joe parsons

MYTHS, LIES, MISUNDERSTANDINGS--AND FACTS--ABOUT RITALIN

By Joe Parsons

There has been a huge volume of misinformation about attention deficit disorder
and its treatment. Much of this information is clearly agenda driven, coming
from sources that have products to sell ("All-Natural Alternatives to Ritalin")
or some other hidden agenda, while some comes from a simple lack of information.
Most of these statements concern the most familiar pharmacological treatment for
ADHD, Ritalin (methylphenidate hydrochloride). While much of the misinformation
is obviously false, some of it often sounds reasonable.

Here are some of the common myths, lies and misunderstandings about
Ritalin--along with the facts.

As always, the many knowledgeable participants in alt.support.attn-deficit are
happy to enter into *rational* discussions of these and other issues surrounding
ADHD.

This do***ent may not be reprinted, reposted or distributed without the express


©2000, Joe Parsons
jmp@cyber-mall.com

MYTH: The production of Ritalin has increased by 700% since 1990. Therefore, it
is overprescibed.

FACT: Since methylphenidate is subject to annual production quotas imposed by
the Drug Enforcement Administration (DEA), the quantities manufactured and sold
are a matter of public record, under FOIA. In 1990, the quota was 1776 kg,
rising to 14,957 kg in 1999 and 2000. The Annual Production Quota (APQ) showed
sharp increases from 1993-1995 (increases of 25.8%, 38.9% and 21.3%
respectively), but began to level; APQ for 1996-1999 showed increases of 11.6%,
14.8%, 4.2% and 3.4%, respectively. The APQ from 1999 to 2000 was unchanged.

Apart from the fact that the production of methylphenidate has increased
dramatically during the last decade, concluding from that fact that the drug is
overprescibed exemplifies an logical fallacy called "hasty generalization." It
is a fallacy because there can be *other* reasons for the increased production,
among them being heightened public awareness of the condition and improved
diagnostic process. In order for someone to defend the assertion that
methylphenidate is overprescibed, they would have to know the following:

1) How many people received prescriptions for Ritalin;
2) How many of those people should NOT have received the drug;
3) How many people SHOULD have received the drug, but did not.

Since at least two of these components are difficult (if not impossible) to
ascertain, any assertion regarding the supposed over- (or under-) prescription
of the medication is essentially indefensible.

MYTH: There are over 10 million children taking Ritalin.

FACT: There may be 10 million *prescriptions* written annually. Some make the
erroneous inference that this number equates to 10 million *people* taking the
drug. It is erroneous because Ritalin, being a Schedule II substance, requires
a new prescription each month. If each patient received a new prescription
every month, 10 million prescriptions would equate to 833,000 patients. Since
some prescriptions *may* last for longer than a month, and since some people do
not take the drug during the entire year, the actual number of patients is
higher.

The Washington State University College of Pharmacy completed a peer-reviewed
study in 1999 indicating that for the year 1995, 1,461,867 children aged 5-18
were taking methylphenidate.

MYTH: Ritalin is an addictive drug. That's why the FDA has made it a Type 2
Narcotic.

FACT: Under the Federal Controlled Substances Act of 1970, The Drug Enforcement
Administration (an arm of the Department of Justice)--not the FDA--has
designated certain drugs, methylphenidate (Ritalin) among them, as "Schedule 2
Controlled Substances." This means that three criteria must be met in the
judgment of the DEA:

1) The drug must have a high potential for abuse;
2) The drug must have a legitimate, recognized medical use;
3) Abuse of the drug may lead to severe psychological or
physical dependence

The text of the Act is at http://www.mninter.net/~publish/csa2.htm

As a division of the Department of Justice, DEA is a *law enforcement*
organization, and as such is concerned primarily with the abuse *potential* of
substances. The fact that this potential does exist is not an indictment of the
appropriateness or safety of Ritalin (or other medications) for treating ADHD.

The Brookhaven National Laboratory (a division of the U.S. Department of Energy)
published a paper on the subject of addiction and methylphenidate:

UPTON, NY - New research on Ritalin, a drug prescribed
to millions of American children with Attention Deficit
Hyperactivity Disorder (ADHD), indicates that it is safe
if taken in pill form for that the****utic purpose.

That finding will be reported in the October issue of the
American Journal of Psychiatry by scientists from the U.S.
Department of Energy's Brookhaven National Laboratory and
the State University of New York at Stony Brook.

The paper can be found at http://www.pubaf.bnl.gov/pr/bnlpr092998.html

Methylphenidate is not a narcotic; as a central nervous system stimulant, it is
actually on the opposite end of the spectrum from a narcotic.

