Stealing, dealing and Ritalin

By Karen Thomas, USA TODAY

Last month, the former principal of an Orem, Utah, elementary school began a 30-day jail sentence for replacing students' Ritalin with sugar pills, and the man who has stepped in for him prays that the embarrassing buzz can be quieted and the community can return to a focus on academics.

But as abuses of Ritalin and other drugs used to calm and focus children with attention deficit hyperactivity disorder (ADHD) become more common, that may prove difficult.

Drug thefts from school offices are being reported and prosecuted with increasing frequency, and students report a higher demand to trade or sell their prescription pills between classes.

Those misuses are further fueled by a shift in drug treatment for children with ADHD from the well-known stimulant Ritalin to amphetamines, a stimulant with a long history of abuse.

The problem has grabbed Washington's attention. This week federal officials will launch an investigation of public elementary and secondary schools to address "theft, illicit sale and any other manners of diversion and abuse of these medications," according to a Sept. 12 letter from the House Judiciary Committee to the General Accounting Office.

"Virtually every data source available confirms what the U.S. Drug Enforcement Administration, state and local law enforcement, and various media outlets have documented: widespread theft, diversion and abuse of Ritalin and drugs like it, within public schools throughout the country," says Rep. Henry Hyde, R-Ill., the committee's chairman. "I am hopeful that the GAO report will help us not only learn more about this problem, but will also point us in the right direction as we in Congress consider ways in which to address it."

Those evaluations, which are expected to be completed by early next year and will be conducted by a company that specializes in drugs used by youths, also will examine how schools supervise student medications and the level of training required to oversee children who have legitimate prescriptions.

More than 19 million prescriptions for various drugs were filled in the past year to treat ADHD, up from 11 million five years ago, according to IMS Health, a research firm that follows the prescription drug industry. Nearly all are for stimulants, which are strongly regulated, with quotas that the DEA sets yearly based on medical need.

Since 1990, the DEA has increased by 650% the quota on production of methylphenidate, sold under the familiar brand name Ritalin. Since 1993, the quota on amphetamine has increased 3,750%. More than 80% of the amphetamine use in the USA, according to the DEA, is for treatment of ADHD.

The medical community estimates that 3% to 5% of school-age children have ADHD, characterized by inattentiveness, impulsiveness and sometimes hyperactivity. Recent studies have found that up to 20% of students in some schools are being treated for ADHD with stimulants, and because many medications require several doses during the day, the drugs are being monitored and dispensed by children themselves or by educators .

In Maine, more than half of all medicines handled by schools are stimulants to treat ADHD, according to a study by state health care workers that asked schools to list the medicines they gave to children on one day last year. More than 6,000 Maine students lined up that day for ADHD medications.

'Diluted' educational process

Safeguards in place in Utah schools are among the nation's strictest, say officials there. Drugs are locked up, and only two school employees, the principal and a school nurse, have keys and dispense the drugs.

"The irony is, he was a very good principal," says Michael Robinson, public information officer for the Alpine School District in Utah, where the Ritalin-sugar swap was discovered.

Parents even lobbied to have the principal, Gerald Smith, stay on. Smith confessed to stealing the drugs; a plea agreement to a misdemeanor charge of theft included having his license rescinded for two years and the 30-day jail sentence.

"The risk for having abuses for any activity is always there. Had we not been organized about it, it could've been much worse," says Robinson, who adds that Smith came forward after an investigation had started. "But we're not in the business of dispensing drugs. We're expected to handle all kinds of things like this, and it's diluted the educational process."

While no agency tracks incidents of theft at schools, anecdotal evidence is growing:

Police in Athens, Ga., are investigating two thefts this school year and are preparing a report after interviewing school personnel. More than 100 pills were stolen from an elementary school during a burglary in October, police say. Of more concern to officials are nearly 300 pills pilfered from a locked office in another school during the current school year. Police say students are not suspected in the thefts, and school employees voluntarily took urine tests. No charges have been filed.

A 52-year-old computer technician at a junior high school in Traverse City, Mich., was caught on videotape stealing Ritalin from a locked cabinet last year. Possession charges were dropped, and the 24-year school district employee pleaded guilty to attempted larceny in a building and was sentenced to 24 days in jail. He resigned.

