by William J. Bailey, M.P.H.
Copyright 1995, The Trustees of Indiana University.
Permission granted for free distribution of copies for non-profit educational use. All other rights reserved.
A familiar stimulant drug, long used to treat hyperactivity in children, is quickly becoming the drug abuse "hot topic" in the American Midwest. Reports of Ritalin (methylphenidate) abuse have taken center stage in television specials and news magazine articles in the fall of 1995. Prescription tablets, which produce mild stimulant effects when taken as directed and at usual prescription doses, can create powerful stimulant effects and serious health risks when crushed and then snorted like cocaine, or injected like heroin.
Producing cocaine-like stimulant effects, snorted or injected Ritalin is just the latest trend in a resurgence in abuse of stimulant drugs that recalls the "Speed Freak" era of the late 1960's.
Ritalin (methylphenidate) is manufactured by CIBA-Geigy Corporation, and is supplied in 5 mg., 10 mg., and 20 mg. tablets, and in a sustained release form, Ritalin SR as 20 mg. tablets. It is readily water soluble and is intended for oral use. Many non-medical users, however, crush the tablets and either snort the resulting powder, or disolve it in waterand "cook" it for intravenous injection. It is a Schedule II Controlled Substance under both the federal and Indiana Controlled Substances Acts.
In medicine, Ritalin is used in the treatment of Attention Deficit Disorder (ADD) (also known as Attention Deficit/Hyperactive Disorder (ADHD), formerly called Minimal Brain Dysfunction) and in the treatment of narcolepsy. In recent years, the frequency of diagnosis for attention deficit disorder has increased dramatically, especially since adults are now diagnosed with this disorder that had previously been considered a children-only disease. Prescriptions for Ritalin have increased more than 600% over the past five years according to the DEA, and a significant portion of these prescriptions are diverted for illicit non-medical use.
Since Ritalin is a Schedule II Controlled Substance, the federal government strictly regulates the amount that may be manufactured, through a system of rigid manufacturing quotas. Over the past several years, as ADD diagnoses increased, the manufacturing quotas have not increased sufficiently to allow for the increased demand. This has led to sporadic and regional shortages of Ritalin. Diversions of drugs into the illicit street drug trade increases the shortages of the drug for legitimate medical purposes.
When purchased in pharmacies with a valid prescription, Ritalin tablets usually cost 25 cents to 50 cents each. In the illicit street drug market, tablets sell for $3 to $15 each. While street prices in the Midwest are now at the low end ($3 to $5 per tablet) compared with some West Coast locations, they have been rising over the past few years.
At a December, 1994 meeting of the Community Epidemiology Work Group, a drug use epidemiology forum, an upsurge in illicit street use of Ritalin was reported on the U.S. West Coast and in the Midwest. Snorting of crushed Ritalin tablets and intraveous injection of a solution made from Ritalin tablets were reported at both Midwestern reporting sites: Chicago and Detroit. Anecdotal reports suggest that suburban and white abusers are somewhat more likely to snort Ritalin, while black inner-city abusers are somewhat more likely to inject it.
Chicago: "The most intensive stimulant abusers...are those who prefer to inject...white IDUs on the North Side are reported to inject phenmetrazine HCl (Preludin)...black stimulant suers on the South Side prefer methylphenidate (italin), or "west coast."
CEWG, Epidemiologic Trends in Drug Abuse, NIDA, 1995.
Epidemiologists at the National Institute on Drug Abuse describe Ritalin abuse over the last two decades as "sporadic but persistent," and rates of use fluctuate over time.
Ritalin (methylphenidate) is a central nervous system stimulant, similar to amphetamines in the nature and duration of its effects. It is believed that it works by activating the brain stem arousal system and cortex. Pharmacologically, it works on the neurotransmitter dopamine, and in that respect resembles the stimulant characteristics of cocaine. When taken in accordance with usual prescription instructions, it would be classified as having mild to moderate stimulant properties, but when snorted or injected it has a strong stimulant effect.
Even when taken according to the prescription directions, there is a risk of developing dependence and tolerance to the drug. The manufacturer cautions physicians to be on the lookout for the following adverse effects:
High doses of stimulants produce a predictable set of symptoms that include:
While death due to non-medical use of Ritalin is not common, it has been known to occur.
