Ritalin (methylphenidate) is a Schedule II Controlled Substance, which means the United States government classifies it as having "a high potential for abuse .. that may lead to a severe psychological and physical dependence." The government considers methylphenidate, the main ingredient in Ritalin, to be as addictive as cocaine, morphine, opium, and other Schedule II drugs.
American physicians write over 18 million prescriptions for Ritalin every year, and it ranks among the most frequently prescribed and most frequently stolen drugs.
Because the drug is so widely prescribed, many people want the government to reclassify it as a Schedule III Controlled Substance. This would loosen up restrictions on its availability and the record-keeping required of doctors and pharmacists dispensing it. However, the U.S. Department of Justice is unlikely to do this anytime soon because of studies such as the one done by Dr. Norma Volkow in 1995. Dr. Volkow and her colleagues found that methylphenidate is identical to cocaine in the way it binds to the dopaminergic pathways in the human brain. When study participants were given Ritalin or cocaine intravenously, they could not tell the difference between the two and told researchers that the "highs" were identical.
Methylphenidate products like Ritalin are banned in Sweden because of their potential for abuse and addiction.
What is Ritalin (methylphenidate)?
Ritalin is a stimulant, which means it is in the same class of drugs as caffeine, cocaine, methamphetamine, and ecstasy. Stimulants speed up the central nervous system, resulting in increased wakefulness, alertness, feelings of pleasure, energy, faster heart rate, higher body temperature, more frequent urination, diarrhea, and increased blood pressure. When taken at high levels, stimulants can cause feelings of euphoria.
Ritalin, a chemical cousin of cocaine, works by increasing two monoamines or neurotransmitters in the brain called dopamine and norepinephrine. These brain chemicals are related to pleasure, movement, and attention, and some research has shown that people with Attention Deficit Disorder have weak dopamine signals in their brains, which is probably why Ritalin eases their symptoms. For a long time, most medical professionals believed that Ritalin worked in the striatum region of the brain; however, in 2012, Dr. Craig Berridge of the University of Wisconsin proved that the drug acts on the upper prefrontal cortex of the brain.
The chemical composition of a methylphenidate molecule looks like this:
Methylphenidate was first synthesized in 1944, and first marketed in 1954 by CIBA Pharmaceuticals as a remedy for chronic fatigue, depression, and narcolepsy. Although Novartis Pharmaceuticals now makes and distributes Ritalin, the pills are still marked "CIBA" on one side.
The 5 mg Ritalin pill is lime-colored and marked 7; the 10 mg is green and marked 3; the 20 mg are yellow and marked 30; and the 20 mg time-released pills are white and are marked 16.
Methylphenidate products come in short-acting, long-acting, and extended release forms, and as pills, capsules, liquids, and skin patches. Trademarked names for them are Ritalina, Ritalin LA, Ritalin SR, Daytrana, Ritatine, Focalin, Concerta, Metadate, Attenta, Rubifen, and Penid.
How is Ritalin Used Medically?
The vast majority of people taking Ritalin for medical reasons are school-aged children who are diagnosed with Attention Deficit Disorder, with or without hyperactivity. Other terms for ADHD are Minimal Brain Dysfunction, Hyperkinetic Child Syndrome, Minimal Cerebral Dysfunction, and Minor Cerebral Dysfunction. Between 1.5% and 2.6% of all school-age children in the United States take the drug, but most experts believe ADHD is actually underdiagnosed and could affect up to 8% of all children and 4.4% of adults. The United States uses 85% of the world's supply of methylphenidate, amounting to over ten tons a year. Methylphenidate products cannot be prescribed to children under six years old.
Ritalin and other methylphenidate drugs are also used to treat narcolepsy, chronic fatigue syndrome, and orthostatic tachycardia.
Why Do People Abuse Ritalin?
Athletes, performance artists, politicians, the elderly, people on diets, hard-driven professionals, and students are those most likely to abuse Ritalin. It is an extremely popular drug in academia, where it is used to enhance concentration and as a study aid that allows you to go without sleep during finals week. Interestingly enough, one study found that those students who do not use Ritalin as a study aid are more informed about its health risks than those who do.
Another researcher found that one in five professors use the drug, and 80% believe it should be legalized. The percent of college students abusing Ritalin is probably between 4% and 15%. One researcher found that 9.2% of 347 college students participating in his survey were abusing it, and 53% knew someone who was selling it. Ninety-seven percent of the users told researchers it helped them study and stay awake, and 52% used it to suppress appetite for weight reduction.
The annual Monitoring the Future Study from the University of Michigan involving over 50,000 adolescents finds that 2% to 4% of high school seniors abused the drug at least once in the past year. Ritalin use seems to peak in the college years, and then slough off after 24 years old.
Some of these studies are indicating, however, that young people believe Ritalin is safe to use because it is a prescription and not a street drug, and because it is prescribed to young children. In the same way that prescription painkillers are becoming a gateway drug to heroin, methylphenidate products may be the new gateway to cocaine and methamphetamine. Ritalin is particularly dangerous when combined with other stimulants such as energy drinks, coffee or "No Doz" tablets, which puts users at risk for a cardiovascular event.
