Ritalin

Ritalin

Overview:

Ritalin is a drug that is a mild form of amphetamine, and is used in the treatment of attention-deficit hyperactivity disorder (ADHD). ADHD occurs mainly in children and is characterized by hyperactivity, inability to concentrate for long periods of time, and impulsivity. Ritalin is the common trade name, and the scientific name is methylphenidate. Most Ritalin in the world is produced and consumed in America (Elliot 2004, 258). While mainly prescribed for ADHD, it also helps with other conditions such as narcolepsy (Britannica Academic 2017). Ritalin is a stimulant, but it calms and focuses people with ADHD. Ritalin works by increasing the level of dopamine in the brain (NIDA 2014). Dopamine is a neurotransmitter associated with pleasure, movement, and attention. Physicians usually prescribe low doses and then increase gradually until there is a therapeutic effect to mimic the natural production of dopamine.

Background/History:

Ritalin was first synthesized in 1944 and was known as methylphenidate. It was originally created to treat narcolepsy. The formula was improved over the years, and it was labeled as a stimulant in 1954. In 1957, Ciba Pharmaceutical Company, which is now known as Novartis, marketed the drug as Ritalin to treat a variety of issues, such as chronic fatigue, depression, and psychosis associated with depression and narcolepsy (CESAR 2013). In the 1960s, it was used to treated “hyperkinetic syndrome,” which eventually became known as ADHD. Ritalin use increased throughout the 1970s and 1980s, but sales increased by 500% during the 1990s (CESAR 2013). The introduction of Prozac in 1988 and future acceptance of it contributed to the Ritalin explosion (Parker 2001). Due to increased awareness of ADHD, parents and teachers would recommend children to doctors regarding the child’s behavior. Doctors had more experience with ADHD children and ADHD symptoms broadened, so physicians diagnosed more children with ADHD. Mental health care reform also affected the increased Ritalin use. The number of therapy sessions was limited, and sometimes, patients had to get medication first before receiving any therapy (Parker 2001). Drug Enforcement Administration (DEA) classifies Ritalin as a Schedule II narcotic, which is the same classification as cocaine, Adderall, and amphetamines (2017) (http://learn.genetics.utah.edu/content/addiction/ritalin/). The DEA classification of controlled substances ranges from Schedule I, which has no accepted medical use in the US and high potential for abuse, to Schedule V, which has low potential for abuse, suggesting that Ritalin has medical benefits but also a propensity for abuse.

While ADHD is usually associated with children, adults are also diagnosed with the condition. In the1990s, increasing numbers of adults came into the doctor’s office for ADHD evaluation (Conrad 2005). Whereas children are usually recommended by their teacher or parents, adults usually diagnose ADHD themselves and ask their physician for confirmation and medication. Pharmaceutical companies cannot directly advertise ADHD or its treatment for adults since it would be an off-label use of the medication, but they can financially support adult ADHD advocacy groups (Conrad 2005).

Different Perspectives and Controversies Regarding Ritalin:

When Ritalin is consumed without a doctor’s oversight, the drug can increase brain dopamine levels rapidly and at an increased intensity. This can disrupt neural networks involved in the reward system, so the risk of addiction is increased (NIDA 2014). Ritalin can also produce euphoria, which gives it a potential for abuse for recreational purposes. The pills can be crushed and then snorted or mixed with water for injection to produce a feeling of high. Since Ritalin suppresses appetite, it has also been abused for weight loss. Furthermore, Ritalin has been abused to improve a student’s academic ability. (http://abcnews.go.com/GMA/story?id=125327) Stimulants promote alertness, but they do not enhance learning or thinking ability for people who do not actually have ADHD (NIDA 2014).Diagnoses of ADHD may lead to further diagnoses of other disorders, or people with other disorders may be additionally diagnosed with ADHD. Other comorbid disorders include Oppositional Defiant Disorder, depression, anxiety, bipolar disorder, learning disorder, conduct disorder, and early speech/communication problems. Patients with ADHD and another disorder have greater impairment in their lives than people with ADHD alone.  Children with ADHD and other comorbid social and emotional problems had higher rates of missed school days, visits to the doctors, and visits to the ER (Classi 2012).

Applicable example to this section of the reading: (http://www.drugtestcentral.com/blog/post/My-Ritalin-Warning-Story.aspx)

Increased rates of Ritalin use and production lead to the rise of Ritalin critics. They argue that Ritalin is unnecessary and tries to correct behavior that is naturally a characteristic of children. They maintain that making an early diagnosis of young children is inappropriate because the behavior may naturally go away when the child grows older. Also, not all children who take Ritalin actually have a medical problem. Medication is an easy bandage to fix a problem, but the root of the issue may come from other factors. Several teachers recommend Ritalin for students who misbehave in a crowded classroom. However, the child may simply want attention, and the teacher does not have the resources to devote attention to every student.  Furthermore, Ritalin has been abused as a ‘cognitive enhancement’ for students or given to children by achievement-driven parents. University of Minnesota professor Carl Elliot states that “Ritalin is simply a drug in tune with the needs of contemporary life” because American society rewards sharpness and concentration (2004, 160). Many people misuse Ritalin to reach a ‘better than well’ state and can give themselves an unfair advantage. These enhancements could only be obtained by people with resources and would widen the gap between the have and have-nots. People with resources already have better access to academic resources. However, too much Ritalin leads to nervousness and irritability. Thus, the student will not be able to concentrate, which goes against the original intent.