In order to make the 5- to 20 mg. dose tablets large enough to handle easily, at least 100 mg. of "inert ingredients" are added to the tablets to increase their size. Depending upon size and formulation, the following inert ingredients are found in Ritalin tablets, according to the manufacturer: lactose, starch, polyethelene glycol, magnesium stearate, sucrose, talc, cellulose, mineral oil, and various dyes and conditioning agents. While these ingredients are "inert" when taken by mouth, they can cause serious problems when injected or snorted.
The hypodermic syringe was designed to deliver a concentrated dose of a drug quickly and efficiently. In doing so, it bypasses many of the body's natural defense mechanisms such as the skin, respiratory cilia, digestive acids, etc. The syringe allows anything in it (drugs, dust, bacteria, pollen, allergens, yeasts, viruses, fillers, etc.) to pass directly into the blood and body tissues. The rapid delivery of drugs via injection makes it difficult for the user to control the intensity of the drug effect, thus making toxic overdoses more likely.
When drugs are prepared for injection by a street user, dust, dirt, and other contaminants fall into the liquid. Bacteria, talc, lint, and other particles are injected along with the drug. The "inert ingredients" that manufacturers include to increase the bulk may be harmless when taken by mouth, but talc, cellulose, mineral oil, and sugars (among other fillers) can create serious problems when injected directly into veins or body tissues. Complications from injection drug use include:
There are numerous reports in medical journals about permanent and irreversible lung tissue damage related to injection of crushed Ritalin tablets.
The delicate epithelial tissues that line the nasal cavities and air passages may be damaged by direct contact with drugs. Ritalin tablets contain the hydrochloride salt of methylphenidate and yield dilute hydrochloric acid when they come into contact with moisture. While this is not a problem in the stomach (hydrochloric acid is one of the digestive acids used in the stomach), in the nasal passages the acid can "burn" the delicate nasal tissues, resulting in open sores, nose bleeds, and possibly in deterioration of the nasal cartilage.
Ritalin (methylphenidate) is a Schedule II Controlled Substance under both the federal and Indiana's Controlled Substances Acts. As such, it is tightly regulated, from manufacture to receipt by a patient. Schedule II drugs are covered by strict manufacturing quotas, careful inventory controls that require special order forms, and separate recordkeeping requirements. Prescriptions may not be refilled -- a new prescription is required for additional supplies. Prescriptions must be in writing, and limited to an amount sufficient for one month plus one week, if used in accordance with the prescribing instructions. In Indiana, Ritalin prescriptions must be in writing, and on special, numbered, three-part prescription forms that permit tracking supplies.
Under both federal and state law, dealing in or distributing Ritalin is a serious felony. Possession without a prescription is a felony under Indiana law as well. Depending upon the quantity, location of transfer, and age of the recipient, dealing in Ritalin could be a Class A Felony resulting in a prison term of up to 45 years, and a fine of up to $10,000, under Indiana law.
Indiana law is so strict that the transfer of one or two tablets from one student to another on school grounds can be construed as dealing in a controlled substance in or on school property -- a Class A Felony!
Indiana's law provides increased penalties for dealing to minors under age 18, or dealing on or within 1000 feet of school property or a school bus; or near pulic parks.
Bailey WJ. Drug Use in American Society, 3rd ed. Minneapolis: Burgess, 1993.
Leland J. A risky Rx for Fun. Newsweek October 30, 1995, p.74.
National Institute on Drug Abuse, Community Epidemiology Work Group (CEWG). Epidemiologic Trends in Drug Abuse: Volume I: Highlights and Executive Summary. DHHS Pub. No. (NIH) 95-3988, 1995.
Physician's Desk Reference, 1995 edition, Montvale, NJ: Medical Economics Company, 1995.
Indiana Prevention Resource Center
Factine on Non-Medical Use of Ritalin (methylphenidate)
Factine Number 9, November, 1995
Indiana Prevention Resource Center
at Indiana University
840 State Road 46 Bypass, Room 110
Bloomington, IN 47405
Last updated: 31 October 1995 wjb
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Copyright 1995, The Trustees of Indiana University
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