'AS EASY TO GET AS CANDY'

A New Massachusetts Study Finds Wide Teen Abuse Of Ritalin

NEWTON - At 13, the girl knew precisely why so many classmates darted into
the school nurse's office in the late morning: There, they swallowed their
daily doses of Ritalin pills to help them concentrate.

That year, she was on Ritalin, too. But instead of a visit to the nurse's
office, she got her pills through the black market that operates out of
school bathrooms and hallways, often for $1 to $5 a pill. And, instead of
swallowing the pills, she crushed them and snorted them through her nose to
get high.

"It's as easy to get as candy," said the teenager, now 15, who spoke on the
condition of anonymity while attending an adolescent drug treatment program
in Newton.

The candy reference is apt. Outside Watertown High School last week, some
students called the pills, which come in blue, yellow, and white,
"Skittles," a reference to the colorful miniature candy balls.

The easy availability of Ritalin - largely from other students diverting
their medical prescriptions - has public health officials worried that the
drug is becoming a popular adolescent approach to tripping, not treatment.

The state now has preliminary figures to back up officials' fears. In a
survey of 6,000 public school students in Massachusetts in the last school
year, nearly 13 percent of high school students said they had used Ritalin
without a prescription at some time in their lives.

Among middle school students in the seventh and eighth grade, slightly more
than 4 percent of youngsters admitted to a non-medical use of Ritalin at
some time.

Researchers can't say if the percentages are up or down, because this is
the first state study of illicit use of Ritalin. While the pills clearly
don't have the adult-like allure of marijuana or alcohol - both considered
"gateway" drugs because they can lead to the use of harder ones - Ritalin
is still a threat. Teenagers abuse Ritalin at rates similar to inhalants
and cocaine, both highly popular substances.

"It's a substantial figure," said Thomas Clark, a research associate at
Health and Addictions Research Inc., a nonprofit health research firm that
conducted the state survey. "The number should be a wake-up call to how
much prescription drugs, including Ritalin, are being used recreationally
by teens."

At the same time, the illicit Ritalin market has another danger: Students
who have a prescription for the drug to control concentration problems
aren't getting the treatment they need if they're selling their pills.
Generally, the pills must be taken every four hours during the school day.

Few reliable national statistics exist on Ritalin use among teens, though
some studies suggest anywhere from 2 to 3 percent of today's high school
students have tried Ritalin at least once in the past year. In the recent
Massachusetts survey, about 4 percent of high school students said they had
used unprescribed Ritalin at least once in the past year.

These numbers come at a time when even the legal use of Ritalin is being
questioned.

Congress has held hearings on the issue, and class-action suits against the
drug have been filed in several states, led by some parents and
psychologists who say the diagnostic criteria for attention-deficit
disorders are so broad that nearly every feisty child qualifies.

Clearly, many children who have trouble focusing in the classroom have
benefited from the drug, but there's been a growing backlash by some
parents and members of the medical establishment who say Ritalin is a
pharmacological quick-fix for schools and families that don't have time to
deal with complex behavioral issues.

With US production of Ritalin at nearly 15,000 kilograms a year, an
eight-fold increase from a decade ago, and about 2 million Americans on
this drug (overwhelmingly children), critics say more of today's youths
need patience - not pills - to see them through their tough times.

Still, some local teens who are aware of Ritalin's illicit market say they
have taken the drug legitimately for attention-deficit disorder and found
it very helpful.

"I could stay focused more," said a 12-year-old Arlington girl while
shopping last week. "My grades improved a lot."

While Ritalin clearly calms many people with attention-deficit disorder -
through a chemical mechanism that remains little understood - it acts as a
stimulant for most people. In fact, methylphenidate, as it is also called,
can produce an emotional high or a caffeine-like jolt, which many college
students take advantage of at exam-cramming time.

Drug-abuse specialists appear to be of two minds on the potential threat of
Ritalin as a new "gateway" drug for the young. On one hand, the popularity
of Ritalin seems limited by the fact that many teenagers appear to regard
it as a kind of substitute drug for their first choices, such as marijuana
or Ecstacy, also known as MDMA.

To achieve an intense high, some teens say they need to snort Ritalin, also
nicknamed Rids, which causes them to worry about physical damage such as
nose bleeds from snorting the drug.

"I'd take pot over Rids any day," said one 17-year-old boy, who also spoke
at the drug treatment center, Sameem Associates, in Newton. "Why ruin your
nose over Rids?"

Nevertheless, Ritalin is easy to get, especially for those who live in a
middle-class suburb where families are more likely to seek treatment for
attention-deficit disorder.

New Hampshire, Vermont, and Massachusetts rank first, third, and eighth,
respectively, among the top 10 states for Ritalin prescriptions.

While marijuana, cocaine, Ecstacy, and other substances require teenagers
to have underground connections to drug dealers, Ritalin's distinction is
that any child with a prescription has the potential to be a dealer. Just
slip a pill into their pocket to take to school, and they have something to
peddle.

A Watertown ninth-grader said he noticed a huge difference between middle
and high school. Because many high school students are entrusted with their
own medicine, "they have prescriptions, but they sell the pills."

Ritalin is under the tightest controls in pharmacies. In fact, federal law
prohibits doctors from including refills in its prescriptions and orders
cannot be phoned in, even by doctors.

Now, law enforcement officials want to restrict what happens when Ritalin
gets into the hands of patients. Norfolk District Attorney William R.
Keating said his drug staff is starting to alert high school groups to
Ritalin abuse.

The US Drug Enforcement Administration is in the process of completing a
brochure for school nurses, asking them to keep all Ritalin in locked
cabinets and calling on school staff members to witness each child with a
prescription actually swallowing the pill before leaving the nurse's office.

Gretchen Feussner, a DEA pharmacologist, said it's important to limit the
illicit supply of Ritalin, particularly in the early teen years.

"Kids often start experimenting with drugs around seventh grade, or at 12
years old," she said. "And they will experiment with drugs that are
available to them."

Edward M. Hallowell, a Concord psychiatrist who has written extensively
about Ritalin's potential benefits, said users need to know that, if
abused, the drug can cause serious side effects, including high blood
pressure, heart racing, and insomnia.

The medical dangers of Ritalin are well documented. Each year, from 1995 to
1998, federal figures show about 2,000 emergency-room admissions for drug
abuse that involved patients who mentioned taking Ritalin, either alone or
with other drugs. In these years, about half the cases involved people
under 17.

In an attempt to keep Ritalin out of the hands of school children, some
health officials have applauded this fall's debut of a drug called
Concerta, a form of Ritalin that lasts for 12 hours, three times as long
the traditional pill. This form allows a student to avoid a visit to the
school nurse, with all pills taken at home.

DEA pharmacologist Feussner pointed out, however, that Concerta also has
risk precisely because it is more potent. She fears that this new, powerful
pill may become more glamorous to teens.

"This drug could be crushed and snorted and be viewed as even more
attractive," she said. "It may just pose other problems for us."