School officials in Indiana handled two incidents last year. An elementary school sent letters to parents, asking for replacement prescriptions, after "many, many doses" were found missing from a locked cabinet. A nurse at another school was ordered into treatment and fined $1,300 for stealing Ritalin, Adderall (an amphetamine blend) and a third drug belonging to six students.

Going for the buzz

It's no surprise that adults are attracted to the stimulants, says pharmacologist Gretchen Feussner of the DEA's Office of Diversion, which oversees misuse and abuse of controlled drugs. Effects on adults who use doses larger than those prescribed for children include euphoria, greater energy and productivity, increased sexual appetite, and an overall feeling of being a lot smarter.

The National Institute on Drug Abuse reported in late 1996 that adults in Phoenix had been admitted to treatment programs for abusing drugs from their children's prescriptions. Similar reports came from Boston. Also, a Medicaid office in Missouri shut down a scam in which parents were using their children to get prescriptions for Ritalin.

When the DEA investigated schools in three states in 1996, few had systems in place for monitoring use of the drugs, Feussner says. The DEA also found a handful of "shocking" instances of school employees stealing drugs, including a principal in North Carolina who insisted on having copies of students' prescriptions. He later was caught having those prescriptions filled at 60 pharmacies.

This year the DEA will distribute brochures to schools, recommending safety measures to avoid abuses by adults and students. "They can't have 15 people overseeing" the distribution and inventory of controlled drugs, Feussner says.

DEA officials discovered kids passing out their medications on the way to school and kids who "palmed" their medication (pretending to take it but holding it in a hand) to give or sell to a classmate.

'Too darn available'

Many school officials told DEA investigators that school workers believed that students in high school were mature enough to manage their own drug regimens.

But adolescence is when many youths start experimenting with drug abuse, Feussner says.

"It's just too darn available," she says. People "think of it as a medication and never worry about it as a drug of abuse. ... Some would say, 'If it's given to a 6-year-old, how bad can it be?' That kind of thinking clouds the issue and makes them more careless ."

Ritalin abuse by kids has been on the DEA radar screen for more than five years, with a growing body of evidence about youths who snort crushed pills for recreational use or to enhance school performance. On the street, one Ritalin tablet — sometimes called "Skittles" or "Smarties" because the pills, 5 to 20 milligrams each, come in pastel colors — can fetch $2 to $20, according to the DEA. At the pharmacy, each costs less than $1.

Two Illinois 14-year-olds told the NBC affiliate in Chicago this year that they were offered $20 by other students for their Ritalin. The boys say they transferred to a new school after being threatened by students who wanted their ADHD medication. In a case pending in Nashua, N.H., two students, ages 14 and 15, were charged with selling two Ritalin pills to another student. They were attending summer school when police and school officials were alerted.

Drug abuse is drug abuse

John Cepaitis, the school superintendent in Nashua, says that abuse of the prescription drugs pales when compared with marijuana and alcohol abuse and that this summer's incident is the only one in a year. But consequences are the same for any student caught on campus with a drug: a 20-day suspension, which can be reduced if the student agrees to complete a program of drug-abuse counseling.

But other areas report growing abuses among younger children. Released last month, a Massachusetts study of 6,000 public school students found nearly 13% of high school students and 4% of middle-schoolers had used Ritalin without a prescription.

A study of 651 public school students in Wisconsin and Minnesota — expected to be published early next year in the Journal of School Psychology — finds even more widespread abuses among all stimulants being used to treat ADHD.

Thirty-four percent of students ages 11 to 18 who take ADHD medication reported being approached to sell or trade their drugs. Among students who weren't taking ADHD medication, 53% reported that some students gave away or sold their medication.

"These are all drugs that have a pretty high probability of abuse," says study co-author William Frankenberger, a psychology professor at the University of Wisconsin-Eau Claire who has been tracking treatments for ADHD for more than 20 years.

The Wisconsin survey also queried students about who dispenses medications during the school day. Twice as many reported getting the drugs from the school secretary (26%) as from the school nurse (13%).

Forty-one percent reported that they dispensed their medications to themselves