1. The truth aboutritalinabuse R-ball Rids es Smarti drugfreeworld.org
2. WHY THIS BOOKLETWAS PRODUCEDT here is a lot of talk about drugs in the world—on the streets, at school, on the Internet and TV. Some of it is true, some not.Much of what you hear about drugs actually comes from those sellingthem. Reformed drug dealers have confessed they would have saidanything to get others to buy drugs.Don’t be fooled. You need facts to avoid becoming hooked on drugsand to help your friends stay off them. That is why we have preparedthis booklet—for you.Your feedback is important to us, so we look forward to hearing fromyou. You can visit us on the web at drugfreeworld.org and e-mail usat firstname.lastname@example.org. 2
3. What is Ritalin?R italin is the common name for methylphenidate, classified by theDrug Enforcement Administration suicidal thoughts and psychotic behavior, as well as aggression oras a Schedule II narcotic—the same violent behavior.classification as cocaine, morphine and One writer put it thisamphetamines.* It is abused by teens for its way: “Parents arestimulant effects. never told: ‘Oh, by theEven when Ritalin is used as a prescription way, once in a whiledrug, it may have severe effects including a child dies simply bynervousness, insomnia, anorexia, loss of taking their prescribedappetite, pulse changes, heart problems and medication.’ Or ‘By the way, children onweight loss. The manufacturer says it is a stimulant medications have twice the futuredrug of dependency. rate of drug abuse.’ Or ‘By the way, one third of all children on these medications developIn June 2005, the US Food and Drug symptoms of obsessive-compulsive behaviorAdministration issued a series of public within the first year.’”health advisories warning that Ritalin anddrugs like it may cause visual hallucinations, * amphetamine: a powerful central nervous system (brain and spinal cord) stimulant, often called “speed.” 3
4. Where is it found? U nfortunately, Ritalin and related “hyperactivity” type drugs can be found almost anywhere. If you Why is it so common? It is all too easy for a “friend” to take some of his little brother’s prescription pills and turn around and sell are in high school or college, you them at $5 a pop. Or a student eager for a are likely to have a quick fix tells a school nurse he has a “study large supply readily disorder” and “can’t concentrate.” He gets to hand, with a prescription and stocks up on the pills for “pushers” (your future use, handing out extras to his friends. fellow students) While the law forbids unrestricted eager to make an distribution of these powerful stimulants,* easy profit from you. the sad fact remains that these substancesIn some schools, as many as 20% of the are freely available almost anywhere.students take the drug regularly. The Drug Kiddie Cocaine, as it has been called, isEnforcement Administration found that handed out like candy.many of these schools had more of these * stimulant: a drug that increases immediate energy anddrugs than the neighborhood pharmacy. alertness but that is accompanied by increases in blood pressure, heart rate and breathing. 4
5. T he symptoms of almost anoverdose kick in.The person gets veryhyper, hyper‑sensitive,hyper‑alert, with veryintense mood swings.It’s crazy.” — Jake 5
6. How Ritalin abuse starts I t seems so simple at first. A student gets a little behind in his studies. An exam comes up and he needs to prepare. He’ll have to stay up late to have even a chance of making the grade. Coffee gives him the jitters, but many of his friends use these pills to give the extra energy they need. Why not? A couple of bucks; one pill; an entire night of study; a feeling of “focus.” That may be where it starts, but it is very often not where it ends. Some students are chopping up Ritalin and snorting it like cocaine for faster absorption. “It keeps you awake for hours,” said one. And just like cocaine or any other stimulant,6
7. that nice “up feeling” is inevitably followedby a “crash,” a feeling of fatigue, depressionand decreased alertness. One student on I first tried Ritalin when I was in 7th grade. It was prescribed to me—they thought I had slight ADDAdderall, another stimulant widely abused on [attention deficit disorder], becausecollege campuses, recounted that a feeling of I pretended to so I could have an“utmost clarity” turned into a state of being excuse for not doing well in school“crashed out and overdone” the next day. Asone user put it, “I usually go into a crash coma (I was just lazy). I never realized thatafterwards.” I was getting myself addicted, and then I was no different than any otherAnd, of course, the user soon comes to know habitual drug user.that this “crashed out” feeling can be relievedwith the “help” of another pill that gets him “I took about 40 mg a day and I felt itback up again. And so it goes. put me at the top of my game. I wouldNext may be larger doses, or snorting it for a stay up for days in a row, to the pointbigger rush. Tolerance increases, so one has to I suffered a severe psychotic episode.use more. In these larger doses, Ritalin can lead It was terrifying! Everything seemedto convulsions, headaches and hallucinations. to be melting and morphing and I wasThe powerful amphetamine-like substance can terrified.” — Andreaeven lead to death, as in the many tragic casesof children who have died of heart attackscaused by damage linked to the drug. 7
8. What does Ritalin look like? And other facts R italin comes in small pills, about the size and shape of aspirin tablets, with the word “Ciba” (the manufacturer’s name) stamped on it. The 5 mg tablets are pale yellow, 10 mg tablets are pale green, and the 20 mg tablets are both white and pale yellow. It is described as a central nervous system stimulant. However, even its manufacturer, in the drug’s package insert, admits that no one really knows how it affects the human body: “The mode of action in man is not completely understood.”