Some indications are that Ritalin is becoming more popular as a recreational drug, and is being used in more dangerous ways. People are crushing the pills into a powder, and snorting it through their noses or else mixing it with liquids and injecting it into their veins. When used this way, methylphenidate works very much like cocaine and causes feelings of euphoria. It is also being abused recreationally along with alcohol as a way to stay awake when you are drunk.
Street names for Ritalin are Kibbles and Bits, Kiddie Coke, Smarties, Skippy, West Coast, Vitamin R, and R balls. When Ritalin is mixed with a painkiller called Talwin, it is called Crackers, Ritz and Ts, or Ts and Rs. Ritalin pills when prescribed cost 25 to 50 cents each; their street value, however, is between $2 and $20 a pill.
Dangers of Abusing Ritalin: Health Risks, Drug Interactions
The most severe danger of taking Ritalin without a prescription is that if you have an undiagnosed heart problem, you may die from a heart attack or stroke the first time you use it. About one in 1000 people have psychotic or severe allergenic reactions to Ritalin the first time they use it.
Since Ritalin is a stimulant that increases blood pressure, people with high blood pressure or heart problems, glaucoma, nervous tics, or overactive thyroids should not take it. Because it is highly addictive and affects brain chemicals that regulate mood, people with histories of drug abuse or alcoholism, mood disorders, suicidal ideation, or bipolar disorder should not use Ritalin.
Ritalin interacts with antidepressant medications like Prozac, and MAO inhibitors like Nardil and Parnate, blood thinning drugs, high blood pressure medications, and anti-acids. Reactions with antidepressants and anti-seizure medications can be fatal.
Most of the studies about Ritalin have been done on children. The drug slows the growth rate of a child by about two centimeters in height over 36 months average. One study of 55,000 children ages three to 20 in Florida found that children taking Ritalin were 20% more likely to go to emergency rooms for heart symptoms.
Side effects of Ritalin are nervousness, insomnia, loss of appetite, increased blood pressure, increased heart rate, headache, irritability, mood swings, visual disturbances and problems with the retina, erectile dysfunction, diarrhea, chest pains, dry mouth, dizziness, frequent urination, and nervous tics. In rare cases people have experienced psychosis, hallucinations and mania. Long-term abuse of Ritalin is linked to heart and kidney problems.
Overdosing on Ritalin disrupts the normal connections between brain cells, and this in turn can create symptoms of bizarre thought patterns, such as euphoria, delirium, confusion, hallucinations, and psychosis. The person is usually flush, sweating, and vomiting, and will require medical treatment.
Signs that you are addicted to Ritalin
Dr. Andrew Weil of the Center for Integrative Medicine takes the controversial stand that certain people can occasionally use stimulants like Ritalin as a performance-enhancing drug before a difficult task, such as athletic contests, public speaking, professional dance, acting on stage, and so forth. However, he also believes that stimulants like Ritalin should never be used by the "overweight, the depressed or the neurotic," the three groups who are most likely to develop addictions to stimulants.
If you think you might be addicted to Ritalin, ask yourself the following questions:
• Do you believe you cannot control your appetite and weight without using Ritalin?
• Do you believe that you are unable to meet deadlines and keep up with your peers at work or school without using Ritalin?
• Does Ritalin make you feel more powerful, social, talkative, self-confident, and less depressed? Do you like yourself better when you are on the drug?
• When you are taking Ritalin, do the people in your life complain that you are aggressive, moody, irritable, argumentative, and hard to get along with?
• Are you having trouble falling asleep because of Ritalin?
• Do you think that you learn quicker and more efficiently and can concentrate only when you are taking Ritalin?
• When you try to quit taking Ritalin, do you develop symptoms of withdrawal, such as depression or fatigue?
• Do you supplement your use of Ritalin with other stimulants like energy drinks?
If you answered yes to any of the above questions and if you feel your use of Ritalin is out of control, you should consult your family doctor for advice.
Treatments and Withdrawal from Ritalin Addiction
Many clinicians who work with addicts have anecdotes about people who are taking 125 mg of Ritalin or more a day, or who are snorting or injecting Ritalin and just as addicted to it as if they were using cocaine. Nevertheless, Ritalin is usually one of many drugs a person is abusing when he or she enters residential treatment. It is often used as a substitute when methamphetamine or cocaine are unavailable, or in conjunction with painkillers, alcohol, and sleeping pills.
Ritalin is highly addictive and as such, people develop tolerances to it and keep requiring higher dosages to achieve the psychoactive effect they want. They also will experience withdrawal symptoms when they try to quit. These symptoms are typically depression, fatigue, irritability, sleep problems, loss of interest in daily activities, and cravings for Ritalin. In rare cases, people in withdrawal from Ritalin have had psychotic episodes, suicidal ideation, or become delirious. Children who are taken off Ritalin experience a "rebound" effect, which means their original symptoms of inattention and hyperactivity return more intensely than before the drug.
