RITALIN HITS THE STREETS

Prescribed For Hyperactive Children, Ritalin Is Emerging As The Latest
Street Drug.

Ritalin, the controversial tiger-tamer drug for difficult kids, has become
a prized street commodity--the amateur drug-dealing equivalent of a nice
little earner. And a very dangerous one.

Following a United States trend, New Zealand children with behavioural and
learning difficulties are prescribed Ritalin for ADD (attention deficit
disorder) or ADHD (attention deficit hyperactivity disorder). The number
diagnosed with these conditions is growing.

About 3500 children are now using the drug. Numbers have risen sharply each
year since 1993, when there were about 300. This year Ritalin is costing
Government drug buyer Pharmac about $1.8 million. And predictably, just as
in the United States where in some states 30 per cent of children are on
Ritalin, the drug has found its way on to the street. This development and
the steep climb in prescriptions has alarmed Pharmac, the Health Ministry,
police, medical and education authorities and those involved with drug
addicts.

In response the ministry has tightened regulations for prescribing Ritalin
and dexamphetamine (also used to treat ADD and ADHD), and the New Zealand
Medical Council has issued guidelines for doctors, some of whom, they fear,
are being cajoled or threatened into prescribing inappropriately.

Says council president Tony Baird: "This initiative follows reports of an
emerging street trade in Ritalin. There is . . . a small but important
minority of doctors falling into the trap of bad prescribing, from which
they find it hard to extricate themselves." The active drug in Ritalin,
methylphenidate (akin to speed), is already believed to have contributed to
the death of one young Dunedin woman this year. Last month five people were
treated in the intensive care unit at Dunedin Hospital. Police have
intercepted one man carrying 2290 Ritalin tablets.

Young teenagers are being harassed into giving up tablets, older children
are selling theirs, and adults are persuading some GPs to prescribe Ritalin
for their teenagers or children which is then used by the parents.

The biggest problem is in the South Island, where other drugs tend to be
more difficult to get. There, Ritalin tablets sell for $10 each--cheap in
street-drug terms--at $200 for a sheet of 20, not a bad return. A child's
monthly Ritalin supply costs just $3 for up to 168 tablets for those
patients who hold a community service card ($10 for others). In the North
Island, where the problem is also growing, the street price per tablet is $5.

Ritalin-buzz seekers take it in tablet form or, more seriously, those in
search of a quick rush break down the tablets and inject it. Injected Ritalin

is especially dangerous, with effects so dramatic they scare even the
street-wise.

Detective Malcolm Inglis, of the Dunedin drug squad, says: "We are finding
it highly addictive. Friends of druggies tell us that their druggy friends
are really out of it, they have been raging with it."

Mr Inglis says: "Parents are having their children prescribed Ritalin, so
they can access and onsell it a small number, but it is happening. We know
of one mother who was selling all her son's Ritalin."

In Dunedin, the producers of Divo, a news-sheet for injecting drug users,
say Ritalin is easily obtained and warn would-be experimenters of bad side
effects--paranoia, hallucinations, psychosis and the risk of brain
haemorrhage and heart attacks.

Divo reports users saying that those with a Ritalin habit "are at real risk
of dying or feeling like you are crazy before you actually manage to stop."

Simon Nimmo, Auckland national coordinator of the needle exchange project,
says that in Auckland, Ritalin's cheapness means it is being used by those
who have traditionally been narcotic users, and this is a big concern
because of its dangers.

"It's a relatively new issue for us," he says. "There is no safe way of
using Ritalin."

Filters that the programme provides to remove impurities in other types of
drug do not work with Ritalin tablets, he says.

In Wellington, police and needle exchange people say that so far Ritalin
has not been a problem, but they're not confident it will stay that way.

Black-market trading is just another development in the confused ADD/ADHD
Ritalin story, to which is attached a whole string of problems, including
diagnosis, management, safe access and potential abuse.

Jim Vause, response coordinator for the Royal New Zealand College of
General Practitioners, says: "It is not a disease that has a gold standard.
It is not something where you can say definitely yes or no, this person has
ADD.

"We can't do a brain scan and say you have ADD, we can't do a biopsy and
say you have ADD. It is really a disorder of behaviour, in many ways."

Paediatricians and child psychiatrists tend to see ADD or ADHD as a
long-term neurological/ chemical impairment correctable by continued
medication.

Psychologists see answers in behavioural change and control therapies--they
talk of children who are uncontrolled rather than uncontrollable.

Ideally, say experts, treatment involves a combination of Ritalin and
behaviour modification methods. Too often, though, support systems, crucial
behaviour-monitoring and family follow-up are either not sought or not
available.

Critics say the drug is being given too easily and are concerned at the
ever-widening definitions of ADD or ADHD; they say that in the era of the
quick-fix, Ritalin is too often seen as an easy answer to hard-work
parenting. But parents who suffer with over-the-top, seemingly untamable
and therefore learning-impaired kids say Ritalin can be a lifesaver for the
child as well as the family.

Dunedin Detective Inspector Chris Kelley accepts that some children need
Ritalin but says: "What I am concerned about is the abuse of legal
prescription and that some kids are being put on Ritalin for their parents'
benefit, and nothing to do with the child."

While specialists and GPs agree some monitoring is necessary, the new
regulations to rein in Ritalin and dexamphetamine prescribing have pleased
few.

GPs say they were not consulted enough over the formulation of new
legislative restrictions, which began this month. They have prescribed
Ritalin for at least 22 years but must now liaise with specialists before
issuing prescriptions with an auditable special authority number issued by
Health Benefit Ltd, Wanganui.

Some GPs see the new regime as a hamstringing slight on their professional
abilities, while specialists say that for their own professional protection
there will be no rubber-stamping GP assessments. They will insist on seeing
patients.

The problem could be access, with too many patients needing to be seen by
too few busy specialists, especially in rural areas. Dr Vause says it would
have been possible to formulate a simple prescribing guideline and audit
tool for GPs.

Of all people, he says, GPs are the ones who know whether a child has ADD
or ADHD. "They're the ones who know the family, they're the ones who know
the kid." His organisation also questions how serious the potential for
Ritalin abuse is. It says: "The reality of clinical practice is that it is
very rare, if at all."

Meanwhile, John Werry, emeritus professor of psychiatry at Auckland
University and a champion of Ritalin for ADD and ADHD, supports the new
prescribing regime.

The fact that about 3500 Kiwi kids are on Ritalin is no surprise to him. He
says that figure is probably too low--still well below the frequency of ADD
among children--and that it is "very conservatively" estimated at 1 to 2
per cent. (Some research figures put it from 3 to 9 per cent.)

At a rough calculation, says Professor Werry, probably 300 of the 3500
children currently taking Ritalin shouldn't be on it. "But then, outside
the group, at a wild guess, there are probably another 300 children who
should be on it."

Professor Werry says he does not think there is a huge problem in
prescribing, and the ministry has moved to deal with it.

"My concern," he says, "is it will break down because of a bottleneck, and
because weak-kneed bureaucrats will give in to clamouring public and GPs
and let people authorise prescriptions who shouldn't be doing it."