It is no secret that, across the globe, university students casually trade Ritalin and other ADHD drugs – snorting or swallowing them without a prescription – but, more recently, school kids as young as 16 have also begun to participate in the abuse of these drugs.
The trend of taking ADHD medication without a prescription has been around for a number of years and is now considered commonplace in universities. While some say they take Ritalin to help them study (misuse), others are simply interested in a quick high (abuse).
Shockingly, this trend has now become rife at a high school level, with teenagers eager to get their hands on "smarties", "rit" or "kiddie cocaine".
There have been a number of local cases where ADHD drug dealing has been uncovered in schools and universities. In June 2014, Times Live reported that a number of grade 11 students from a Johannesburg high school had been expelled for operating an ADHD drug ring. The kids implicated were not only dealing the drugs but were even caught training younger boys how to fake ADHD to a doctor in order to get more prescriptions for their growing business.
A study by the University of Michigan published in the June/July 2015 edition of the journal Drug and Alcohol Dependence seems to confirm that the non-medical use of ADHD medication is beginning at a younger age in the U.S.A as well. The study, which examined close to a quarter of a million students, found that the misuse of Ritalin, Adderall and other ADHD drugs occurs most frequently in teenagers aged 16 to 19 years.
Read: Teens abusing ADHD drugs
Understanding ADHD drug misuse
To get a better understanding of the issue, Health24 spoke to Quintin van Kerken, CEO of the Anti Drug Alliance of South Africa, who is considered to be one of the leading experts on drug abuse in South Africa and is currently very involved in tackling the issue in our country's schools.
Quintin explains that the abuse of ADHD drugs is very common in South Africa and believes that the majority of ADHD prescriptions in the country are being misused:
"We are currently compiling stats; however, we are able to confidently say that at least 60% of all prescriptions for ADHD meds are not being used for the condition and are being distributed in schools and universities for recreational use. This figure excludes the ADHD medications bought and sold on the black market."
Ritalin has been dubbed "the rich kids' tik" as it is predominantly being used by kids in private schools. "We have found that private schools are hardest hit; however, government schools in middle to upper class areas are seeing a massive surge," Quintin explains.
Illicit drug dealers
As with university students, it is very easy for high school kids to get their hands on the drugs without a prescription. Quintin has found that there are a number of different ways of getting pills. One such avenue for prescription drug supply is through illicit drug dealers who "would have robbed pharmacies, got the medication from hijacked pharma trucks, or imported these drugs from dubious manufacturers in countries such as India". This isn't however the most common method for students to get their hands on the drugs.
As was the case with the Johannesburg students who were expelled, Quintin has found that, in the majority of cases, kids are acquiring and distributing Ritalin and other ADHD medication themselves:
"Generally, we find that groups of school kids or university students will form syndicates, coercing other kids to supply them with their meds, or teaching them how to get the meds through a doctor by faking symptoms."
The students sell the drugs to each other rather than passing them around freely. The price per pill seems to vary quite significantly. Quintin has found Ritalin to be sold for as little as R 5.00 per pill, although prices usually average around R 15.00 – R 30.00. He has seen prices as high as R 50.00 per pill.
Read: SA has one of the highest prescription rates of ADHD medication
Pressure to perform, or a quick high?
One might wonder the reasons behind the recent surge in students misusing these medications. Are our children under so much pressure that they take the drugs in desperation to help them study and get better results?
"Yes and no," Quintin responded. "A small percentage allegedly use them for this, but we are finding that the majority of kids are using them to get high."
The fact that kids tend to crush and snort Ritalin seems to support this. Snorting the pill, instead of taking it orally as directed provides a "quicker and more intense" high, Quintin explains.
Dr. Shabeer Jeeva, a psychiatrist and leading specialist on ADHD clarified that taking Ritalin orally will not cause a high but rather improve concentration. Kids who are taking the medication orally, therefore are more likely to be taking it to improve their performance at school – something that may give them an unfair advantage over their peers. Kids who are snorting the drug, however, are intentionally getting high.
Dr. Jeeva adds that "the high that you get from snorting it can get you into an abusive pattern" but that this is not likely with kids taking Ritalin orally.
Read: ADHD is overdiagnosed
Combining different ADHD drugs
Another trend is to combine two different ADHD medications together, for example, taking Ritalin and Concerta together.
Dr. Jeeva explains that when prescribing ADHD medication, it is common for a doctor to give a patient both these drugs. Ritalin is fast-acting whilst Concerta has a slower release, therefore a combination of the two will provide extended coverage throughout the day – something that is especially important for students with ADHD.
While taking both Ritalin and Concerta under the supervision of a specialist is safe, it does require specific timing and balanced doses. Kids combining the two of their own accord could end up taking much higher doses than what is safely prescribed. Dr. Jeeva explains that kids "may get too much stimulation" which can cause a rapid heart rate, chest pains and even panic attacks.
Read: Side effects of ADHD medication
Tackling the issue effectively
The issue of ADHD medication is controversial. Many believe that Ritalin, Concerta and other ADHD drugs are too easily prescribed. Others feel that the increase in ADHD prescription rates is due to the increasing prevalence of the condition. Some feel that the diagnostic criteria can be misinterpreted by those who aren't specialists in the field.
ADHD is a complicated condition that cannot be diagnosed with a single test or procedure. For this reason, Cape Town-based psychiatrist Dr. Pieter Cilliers believes that general practitioners should not prescribe medications themselves but instead refer patients to a psychiatrist for a full evaluation if they suspect ADHD.
Quintin believes that the entire system needs to be investigated. While Health24 has not been able to verify his claims, Quintin says that he has "evidence" that doctors "receive kickbacks in the form of incentives such as holidays, bursaries for their children's education and a whole host of other financially rewarding things from pharmaceutical companies to prescribe these medications".
He also believes that regular screening should be done to ensure patients display consistent symptoms: "Every person on these medications needs to go through testing every 3 months to ascertain whether they require the drug or not."
Dr. Jeeva feels that new research into ADHD may yield the answer. He explains that two genes linked to the development of ADHD have been discovered and therefore testing for these may form part of the diagnostic criteria for the condition in the future:
"Two genes for ADHD have been discovered, and hopefully in two to three years time we will have a gene test for ADHD."
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