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 FDA issued a Public Health Advisory on Adderall, following Canada’s decision to suspend sales of the drug due to safety concerns. Canadian officials reviewing the manufacturer’s safety information found 20 international reports of sudden death and 12 incidents of stroke (that were not a result of misuse) in patients who were taking the drug. 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, the agency recently 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.

According to a recent report from Brookhaven National Laboratory, 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.

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.

While the true incidence of abuse is unknown, all signs point to a potentially serious problem. In fact, prescription drug abuse generally is on the rise: According to the National Center on Addiction and Substance Abuse at Columbia University, teen abuse has more than tripled over the past 10 years, and nearly 10 percent of 12 to 17-year-olds abuse prescriptions. In fact, according to a 2007 report from US Office of the National Drug Control Policy, prescription drugs are second only to marijuana when it comes to drug abuse for this age group. A University of Wisconsin study published in the Johns Hopkins Newsletter in 2002 found that as many as one in five college students illegally used drugs such as Ritalin or Adderall. Nearly 7 percent of the 44,232 high schools students who responded to a 1998 Indiana University survey said they had used Ritalin without a prescription. Two and a half percent said they took the drug at least once a month. And according to a 2003 report in the Journal of the American Academy of Child and Adolescent Psychiatry, calls to poison centers for Ritalin overdoses increased sevenfold between 1993 and 1999.

To date, no medications have been 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.

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.

-- Chris Woolston, MS, has a master's degree in biology and has written for Health, Hippocrates, and many other publications. Senior editor Benj Vardigan contributed to this report.

References

First published June 22, 2004
Last updated October 30, 2007
Copyright © 2004 Consumer Health Interactive

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