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Generation Rx
The Partnership for a Drug Free America warns that the country is being overwhelmed by a wave of teen prescription drug abuse. Jacob Sullum offers some criticisms of the misleading way the data is being presented. Still, the abuse is there. I wonder how serious a problem this really is, though. Take the 2.3 million million teens who have, at one point or another, taken ritalin or adderall without a prescription. What kind of bad stuff happens to these kids? These are drugs which, keep in mind, are designed to be safe for regular, long-term use. Google doesn't seem to reveal even anyone warning that kids who take these pills to stay up late and study, or even kids who crush the pills and snort them, are liable to wind up dying of an overdose. I've never heard of anyone becoming a ritalin junkie -- losing jobs because of his habit and robbing people to get a fix -- the way you hear with opiates and OxyContin and so forth. Generally speaking, it seems pretty damn benign compared to most illegal drugs, the vast majority of prescription drug abuse, and even perfectly legal stuff like beer, Fritos, Mountain Dew, and other things people consume to have fun or stay awake or whatever. I'll happily stand corrected if that's wrong, but in the greater scheme of things I'm not seeing much worth worrying very much about, especially since the only feasible way to cut down on abuse would be to drastically curtail its availability for legitimate purposes.
April 22, 2005 | Permalink
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Comments
As someone that works in a substance abuse rehab for teens, you better believe this is a problem! Most kids still come in with marijuana being the primary drug of choice but over the last year or so more and more kids are putting down Xanax as there drug of choice. These kids take 4 or more Xanax at a time and call it "bars" or "footballs". It's a scary trend right now and there is literature out there showing the rise of abuse in illegal prescription drugs by teens. What is scary is the thought that folks don't think this is a problem and can just dismiss it cause it doesn't seem as serious as some other drugs out there. I challenge you to talk to any substance abuse counselor who works with teens and ask if this is not a serious problem.
Posted by: zzz | Apr 22, 2005 2:02:35 PM
Some people are also justifiably skeptical about the legitimate purposes of ritalin - many people seem to have it prescribed for them who do not seem to really need it, as evidenced by there not taking it regularly.
Also, the entire tendency to prescribe mind altering drugs and then not supervise usage very well seems somewhat problematic.
Posted by: MDtoMN | Apr 22, 2005 2:04:48 PM
zzz,
All you've stated is that, yes, lots of kids take these drugs. You haven't given any evidence that it's a big problem. You said that marijuana is the usual drug of choice -- well, marijuana was the drug of choice for just about everyone I knew in high school, and most of them have turned out OK.
Posted by: Steve | Apr 22, 2005 2:06:32 PM
Also, zzz, I asked a question about ritalin and you have me an answer about xanax. If you have an answer about ritalin, I'd be glad to hear it.
Posted by: Matthew Yglesias | Apr 22, 2005 2:24:36 PM
"things people consume to have fun or stay awake or whatever."
See, that's the problem with these drugs right there. Can't have people having fun or staying awake . . .
I'm right, aren't I, zzz?
Posted by: rea | Apr 22, 2005 2:29:36 PM
Am I the only one here thinking "Look Matt, if you really need the Ritalin to keep the blog and pundit career going, I'm sure you can find a doctor to write you a legit prescription."?
Posted by: Paul Callahan | Apr 22, 2005 2:32:39 PM
Where are the teens getting this stuff?
I saw a report scaring people about online pharmacies being abused by kids but I'm a little skeptical. Don't you need a credit card to order from them? How are these "teens" getting credit cards?
And if they are using their parent's credit cards then the real problem is Mom and Dad not monitoring the use of their credit cards.
I think part of this is a scare tactice by big pharma to thwart people getting legit meds at a lower price outside the country.
For example Minnesota gets some of the meds from Canada and the feds don't like this.
Posted by: Tripp | Apr 22, 2005 2:42:29 PM
There is no doubt that people will continue to over consume things; food, booze, drugs, etc. I would hope people working in certain rehab and substance clinics would perceive this as a problem. After all, its what they do day in and day out.