9. Abusers grind the tablets into a powder andsnort it. The drug is water-soluble, makingit easy to convert into a liquid which can beinjected.As noted by the Drug EnforcementAdministration, “pharmaceutical productsdiverted from legitimate channels are theonly sources of methylphenidate available for abuse.” In other words, every tablet of the drug that is abused, either in its original form or ground into a powder or dissolved with water, N ow I have built up a tolerance to taking two to three 20 mg pills to get the high. originated from the manufacturer. None I recognize my dependence . . . of it is manufactured I have become ‘cracked-out’ or on the streets. zombie-like.” — Alex 9
10. Street names Ritalin is called by a variety of names on the street, including: • Diet Coke • oor man’s P • Kiddie Cocaine cocaine • Kiddie Coke • Rids • Vitamin R • Skittles • R-ball • Smarties
11. Poor man’s T est subjects who were given cocaine cocaine and Ritalin could not tell the difference.R italin is easy to get, and cheap. Taken from someone’s prescription, stolenfrom a sibling or obtained by a fraudulentprescription, these tablets are then broadlysold. The price runs from a dollar or two inschool to $20 per pill on the black market.The comparison of Ritalin to cocaine is notjust a slogan. Ritalin is chemically similar tococaine. When injected as a liquid, it sendsthat “jolt” that addicts crave so much.In 2000, the Drug EnforcementAdministration (DEA) revealed the resultsof studies on both animals and humans whowere given cocaine and Ritalin. The testsubjects could not tell the difference. TheDEA concluded that, “They produce effectsthat are nearly identical.” 11
12. Scope ofRitalin abuse A buse of prescription drugs such as Ritalin is increasing. By 2006, nearly 7 million Americans abused prescription drugs, including Ritalin—more than the number who abused cocaine, heroin, hallucinogens, Ecstasy and inhalants, combined. That 7 million was just 3.8 million in 2000—an 80% increase in only six years. In 2007, 3.8% of 12th graders reported having used Ritalin without a prescription at least once in the past year. A major factor contributing to the abuse is the huge increase in the number of prescriptions written for Ritalin and other stimulants.
13. In the US, the number of stimulant prescriptionssoared from around 5 million in 1991 to nearly35 million in 2007. I ended up doing a lot of stronger amphetamines that brought me down prettyIn 2004, methylphenidate (Ritalin) was involvedin an estimated 3,601 hospital emergency quick, and I don’t knowdepartment visits, compared to 271 in 1990. if I would have gotten interested in them if IFrom 1990 to 2000, 186 deathsin the US were linked to Ritalin. hadn’t started using Ritalin.” — AndyThe risk is highest for those whosnort large amounts of the drug. 2004 Emergency room visitsSince 1995, it has ranked involvingon the Drug Enforcement RitalinAdministration’s list of“most‑stolen” medications. 13 times more Ritalin abusers checked into 1990 Emergency roomemergency rooms visits involving in 2004 than Ritalin in 1990.
