Student abuse of Ritalin raises questions about familiar drug

It used to be caffeine and caffeine pills. Then it was amphetamines like speed. Now, it seems that Ritalin is fast becoming the stimulant of choice for stressed-out university students.

Attracted by its concentration-enhancing effects, many students across North America have turned to methylphenidate, manufactured under the brand name Ritalin, as a boost for late-night study sessions. The drug is normally prescribed to treat Attention Deficit Disorder (ADD), but has surfaced on the underground market on campuses as a study aid.

The concern about the drug's abuse is the latest strain in a growing public discourse about Ritalin and the condition which it is meant to treat. Ritalin prescriptions have more than quadrupled in Canada in the past five years, and there are worries that prescription of the drug following misdiagnosis may be marring the reputation and effectiveness of a legitimate treatment for Attention Deficit Disorder.

For the past few years, newspaper reports across the U.S. have pointed to Ritalin abuse by students at New England universities and prep schools, and last March, the American Drug Enforcement Administration warned that teenagers were misusing the drug. Now similar reports of abuse have surfaced in Canada.

In Montreal, public attention was focused on Ritalin abuse when a January 22 Montreal Gazette article boasted the headline: "Students popping Ritalin to stay alert." Referring to McGill and Concordia universities, the article claimed that thousands of students were taking Ritalin to help them study. And while that number certainly seems on the high end, there is evidence that students in Montreal are abusing the drug.

While officials at Concordia University say they have not seen any evidence of Ritalin abuse among students at their school, representatives of McGill's health services concede that, while the numbers are hard to quantify, some students are probably using Ritalin illicitly.

"We can't [quantify] it, but our impression is that it is being abused just like anywhere else. We're no different," Pierre Paul Tellier, director of health services at McGill, said. Several McGill students surveyed for this article said that they had heard of Ritalin being used as a study aid on the campus.

"I've heard it makes you study and it doesn't put you to sleep," Mike, a first year McGill student who asked that his real name not be used, said. While he says he hasn't tried Ritalin himself, Mike says he has several friends who have.

"You get it through a friend," he adds. "People say it's not hard to get." Norman Hoffman, director of McGill's mental health service, says several students have told him that Ritalin is readily available and inexpensive on campus. But like Tellier, Hoffman admits that it is difficult to estimate exactly just how many McGill students are abusing Ritalin.

"Someone will come in and say they know 10 to 20 students who use it... [while] others don't know anyone using it," he says of his patients.

Based on anecdotal evidence, Hoffman guesses that about five per cent, or 125 of McGill's 25,000 students, are casually experimenting with Ritalin. He says he has seen only a few cases of extreme addiction, and estimates that about 50 McGill students may be abusing Ritalin regularly.

Still, McGill officials are quick to point out that Ritalin abuse is not endemic. "A lot more students are using alcohol than Ritalin," Tellier points out.

He adds that McGill's health centre has not had students come in high on Ritalin. (Students invariably come in at exam time hyped up on caffeine pills and similar stimulants, wondering how to deal with the jitters, fast heartbeat, and other symptoms they produce.)

Hoffman and Tellier also point out that many students come to them seeking a prescription for Ritalin to help them perform better. They say an increased awareness about the drug and Attention Deficit Disorder lead some students to come looking for a diagnosis and quick-fix to their problems.

But concentration and organizational difficulties, associated with ADD and detrimental to a university career, can also be caused by other factors such as depression and anxiety. According to Tellier, many students aren't willing to confront the real cause of their concentration problems, and so look for a magic pill.

"What we need is an education campaign on how students should deal with stress and prepare for exams long-term. Ritalin is a quick fix," he said. At the same time, Ritalin may not always work. While students take the drug because they've heard that it's a wonder drug which will kick-in instantly and improve their ability to focus on their studies, many find that it doesn't work that way. For some people, taking Ritalin without a prescription can lead to agitation, depression, or psychotic episodes--impairing, not enhancing, their concentration abilities. "This is a potentially dangerous drug," Hoffman says.

In the end, experts agree that for most people, the best way to lower anxiety, boost energy, improve concentration and generally do well at school is through exercise, a balanced diet, adequate sleep and relaxation.

While health officials are cautious in their estimation of how many students are actually abusing Ritalin, they do know that there is a general increase in the number of people-- including students--taking Ritalin for legitimate reasons such as ADD.

In both Canada and the U.S., methylphenidate prescriptions have increased substantially in the past five years. According to IMS Canada, a Montreal-based company which supplies information and analysis to Canada's health and pharmaceutical industry, methylphenidate prescriptions were up to 652,000 in Canada last year from 181,000 in 1992. This increase of 260 per cent has caused some health workers to stop and take notice, especially since it is not a new drug. Ritalin has been on the scene since the early 1990s.

Experts say while the rise in prescriptions is substantial, it can be partly explained by an increased awareness about ADD. In addition, doctors have recently learned that ADD, previously seen as a children's disease that was eventually outgrown, can continue into adolescence and adulthood.

According to Joan Wolforth, director of McGill's centre for students with disabilities, that means more people are being diagnosed and are staying on Ritalin for longer periods of time. She says the number of students she deals with who have been diagnosed with ADD and are taking Ritalin has increased "from zero to 20 over the last five years.

"Still, experts like Wolforth wonder if part of the increased use of Ritalin in Canada may be attributed to a tendency for some doctors to make hasty ADD diagnoses. "What may be happening is that because it's very much on the public eye some people may be jumping to make a diagnosis," Wolforth says of the disorder.

Both Tellier and Hoffman agree that there is a problem with misdiagnosis of ADD and subsequent Ritalin use.

"I agree there's misdiagnosis both ways. Some people who have the diagnosis are missed and some who don't have it are diagnosed improperly," Tellier says.

According to McGill's health officials, they are careful to make sure that an ADD diagnosis has been made cautiously, and it usually involves more than one consultation with the student.

The discussion about misdiagnosis of ADD and student abuse of Ritalin are two recent installments in the growing debate over the drug. Concern about the possible negative side- effects of Ritalin and the growing number of children with ADD being placed on it began in the early 1990s, when, like Prozac, Ritalin became a household word across the U.S. and Canada.

Critics have charged that the drug can lead to behavioural or addiction problems, and that it is too readily prescribed to children.

In the meantime, however, there remain many children and adults who have ADD and are helped by Ritalin. Health care workers like Wolforth, who work with people who have ADD, are concerned that too much focus on the small amount of people who abuse Ritalin will detract from the drug's legitimacy as a beneficial treatment for many people. According to Wolforth, emphasis on the few students who abuse Ritalin or seek a false ADD diagnosis so they can receive it, "builds up a sense that [the disorder] doesn't exist."

For Wolforth, the concern is to prevent reports of abuse from undermining the fact that ADD is a real disorder, one which has only recently begun to be understood.

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