MYTH: People always build a tolerance to Ritalin; that's why they have to take
more and more.

FACT: The appropriate dosage is typically determined by a process called
"titration;" the patient begins at a very small dose, increasing it
incrementally every few days, until the desired result is achieved. The
the****utic dosage seems to be independent of body weight; a 70 pound child
might take 20 mg three times a day, while a 200 pound adult might experience
relief of symptoms at 5 mg twice a day. There is no evidence that a patient
develops tolerance to Ritalin, but for some, the required the****utic dosage may
change over time. For many, the dosage remains static. In those cases where a
patient finds his or her the****utic dosage increasing, changing to a different
stimulant (Dexedrine, Adderall, Desoxyn or Cylert) is often preferable to
increasing the dosage.

MYTH: Ritalin always has a "rebound" (withdrawal) effect when the drug is
withdrawn.

FACT: Some people do experience "rebound" as their last dose wears off: their
symptoms may return for a time in more severe form, together with possible
irritability and anxiety. This effect is not universal, but when it does occur,
it can be managed by taking a smaller dose as the last dose of the day, by
adding an antidepressant like Wellbutrin or Effexor, or by switching to a
different stimulant, like Dexedrine or Adderall.

MYTH: Ritalin is overprescibed; over 11 million children are addicted to it, and
the number is growing rapidly.

Since methylphenidate is a Controlled Substance, the DEA imposes quotas on its
production. These quota figures are public, and based on the most recent
production figures, it appears that there are approximately 2.5 million
individuals of all ages taking the medication. The University of Washington
School of Pharmacy has recently completed a six-year study on the diagnosis of
ADHD and the prescription of stimulants for children between the ages of 5 and
18. The results were published in the peer-reviewed "Journal of Pediatrics" in
March, 1999. According to this study, there are 2.04 million children receiving
stimulants for ADHD, and the incidence of prescription has decreased slightly
during the last three years.

MYTH: Ritalin is a chemical strait jacket, used to turn normal, spirited kids
into compliant zombies.

FACT: Two of the core symptoms of ADHD are impulsivity and distractibility.
These two traits are closely tied to the brain's production and use of the
neurotransmitter, dopamine; many practitioners and researchers believe that
underproduction (or underutilization) of this chemical is a major culprit in the
cause of ADHD. Stimulants like Ritalin, Dexedrine, Adderall and others work
either by increasing the amount of available dopamine or by allowing it to be
utilized more efficiently.

A person taking the correct dosage will be better able to "filter out"
distractions and to learn a "reflective pause" before speaking or acting
impulsively. Neurotypical people possess these "filtering" and "reflective
pause" mechanisms to a greater extent than people who meet the criteria for
ADHD. Stimulant medication can assist the patient in learning to manage her own
behavior and attention--not force her to behave in a certain way.

MYTH: Ritalin changes one's personality.

FACT: Stimulant medication, as used in treating and managing ADHD, helps the
ADHD person develop appropriate coping strategies and to learn to manage his own
behavior. A stimulant will improve the patient's ability to recover from
distractions and to manage impulsivity. It has no effect on that person's
personality--who that person is.

MYTH: Ritalin is always used as a "quick fix" by parents and teachers too lazy
to do their jobs.

FACT: For most parents, the decision to incorporate medication into the
treatment plan for their children is a difficult one, and is not entered into
frivolously. A proper diagnosis is arrived at only after eliminating other
factors, such as allergies, family stressors and other medical conditions. The
initial testing and diagnosis may be accomplished by a psychologist who
specializes in ADHD, but in those cases where medication is appropriate, only a
medical doctor is permitted to prescribe. By law, teachers and school
administrators are prohibited from insisting that a child take medication as a
condition of instruction. They are not allowed to "diagnose" a child. What they
ARE allowed to do is to confer with the parents or guardians and to recommend
evaluation by the appropriate practitioner.

MYTH: Ritalin stunts growth

FACT: There is no evidence to substantiate this. A common side effect of
stimulant medication is appetite suppression; some may have concluded that this
appetite suppression MUST lead to reduced stature in adulthood. Current
thinking indicates that the growth cycle of ADHD people may be on a different
time frame than for others. Joseph Biederman, M.D. (Massachusetts General
Hospital) discusses these issues in "The Journal of the American Academy of
Child Adolescent Psychiatry 1996 Nov;35(11):1460-9:
Http://x28.deja.com/getdoc.xp?AN=441833002

MYTH: Ritalin causes cancer

FACT: A research study was done by the National Institute of Health (NIH) under
the aegis of the FDA, and the results of that study were published on January
12, 1996. In this two-year study by the National Toxicology Program, rats and
mice were given methylphenidate, with the following results:

The [FDA]continues to regard Ritalin as a safe and
effective drug.

