly, it helped him. But she's also concerned about what she suggests are the double messages schools send on drug use.
"When you have a child that is taking a controlled substance legally, and in the schools you have a zero-tolerance program, it's really hard for them when you say, 'On the one hand, don't take any drugs, but on the other do take drugs,' " she says. "It confuses them. "
Fluor believes that aggravated some self-esteem issues her son was dealing with in adolescence. He wanted "to be normal" but didn't feel that way because he was taking medication.
"We need to be hyper-vigilant about the legal drugs, educate kids about them, and make sure that they're doing what they're intended to do," she says. "They also need to be closely monitored."
Impact on illegal drugs
The Fluor family's story highlights a heated controversy under way in the medical community about whether Ritalin hinders illegal substance abuse or gives kids a taste for more mind-altering drugs.
A study at the University of California at Berkeley, which tracked 500 children for more than 25 years, found that use of methylphenidate and other stimulants in the treatment of ADHD increases the likelihood that a child in later life will take up smoking, cocaine, and other stimulants.
In testimony before a congressional subcommittee last spring, the study's author, Dr. Nadine Lambert, said use of Ritalin as much as doubles the risk of future substance abuse.
But a group of Harvard psychiatrists disputes that. They studied 500 children diagnosed with ADHD between the ages of 10 and 15 over four years and found just the opposite.
They concluded that Ritalin helped calm kids and decreased antisocial behavior. The kids in the study who did not take Ritalin ended up having much higher rates of illegal substance abuse than their peers.
While that dispute rages in the scientific journal, parents still have to cope with their children every day in an environment where both legal and illegal drugs abound.
Advice to parents
If parents suspect their child might be abusing Ritalin or any other prescription medicine or illegal drug, the DEA's Fuessner suggests having a good long talk. "One of the worst things you can do is bury your head in the sand, because the consequences can be very serious," she says.
(c) Copyright 2000. The Christian Science Publishing Society