I would think there is room to also believe that a case can be easily overstated. In that, people will think this is a problem until extremely low levels are abusing these drugs. Well, that is never going to happen. There question is whether use is on the rise (it is) and whether its alarming (an epidenmic.)
You want a toe? I can get you a toe in 3 hours.
As far as access is concerned, making it harder for legitmate users to get doesn't solve anything. As someone who could obtain some of the drugs listed here in a matter of hours, I know these things aren't simply being stolen from the parents' medicine cabinets. There is a whole culture of dealers dedicated to the distribution of it.
Posted by: Adrock | Apr 22, 2005 2:50:29 PM
It's been several years since I last abused ritalin or adderoll and I don't really plan on doing it again, but I will say that my skepticism that this is a bona fide social problem does have some roots in personal experience.
Posted by: Matthew Yglesias | Apr 22, 2005 2:53:02 PM
Ritalin for the kids and Viagra for the old folks. These lifestyle drugs will see no bounds.
Posted by: raj | Apr 22, 2005 2:53:59 PM
Why aren't kids sticking with the old standby -- cough medicine? Despite the fact that is an easy way for kids to get their hands on alcohol, nobody seems too worried about it.
Posted by: janet | Apr 22, 2005 2:54:06 PM
Well, I'm the last one to encourage anything that makes it harder for people to get medicines they actually need, but I don't think Matt's well advised to be so flip about the issue. For one thing "prescription drugs" is a huge category that, yes, includes some things that may seem pretty benign and other things that can be really dangerous and f$*& up one's life pretty badly, and while we do make some clear distinctions here, it's not clear to what extent teens and tweens understand these distinctions. More significantly, a lot of drugs haven't been adequately tested on children in experimental settings, or are relatively new, so we don't know for sure how safe or potentially dangerous they are for kids. The other thing that I'd argue is worth being concerned about is if "medicines" kids may be taking inappropriately mask other issues that they need to deal with, or prevent them from learning healthy coping skills. Lots of kids really do need Ritalin or antidepressants to have a shot at living a decent life. But the teens are a critical time to learn to deal with life and other people, and people who don't learn this then have a harder time learning it later.
Posted by: flip` | Apr 22, 2005 2:57:30 PM
A certain percentage of human beings, and a similar but slightly larger percentage of teens, will use and abuse whatever mind/body-altering substances are available to them. Be it alcohol, hemp, quat, synthetic drugs, whatever. I doubt these percentages have changed much since humans first learned to ferment fruit 30,000 years ago, and I doubt they ever will: some people just need a kick every once in a while, and some want it more often and get addicted.
Of course, every generation of parents and preachers gets worked up about it, too. Thus I guess is the circle of life completed.
Cranky
Posted by: Cranky Observer | Apr 22, 2005 3:00:09 PM
Flip -- as with zzz, I'm going to have to ask you to read the post more closely. I'm asking about ritalin and adderoll -- two anti-ADHD drugs which have been extensively tested for use on children who are, indeed, the main targets of legitimate uses of the medicine. I'll happily concede that other drugs may be different. But is ritalin abuse really a serious health problem? And if so, it's serious compared to what? Worse than Coca-cola and Fritos? Why? How?
Posted by: Matthew Yglesias | Apr 22, 2005 3:21:48 PM
Elizabeth Wurtzel wrote a book about her addiction to Ritalin. She's now at Yale Law, so it evidently wasn't a life-destroying experience. Then again, she did have the cushion of being a successful author with plenty of money to keep her off the street.
Posted by: Amber | Apr 22, 2005 3:29:43 PM
I'm seeing a number of different issues being confused in these comments: inappropriate prescribing of Ritalin to teenagers; teenagers' abuse of other prescription drugs; and Matt's original question about Ritalin abuse. For the record, I think the first is the most serious problem, though I haven't seen much good research on the issue -- however, my observation is that Ritalin, specifically, almost always prescribed Ritalin, acts as a gateway drug to cocaine, specifically, and that that has to do with how people with ADHD function in the world. I think Malcolm Gladwell's interesting piece suggesting that people with ADHD used to smoke (nicotine is well established in the literature to improve memory and concentration) is quite relevant here. I don't think a rational discussion of the health and social tradeoffs involved in the shift from nicotine to Ritalin is going to happen any time soon, though. But so many boys are being prescribed the drug now that the group who will look for the same effects from cocaine is perforce getting larger.