If a person goes through withdrawal under medical supervision, physicians will typically reduce dosages of Ritalin gradually to avoid severe withdrawal symptoms. Physicians will also prescribe anti-anxiety drugs, sleeping pills, and Clonidine (a blood pressure medicine) during the detoxification period to ease symptoms.
The vast majority of people addicted to Ritalin have underlying psychiatric problems that need to be addressed as separate issues when they enter treatment. They are medicating themselves with stimulants most often because of eating disorders, depression, lack of self-esteem, workaholic and driven behaviors, and/or social anxiety. These issues and others can be addressed in psychotherapy, in which professional counselors can help the client learn to relax and set realistic goals.
Morton, W. Alexander and Gwendolyn G. Stockton "Methylphenidate Abuse and Psychiatric Side Effects," Journal of Clinical Psychiatry. 2000 October; 2(5): 159–164. Clarke, Toni. "Shortage of ADHD drug persisting," Reuters, January 1, 2012, see http://www.reuters.com/article/2012/01/01/us-adhd-adderall-shortage-idUSTRE80009E20120101
Volkow ND, Ding Y, Fowler JS, et al. "Is methylphenidate like cocaine?" Archives of General Psychiatry. 1995;52:456-463.
“Methylphenidate, A Background Paper,” The U.S. Department of Justice, Drug Enforcement Agency, posted at http://www.methylphenidate.net/.
See "Methylphenidate," in the Physicians' Desk Reference, 66th Edition, 2012.
National Institute on Drug Abuse, "InfoFacts: Stimulant ADHD Medications - Methylphenidate and Amphetamines," see http://www.drugabuse.gov/publications/infofacts/stimulant-adhd-medications-methylphenidate-amphetamines/
Volkow ND, Ding Y, Fowler JS, et al. "Is methylphenidate like cocaine?" Archives of General Psychiatry. 1995;52:456-463.
Berridge CW, Shumsky JS, Andrzejewski ME, Devilbiss DM, Spencer RC, Waterhouse BD. (2012) Differential sensitivity to psychostimulants across prefrontal cognitive tasks: differential involvement of noradrenergic α1- and α2-receptors. Biological Psychiatry, 71:467-473. PMCID: PMC3233638. E-Published 2011.
The National Toxicity Program, Department of Health and Human Services, see http://ntp.niehs.nih.gov/?objectid=555C0D75-94FC-5AC9-E6B2DCF51F368FF6 Novartis website, (Manufacturer's) Information on Ritalin, see http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/ National Institute on Drug Abuse, "InfoFacts: Stimulant ADHD Medications - Methylphenidate and Amphetamines," see http://www.drugabuse.gov/publications/infofacts/stimulant-adhd-medications-methylphenidate-amphetamines National Institute of Mental Health, "Attention Deficit Hyperactivity Disorder Medications," see http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml National Institute on Drug Abuse, "Stimulants," see http://www.drugabuse.gov/publications/research-reports/prescription-drugs/stimulants Carroll, Bronwen; Mclaughlin, Thomas, and Diane Blake. "Patterns and Knowledge of Nonmedical Use of Stimulants among College Students," The Archives of Pediatric and Adolescent Medicine, May 2006, p. 481-485.
“Scientists use pill enhancers,” The Boston Globe, April 9, 2008, at http://www.boston.com/news/health/blog/2008/04/move_over_jose.html Carroll, Bronwen; Mclaughlin, Thomas, and Diane Blake. "Patterns and Knowledge of Nonmedical Use of Stimulants among College Students," The Archives of Pediatric and Adolescent Medicine, May 2006, p. 481-485. The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/ “Methylphenidate, A Background Paper,” The U.S. Department of Justice, Drug Enforcement Agency, posted at http://www.methylphenidate.net/. National Institute on Drug Abuse, "Stimulants," see http://www.drugabuse.gov/publications/research-reports/prescription-drugs/stimulants The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/ Morton, W. Alexander and Gwendolyn G. Stockton "Methylphenidate Abuse and Psychiatric Side Effects," Journal of Clinical Psychiatry. 2000 October; 2(5): 159–164. Novartis website, (Manufacturer's) Information on Ritalin, see http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf See "Methylphenidate," in the Physicians' Desk Reference, 66th Edition, 2012. The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/ The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/ Novartis website, (Manufacturer's) Information on Ritalin, see http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf Boyles, Salyn. "Heart Events Rare in Kids with ADHD," WebMD, May 2, 2012, http://www.webmd.com/add-adhd/news/20071205/heart-events-rare-kids-adhd-drugs
See "Methylphenidate," in the Physicians' Desk Reference, 66th Edition, 2012. National Institute on Drug Abuse, "Stimulants," see http://www.drugabuse.gov/publications/research-reports/prescription-drugs/stimulants/ See websites of residential treatment centers for drug addictions.
Colvin, Rod. Prescription Drug Abuse (Omaha, NB: Addicus Books, 2002), p.16. The U.S. Library of Medicine, "Methylphenidate," see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/