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Stimulant Abuse By School Age Children
A Message from the Drug Enforcement Administration
The Drug Enforcement Administration (DEA) has a unique mission. In addition to making cases against the most significant traffickers in illicit drugs, we are mandated by law to ensure that adequate supplies of pharmaceutical controlled substances are available to meet legitimate medical needs. We must also prevent, detect, and eliminate diversion of these same drugs into illicit traffic. In striving to maintain this balance, DEA has made every effort to keep the health and safety of our young people uppermost in our minds.As you are aware, school officials need to know the facts about the drugs our children may come in contact with. Most schools are doing a commendable job teaching their students about the dangers associated with illicit drug use. However, the abuse of licit drugs—especially controlled substances—is also a serious social and health problem in the United States today. Well-informed school personnel can better recognize if a child has symptoms of drug-related problems and help prevent the diversion and subsequent abuse of drugs by students in their schools.
Two prescription drugs being abused by school age children are methylphenidate (commonly known as Ritalin®) and amphetamine (primarily Adderall® and Dexedrine®). Both are used in the treatment of attention deficit (hyperactivity) disorder, commonly referred to as ADHD or ADD. While these medications benefit many children, they have a great potential for abuse and stringent controls have been placed on their manufacture, distribution and prescription.
The reports of methylphenidate and amphetamine misuse/abuse among adolescents and young adults are particularly disturbing. Adolescents don’t have to rob a pharmacy, forge a prescription or visit the local drug dealer to acquire these drugs—they have little difficulty obtaining them from friends or classmates at school.
This guide will help you understand why medications such as methylphenidate and amphetamine are being abused and how you, as a school official, can institute procedures that will ensure that these medications are handled in a safe and appropriate manner. By working together we can greatly reduce the opportunities for the diversion and abuse of these drugs.
Laura M. Nagel
Deputy Assistant Administrator
Office of Diversion ControlWhy are methylphenidate and amphetamine medications prescribed for children?
Methylphenidate and amphetamine are central nervous system stimulants that are prescribed for children who have been diagnosed with ADHD. These children have abnormally high levels of activity and/or difficulty concentrating. These medications, when taken as prescribed, have a calming effect on hyperactive children and a "focusing" effect on those children who have trouble concentrating.
Why is ADHD prescribed medication abused?
These medications are sought after by individuals who want them for their psychoactive effects: to get high, stay awake for extended periods of time to study or party, to lose weight or mix with alcohol or other drugs to enhance their effects.
How is it being abused?
Methylphenidate and amphetamine can be abused orally or the tablets can be crushed and snorted or dissolved in water and injected. The pattern of abuse is characterized by escalation in dose, frequent episodes of binge use followed by severe depression and an overpowering desire to continue the use of these drugs despite serious adverse medical and social consequences.
What are the dangers in abusing stimulant medication?
Methylphenidate and amphetamine are potent stimulants associated with high abuse potentials and psychological dependence profiles. That does not mean that a child or young adult who is properly diagnosed with ADHD and prescribed a stimulant as part of his or her treatment would become "addicted" to his/her medication. Low-dose, oral ADHD medication is generally not associated with drug abuse or addiction. However, when these medications are taken at doses higher than those prescribed for medical treatment, one of the serious risks is drug addiction.
Misuse of these medications may cause short, intense periods of high energy. High doses often produce agitation, tremors, euphoria, tachycardia, palpitations and hypertension. Psychotic episodes, paranoid delusions, hallucinations and bizarre behavioral characteristics similar to amphetamine-like stimulant toxicity have been associated with methylphenidate abuse.
Students who give or sell their medication to friends or classmates are not only participating in conduct which could cause serious harm to another individual, but they are also engaged in illegal activity.
What is the extent of this problem?
The full extent to which adolescents are abusing methylphenidate or amphetamine products is unknown. A 1998 Indiana University survey of 44,232 high school students found that nearly seven percent of the students surveyed reported having using methylphenidate illicitly at least once and 2.5 percent reported using it monthly or more often.
Information from physicians, parents, schools, poison control centers, adolescent treatment centers, surveys, and law enforcement data suggest that adolescents who are using methylphenidate and amphetamine drug products illicitly obtain them from individuals who have been prescribed these medications for ADHD. Adolescents and young adults are giving and selling their AD HD medication to friends and classmates who either ingest the tablets, or to get a more intense reaction, will crush them into a powder that is snorted like cocaine. DEA information indicates that current prices being paid by abusers for methylphenidate (20 mg. dosage unit) range anywhere from $2.00 a tablet to as high as $20.00 a tablet in some areas.
Is there drug diversion in the schools?
The manner in which ADHD medication is handled at some schools has provided opportunities for some individuals to divert and abuse this medication. For example:
Students have been discovered taking medication from teachers’ desks where medication was being stored.
A student who left home with a month’s supply of medication arrived at school with only six tablets, having distributed the others to friends on the bus on the way to school.
Students have been given ADHD medication in the school clinic, only to leave the room and hand their medication over to a friend or classmate waiting in the hallway.
Schools have been broken into and medication supplies have been taken. In some of the police reports, the schools reported having no idea exactly how much or whose medication was taken. It is not at all surprising that these types of activities could occur.A 1996 DEA sampling of practices employed by schools for the handling of ADHD medication indicated that most schools did not have a nurse dispensing medication. Frequently supplies were kept in unlocked desks and a variety of untrained people were tasked with giving medication to the students; namely school secretaries, parent aides, and teachers. Although most schools had regulations prohibiting students from having drugs in their possession, many junior and senior high school students were permitted to carry or administer their own medications.
What precautions can schools take to ensure the safe handling of these medications?
DEA recommends that:
Schools consider prohibiting students from carrying ADHD medication to or from the school. This would necessitate having a parent, guardian, or other responsible adult deliver to and remove these medications from the school.
ADHD medication be provided to the school in a properly labeled container that identifies the name of the medication, the dosage to be administered and the frequency of administration.
One person (preferably the school nurse) maintain primary control of the medication supply. An incoming/outgoing medication inventory log would enable school staff to track amounts of medications received and dispensed. A log could be maintained that indicates:1. the name and strength of the medication received by the clinic;
2. the amount of medication received by or removed from the school (a physical count of the medication would be conducted in the presence of the parent or guardian. This same adult would initial and date the medication log);
3. the dates of dispensing; and
4. the name of the student to whom dispensed.
Schools consider not permitting a student to self-administer ADHD medication outside the presence of school staff so that verification can be made that the medication has, in fact, been consumed.
The drug supply be secured by means such as a locked room, drawer or cabinet. Non-duplicative keys to the locked drug storage area should be limited, and an inventory and accountability system for these keys should be maintained.
Unused medication not removed from the school by a parent or other responsible adult be destroyed by the school nurse. It is advisable that the destruction of the medication be witnessed by at least one other person and documented.Nothing in these recommendations should be construed as authorizing or permitting any person to conduct any act that is contrary to state or local laws and regulations.
This guide was developed and published by:
The Drug Enforcement Administration
Office of Diversion Control
and
Office of Congressional and Public Affairs
Demand Reduction Section
June 2001Treatment of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorders for Children and Adults
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