14. The vicious effectsof prescription stimulantsT his amphetamine-like substance causes the same types of effects onthe body as other forms of speed—loss of also contain tiny particles of insoluble fillers. These solid materials block the small blood vessels when injected into the bloodappetite, insomnia, increased heart rate. stream, causing serious damage to theThe abuse of this drug in larger doses, lungs and to the eyes.especially through injection or snorting, Aside from the physical impact, there areputs an even greater strain on the body. also severe emotional conditions causedThe stress on the heart can be fatal. by even short-term use of this drug.Take the case of a teenager—a long-term Hallucinations and psychotic behavioruser of Ritalin—who collapsed one day are not uncommon.while skateboarding. Dead of a heart A researcher in Texas found that Ritalinattack. use may heighten the danger of cancer. ThisAn injection of Ritalin has an additional, study found every one of a dozen childrenhorrible effect on the body. While the treated with methylphenidate experiencedchemical compound methylphenidate genetic abnormalities associated with andissolves completely in water, the tablets increased risk of cancer.14
15. Short-term effects Long-term effects • Strong• oss of appetite L • ermanent damage to P psychological• ncreased heart rate, I blood vessels of heart dependence blood pressure, body and brain, high blood • Psychosis temperature pressure leading to • Depression• Dilation of pupils heart attacks, strokes • amage to the D• Disturbed sleep patterns and death brain including• Nausea • iver, kidney and lung L strokes and• izarre, erratic, B damage possibly epilepsy sometimes violent • estruction of tissues in D behavior nose if sniffed• allucinations, H • Respiratory (breathing) hyper‑excitability, problems if smoked irritability • nfectious diseases and I• Panic and psychosis abscesses if injected• onvulsions, seizures and C • Malnutrition, weight loss death from high doses • isorientation, apathy, D confused exhaustion 15
16. Ritalin leads to other drugs A study supported by the National Institute on Drug Abuse found that users of Ritalin and similar drugs “showed the highest percentage of cocaine abuse.” Because a tolerance builds up, abuse of Ritalin can lead users to consume stronger drugs to achieve the same high. When the effects start to wear off, the person may turn to more potent drugs to rid himself KURT’S STORY: Rock legend Kurt Cobain started on Ritalin at age 7. Cobain’s widow, Courtney Love, believed that this drug led to his later abuse of stronger drugs. He committed suicide with a shotgun in 1994. Love was also prescribed Ritalin as a child. She described the experience this way: “When you’re a kid and you get this drug that makes you feel that [euphoric] feeling, where else are you going to turn when you’re an adult?”
17. of the unwanted conditions that prompted Commonhim to abuse the drug in the first place. JustificationsRitalin itself does not lead the person to (Don’t fall intoother drugs: people take drugs to get rid of the trap):unwanted situations or feelings. The drug There are many justificationsmasks the problem for a time (while the user for taking this powerful drug.is high). When the “high” fades, the problem, Recognize them for what theyunwanted condition or situation returns moreintensely than before. The user may then are—Lies!turn to stronger drugs since Ritalin no longer • Everyone is using it.“works.” • It’s just for study. • My brother takes it for aA study of 500 students over a period of25 years found those who used Ritalin and learning disorder, it can’t berelated drugs had a greater likelihood of using that bad.cocaine and other stimulants later in life. • It’s not addicting. • ou can control it. You don’t YAccording to a 2005 study, teens who abuse have to use it again if you don’tprescription drugs are 12 times likelier to useheroin, 15 times likelier to use Ecstasy and want to.21 times likelier to use cocaine, compared Don’t let others—including yourto teens who do not abuse such drugs. friends—lead you into the trap. 17
18. DEATH from RitalinH igh doses of Ritalin lead to similar symptoms such as other stimulant abuse, including tremors andmuscle twitching, paranoia,* and a sensation of bugsor worms crawling under the skin.One 17-year-old, after snorting crushed Ritalin pillsand staying awake for days, went psychotic, killed hisparents and severely injured his brothers and sisterMATTHEW’S STORY:Matthew was a teenager who had been on Ritalin for7 years. He died suddenly in March 2000. Althoughhe had no history of heart problems, the autopsyrevealed clear signs of small-vessel damage. Hisparents were told by one of the medical examinersthat the heart of a healthy, fully grown man weighsabout 350 grams. Matthew’s heart weighed 402grams. His death certificate reads: “Death causedfrom long-term use of methylphenidate (Ritalin).” 18* paranoia: suspicion, distrust or fear of other people.