The study in rats revealed no cancer-causing activity.
The findings in mice included increased rates of a
non-cancerous liver tumor (hepatocellular adenomas) and,
in males only, the occurrence of malignant liver tumor
(hepatoblastomas).

The positive findings were seen in one species of
rodent (the mouse) and in only one organ -- the liver -
which is known to be particularly likely to develop tumors
to a wide variety of stimuli.

-- The increased rates were seen primarily in non-malignant
tumors.
-- There was no increase in mortality associated with the
tumors.

The entire text of the letter is at the FDA website:

Http://www.fda.gov//bbs/topics/ANSWERS/ANS00705.html

The study itself is at

http://ntp-server.niehs.nih.gov/htdocs/LT-studies/tr439.html

MYTH: Ritalin is an untested, dangerous drug whose effects are not at all
understood

FACT: Methylphenidate was first synthesized in Europe in 1944, with the
objective of producing a non-addictive stimulant. It was introduced to the U.S.
in 1955 and approved by the FDA for the treatment of drug-induced lethargy, mild
depression and narcolepsy. The Swiss company, Ciba-Geigy, began marketing it in
the 1960s, primarily as a way to improve the failing memory of geriatric
patients--and for hyperactivity in children. To date, there have been no
reported instances of mortality or of damage resulting from the the****utic use
of methylphenidate.

[NOTE: While this statement was correct as of its initial writing, there has
been one death reported where Ritalin was implicated. On March 21, 2000,
Matthew Smith, 14, of Clawson, Michigan collapsed and died of heart failure. The
Oakland County, Michigan medical examiner, Dr. Ljubisa Dragovic, reported that
the cause of Matthew Smith's death was "long term use of methylphenidate."
Matthew Smith had taken methylphenidate for ADHD for approximately 8 years.
Several reports mention that he had complained in previous years of "chest pains
and racing heartbeat," but the drug was not discontinued. There remains
controversy among other physicians concerning Dr. Dragovic's finding.]

The mechanism by which methylphenidate operates is not *completely* understood,
but the same can be said of many other useful drugs--like aspirin. To say (or
infer) that it is a complete mystery, however, is inaccurate and misleading.
Methylphenidate works by stimulating that area of the brain that appears to be
less active in ADHD persons than in neurotypicals. This stimulation results in
increased production and improved utilization of the neurotransmitter, dopamine,
and to a lesser extent, serotonin. Dopamine is believed to be responsible for
attention, impulsivity and motor activity.

MYTH: The powerful ADD advocacy group, CHADD (Children and Adults with ADD) is
bankrolled by Ciba-Geigy, the manufacturer of Ritalin. The Swiss pharmaceutical
giant gave the money to CHADD in exchange for CHADD's mobilizing its members to
petitioning the DEA about slackening the stringent controls on Ritalin. This
financial backing was kept secret from the members until it was exposed on a
television program.

FACT: CHADD has received financial support from Ciba-Geigy (now Novartis
Pharmaceuticals, Inc.). The advocacy group was incorporated in 1987 as a
nonprofit corporation under S.501(c)(3) of the Internal Revenue Code. CHADD
sought financial support from a number of corporations, Ciba-Geigy among them.
In the seven years between 1987-1994, CHADD received approximately $813,000 in
cash grants. The annual budget of the organization is in excess of $2 million.

In order for CHADD to be granted and to retain tax exempt status, its financial
statements MUST, as a matter of law, be of public record--including any
contributions from corporate donors. Therefore, no one can reasonably claim
that the donations were "secret."

With regard to the petition to ease the controls on Ritalin, many
people--doctors and patients alike--find the additional paperwork and
bureaucracy to be burdensome. Because (in most states) prescriptions for
Schedule II substances like Ritalin can be issued for no more than a 30 day
supply and cannot be refilled or phoned into the pharmacy, a doctor's visit is
required for each month's prescription.

Questions, comments, corrections or complaints about this information should be
addressed to the author, Joe Parsons (jmp@cyber-mall.com) via e-mail or by
posting publicly to the Usenet newsgroup. alt.support.attn-deficit.

Revision history:

8/1/03: Added updated information concerning the death of Matthew Smith. Thanks
to "perl_hacker" for bringing the matter to my attention.

©2000, 2003, Joe Parsons