However, I agree with Matt that there's not much evidence that teenagers who use Ritalin for fun are in any way ruining their lives. Of course, the same could be said of all sorts of things, since these debates are all about demonizing teenagers, and not at all about identifying actual health risks.
Posted by: mollym | Apr 22, 2005 3:52:24 PM
Ritalin, Adderol and this other pill (small, yellow, can't remember the name) were large study drugs in my school. This would be 2 to 3 years ago and of course, this is college I'm talking about. But those little pills went for a pretty penny.
Personally, as far as the younguns are concerned, I don't see that much value in them other than the notion that doing a drug is "cool" in some circles. While they definitely do something to you, its not a large, encompassing high. Anymore than eating too much sugar. But addiction doesn't take much effort, and thats likely a problem, however large I don't know.
Posted by: Adrock | Apr 22, 2005 4:06:14 PM
An equally serious problem is all those kids hooked on phonics.
Posted by: old guy | Apr 22, 2005 4:18:53 PM
I did read the post carefully, but apparently didn't write as carefully. So let me try again:
--A potential problem of wide-spread ritalin abuse is that if young kids say, 8 to 12 year olds, are abusing ritalin and think it's okay because it's a prescription drug, they may not understand that it's more benign than other prescription drugs and may think that anything that can be prescribed by a doctor is ok. It's not the ritalin abuse that's the problem, per se, but young kids having a widespread perception that it's safe to abuse prescription drugs. I'm less concerned about older teens who can tell the difference.
--Ritalin and adderall may be well-established, but the pharmaceutical industry has learned that it can make greater profits by turning out new "better" drugs to address the problems that Ritalin and adderall address. Because, as we've recently seen (in the case of antidepressants), the standards the FDA requires for testing the effects of drugs on kids are fairly low, not all these drugs have been well tested, and we don't yet know what their longterm impact on developing systems could be.
--I think it matters WHY people are abusing Ritalin. (And, per the Coke and fritos problem, I also think it matters WHY people abuse food--I grew up with an eating disorder and while the foods I was eating weren't inherently dangerous, the way I was using them and the underlying mental state causing that to happen were) I understand some people abuse Ritalin for fun. Okay. But some of the above comments refer to Ritalin as a "study" drug--If kids need to rely on Ritalin to reach the expected level of performance, then we have one of two problems, either kids aren't being taught to deal with stress and manage time properly, or the expectations of their performance are unreasonably high. Neither of these is a good or socially beneficial situation.
Do I think abusing Ritalin is worse that abusing Coke or fritos--possibly, because while the impacts of bad food on the body are predictable, the way people respond to Ritalin is less so (kids with ADHD and ADD put on the drug have all different kinds of responses, from becoming more beligerent to becoming like zombies) and some impacts (for example, GI disruption) may not be easy to connect to the drug. But by and large, no. But that doesn't mean I think people that care about kids shouldn't be concerned about them drinking too much Coke or eating too many fritos, or that parents shouldn't be aware of these behaviors as a potential issue/problem. I don't think any of the handwringing over child ritalin abuse has any policy significance, but that doesn't mean parents shouldn't give some attention to these issues.
Posted by: flip | Apr 22, 2005 4:45:23 PM
I did read the post carefully, but apparently didn't write as carefully. So let me try again:
--A potential problem of wide-spread ritalin abuse is that if young kids say, 8 to 12 year olds, are abusing ritalin and think it's okay because it's a prescription drug, they may not understand that it's more benign than other prescription drugs and may think that anything that can be prescribed by a doctor is ok. It's not the ritalin abuse that's the problem, per se, but young kids having a widespread perception that it's safe to abuse prescription drugs. I'm less concerned about older teens who can tell the difference.