19. with a hatchet. A 14-year-old, on Ritalin sincehe was 7, beat another boy to death with a I realize that my interest in and resulting dependence on speed started when I was prescribed Ritalin. At first it wasbaseball bat. every weekend, then it was every day.Ritalin can cause aggression, psychosis and “I began to get hallucinations of birdsan irregular heartbeat that can lead to death. flying overhead, feelings of people inIT’S A CRIME TO ABUSE IT the same room as me when I was alone,In the United States, Ritalin is subject to and the beginnings of paranoia. I used upsevere criminal penalties for abuse. The [my friend’s] entire Dexedrine prescriptionpenalties for a first trafficking offense (which within a week. Then I went back to myyou would be guilty of even if you just shared Ritalin and went on from there.one or two pills with a friend) includes up “I don’t remember much of 12th grade. Butto 20 years in prison and a fine of up to I do remember overwhelming depression$1 million. and an inability to understand what exactly If death or serious injury results from a was the reason I was doing worse than ever first offense, the penalty is in school. I barely graduated, and made absolutely no college plans. 20 years to life in prison. If the drug is injected, “At the last minute I enrolled in the local it becomes a drug college. I was able to stay clean for about offense with even 17 days before the need for speed overcame harsher penalties. all. I attended class for one week, and failed miserably.” — Sam 19
20. The Truth About DrugsD rugs are essentially poisons. The amount taken determines the effect. Drugs block off all sensations, the desirable ones with the unwanted. So, while providing short-term help in the relief of pain, they also wipe out abilityA small amount acts as a stimulant (speeds you and alertness and muddy one’s thinking.up). A greater amount acts as a sedative (slowsyou down). An even larger amount poisons and Medicines are drugs that are intended to speed upcan kill. or slow down or change something about the way your body is working, to try to make it work better.This is true of any drug. Only the amount needed Sometimes they are necessary. But they are stillto achieve the effect differs. drugs: they act as stimulants or sedatives, and tooBut many drugs have another liability: they much can kill you. So if you do not use medicinesdirectly affect the mind. They can distort the user’s as they are supposed to be used, they can be asperception of what is happening around him or dangerous as illegal drugs.her. As a result, the person’s actions may be odd,irrational, inappropriate and even destructive. 20
21. The real answer is toget the facts and notto take drugs in thefirst place.
22. why do people take drugs?People take drugs because they want to They think drugs are a solution. Butchange something in their lives. eventually, the drugs become the problem.Here are some of the reasons youngpeople have given for taking drugs: Difficult as it may be to face one’s problems, the consequences of drug use• To fit in are always worse than the problem one• To escape or relax is trying to solve with them. The real• To relieve boredom answer is to get the facts and not to take drugs in the first place.• To seem grown up• To rebel• To experiment22
23. Millions of copies of booklets such asREFERENCES Vanderbilt University Psychology Dept. this have been distributed to peopleDrug EnforcementAdministration Fact Sheet on The Harvard Crimson Center around the world in 22 languages. As for Substance Abuse ResearchPrescription Drug Abuse new drugs appear on the streets and more Novartis (Ritalin description)Monitoring the Future–National information about their effects becomesResults on Adolescent DrugUse, Overview of Findings University of Texas Medical known, existing booklets are updated and Branch, Galveston2007, National Institute on new ones created.Drug Abuse University of Indiana Prevention Resource CenterU.S. Dept of Health Human The booklets are published by theServices, Testimony by Nora D. Royal Canadian Mounted Foundation for a Drug-Free World, aVolkow, MD, before the Senate PoliceJudiciary Subcommittee on nonprofit public benefit organization New York University HealthCrime and Drugs, 12 Mar 2008 Center headquartered in Los Angeles, California.Emergency Department Visits The Family Council on DrugInvolving ADHD Stimulant Awareness The Foundation provides educationalMedications, SubstanceAbuse and Mental Health PHOTO CREDITS: Pages 4 materials, advice and coordination for itsAdministration, 2006 and 5: istockphoto.com/Matty international drug prevention network.United Nations Office on Symons; Page 11: Itar-TassDrugs and Crime It works with youth, parents, educators,“Millions Have Misused volunteer organizations and governmentADHD Stimulant Drugs, Study agencies—anyone with an interest inSays,” Shankar Vedantam,Washington Post, 25 Feb 2006 helping people lead lives free from drug“NIDA InfoFacts: Stimulant abuse.ADHD Medications—Methylphenidate andAmphetamines,” NationalInstitute on Drug Abuse 23