Some people complain about the ‘overmedicated child,’ which refers to children taking multiple prescriptions that some people think are to the point of excess. Children may take atypical antipsychotics for ADHD, bipolar disorder, developmental disabilities, and other behavior disorders.  One of Ritalin’s side effects, although relatively rare, is tics. They are repetitive involuntary movements (motor tics) or sounds (vocal tics) (Shprecher 2009). Additional medication can help reduce the severity of tics but do not eliminate them. However, medication used to treat another drug’s side effect has its own side effects as well.

However, another group of people support the use of Ritalin and argues that ADHD is a real problem. Children with ADHD often underperform compared to other children in school, and poor academic performance leads to fewer opportunities in the future. Elliot describes one case of a young boy who desperately needed Ritalin to focus (2004, 253). Doctors say that diagnosis has increased over the years because they have become better equipped to recognize it. Furthermore, the symptoms of activities that constitute ADHD has broadened. Some would say that Ritalin is not being prescribed enough, and there are children who need help but are unable to receive it. The ADHD diagnoses provide a socially legitimate reason to take a stimulant. A person’s behavior has a biological basis rather than personality defect, so it shifts the responsibility from the person to the illness. Also, some people support the use of Ritalin as a cognitive enhancement. Bioethics professor John Harris argues that people should be able to take cognitive enhancing drugs to improve their mental ability and says that stopping them from doing so would be unethical (2009). He mentions that current humans are due to natural selection and evolution, so the cognitive enhancement would be a continuation of human development (Harris 2009).

Politics of Health:

Ritalin relates to the politics of health through the concepts of medicalization, biological citizenship, and pharmaceutical citizenship. Medicalization refers to the process by which normal human behaviors have become medical conditions, and therefore treated with medicine. Overall, the issue with medicalization is that people have become trained to believe that deviances in “normal” behavior are likely problems that need to be treated with medicine. In regards to ADHD, opponents against Ritalin argue that hyperactivity and inattentiveness have become medicalized (as ADHD) by the health care community. Physicians may feel pressured to prescribe Ritalin when the parent or adult comes into the clinic expecting medication, creating a higher demand and “necessity” for the drug than should be needed. Pharmaceutical companies have a financial interest in the medicalization of ADHD, which brings about more controversy regarding the intentions of medicalization as profit-driven for the companies or beneficial to the people. The internet plays a large role in the medicalization because parents and teachers have access to information pertaining to ADHD symptoms, and websites offer self-administered screening tests. People seek out this information because they are under the impression that they require medicine (due to the medicalization of society). Also, people can connect with others who have ADHD and try to confirm if their child or themselves have the disorder. This has created a world in which people can become the “experts” of themselves rather than their doctors. While the doctors have the power to prescribe, the people essentially feel like they have the power to diagnose. This is highlighted by the explanation of controversy surrounding the argument of whether or not there is a true need for these medications and to whom they should be prescribed to.

Anthropologist Stefan Ecks describes pharmaceutical citizenship in the context of India (2005). In his article, he argues that when people with mental illnesses are marginalized and they take antidepressant drugs, it can effectively reintegrate them into society. People with undiagnosed ADHD or those who do not take their medication are recognized as acting with too much energy and have trouble paying attention in class. As deviants from the norm, they use drugs such as Ritalin to help bring them back to “normal.” The drugs themselves offer this population a way to bring themselves back to normal and fit in with society’s standards. This is a dangerous concept because it suggests that our society is so engrossed in its standards that medicalization will continue to proliferate and affect American society. Another way of viewing pharmaceutical citizenship is that people who do not have ADHD but take Ritalin establish a new norm of cognitive enhancement. People without these enhancements will be academically behind and feel pressured to take them to aspire to the new norm. Therefore, Ritalin itself is dangerous because its potential for abuse and its ability to enhance created a pressure for more of it, and therefore more medications being prescribed, thus revealing the cycle of help and harm for the American population on Ritalin.

Citations:

Britannica Academic, s.v. “Ritalin.” Accessed March 20, 2017. http://academic.eb.com/levels/collegiate/article/Ritalin/384193.

Center for Substance Abuse Research. “Ritalin.” Accessed March 21, 2017. http://www.cesar.umd.edu/cesar/drugs/ritalin.asp

Classi, Peter, Denair Milton, Sarah Ward, Khaled Sarsour, and Joseph Johnston. “Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization.” Child Adolescent Psychiatry Mental Health 6, no. 1 (2012): 33. Accessed March 21, 2017.

Drug Enforcement Administration. “Drug Schedules.” Accessed March 21, 2017. https://www.dea.gov/druginfo/ds.shtml

Elliot, Carl. Better Than Well: American Medicine Meets the American Dream. New York: W. Norton & Company, 2004.

Harris, John. “Is it acceptable for people to take methylphenidate to enhance performance? Yes.” British Medical Journal 338: b1955

National Institute on Drug Abuse. “Stimulant ADHD Medications: Methylphenidate and Amphetamines.” National Institutes of Health. Accessed March 21, 2017. https://www.drugabuse.gov/publications/drugfacts/stimulant-adhd-medications-methylphenidate-amphetamines

Parker, Harvey. “The Ritalin Explosion.” PBS Frontline, 2001. Accessed March 22, 2017.  http://www.pbs.org/wgbh/pages/frontline/shows/medicating/experts/explosion.html

Shprecher, David, and Roger Kurlan. “The Management of Tics.” Movement Disorders: Official Journal of the Movement Disorder Society 24, no. 1 (2009): 15–24. Accessed March 21, 2017.