--Ritalin and adderall may be well-established, but the pharmaceutical industry has learned that it can make greater profits by turning out new "better" drugs to address the problems that Ritalin and adderall address. Because, as we've recently seen (in the case of antidepressants), the standards the FDA requires for testing the effects of drugs on kids are fairly low, not all these drugs have been well tested, and we don't yet know what their longterm impact on developing systems could be.
--I think it matters WHY people are abusing Ritalin. (And, per the Coke and fritos problem, I also think it matters WHY people abuse food--I grew up with an eating disorder and while the foods I was eating weren't inherently dangerous, the way I was using them and the underlying mental state causing that to happen were) I understand some people abuse Ritalin for fun. Okay. But some of the above comments refer to Ritalin as a "study" drug--If kids need to rely on Ritalin to reach the expected level of performance, that may mean they aren't being taught to deal with stress and manage time properly, or the expectations of their performance are unreasonably high. Neither of these is a good or socially beneficial situation.
Do I think abusing Ritalin is worse that abusing Coke or fritos--possibly, because while the impacts of bad food on the body are predictable, the way people respond to Ritalin is less so (kids with ADHD and ADD put on the drug have all different kinds of responses, from becoming more beligerent to becoming like zombies) and some impacts (for example, GI disruption) may not be easy to connect to the drug. But by and large, no. But that doesn't mean I think people that care about kids shouldn't be concerned about them drinking too much Coke or eating too many fritos, or that parents shouldn't be aware of these behaviors as a potential issue/problem. I don't think any of the handwringing over child ritalin abuse has any policy significance, but that doesn't mean parents shouldn't give some attention to these issues.
Posted by: flip | Apr 22, 2005 4:46:15 PM
Sorry about that. Computer acting wierd. All really stupid things I may have written should also be blamed on said computer.
Posted by: flip | Apr 22, 2005 4:47:14 PM
Keep in mind that Adderal is amphetamine and Desoxyn is methamphetamine. The big difference is that the prescriptions are issued in controlled, known doses (which are certainly taken in larger-than-prescribed amounts at times). But these doses are clean, free of toxic additives or contaminants found in street drugs. Moreover, the form in which these drugs are issued make them less susceptible to being injected IV or being smoked (or even snorted), as the high-quality street meth is almost 100% pure. Although these drugs can clearly be dangerous if taken in higher-than-recommended doses or ingested in other-than-oral ways, I think that people who have access to these medications legally are less likely to seek out street doses.
Posted by: Anonymous | Apr 22, 2005 5:53:35 PM
Erowid describes the chemical similarities between these drugs and other amphetamines and methamphetamines. Same family. I don't disagree with Matt that these are probably not the kinds of really dangerous drugs worthy of intense government scrutiny, but they are not on the same level as caffeine and fat.
Posted by: Joseph Hovsep | Apr 22, 2005 6:25:11 PM
(1) Ritalin and similar agents are well known to occasionally cause seizures, mania, and cerebral vasculitis, to name the worst. At least one kid suffered cardiopulmonary arrest and anoxic brain injury after snorting crushed tablets. But most overdoses in kids cause not-too-severe tachycardia, insomnia, agitation, and/or rash. Worth the risk? We report, you decide.
(2) Anonymous is right. While synthetic psychotropics can be dangerous -- after all, we're pretty amateurish in our understanding of how the brain responds to manipulation -- at least they're not likely to be mixed with toxins or rat feces...
Posted by: tinman | Apr 22, 2005 7:39:28 PM
flip posted above in part:
But some of the above comments refer to Ritalin as a "study" drug--If kids need to rely on Ritalin to reach the expected level of performance, that may mean they aren't being taught to deal with stress and manage time properly, or the expectations of their performance are unreasonably high. Neither of these is a good or socially beneficial situation.
This is a little simplistic, if Ritalin helps kids reach expected levels of performance, lazy kids will be tempted to use Ritalin even if they could also reach the expected level by working hard. And of course kids are generally evaluated at least in part by how well they do compared to their peers (grading on the curve) which leads to competitive pressure to use Ritalin.
Posted by: James B. Shearer | Apr 22, 2005 8:54:49 PM
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