Snorting Rit

2012-12-19 00:00

“IF I have an eye problem, I either need to wear glasses or contacts,” says clinical psychologist Scott Wood. “When I put these contacts in, suddenly I can see properly.”

This metaphor illustrates the effect Ritalin, specifically Methylphenidate, has on someone with ADHD.

Wood, who heads the substance abuse treatment unit at FEH, has treated Methylphenidate addicts, some of whom have ­ADHD, some who don’t.

There is a particular risk of addiction in patients diagnosed later on in life, because it is only after they have experienced the effects of the medication that they realise the full extent of their ADHD. Medication should be taken in certain doses and at certain intervals so that a tolerance is not built up.

“Often [patients] have to decide when they need to ‘see’ — or think or focus,” Wood says. “For example, you might be working perfectly until seven o’clock at night, when it wears off, and there is a massive pull to want to take it again.” The risk of addiction in non-ADHD patients is often higher than in those who suffer from the condition.

Even if you don’t need glasses, there might be times when you need to use a pair of binoculars, says Wood. In the same way, he says, even if you don’t need Ritalin for ADHD, you might find you need it in order to study for long hours.

The effect of Ritalin on the non-ADHD brain may be different, but it is still powerful. It might not serve to correct sight (or the functioning of the brain) but, as with binoculars, it can enhance it. Methylphenidate makes it easier to make mental links.

Ritalin, or “Kiddie Coke”, not only shares neurochemical properties with cocaine, but the two drugs work in similar ways.

While Ritalin is not as addictive as cocaine, the resemblances are striking.

“If you were to inject cocaine intravenously or inject Ritalin, most of us who aren’t very experienced with these drugs wouldn’t recognise a big difference,” says Professor Glen Hanson, head of the department of pharmacology at the University of Utah.

However, a regular cocaine user would be able to tell the two apart.

“The cocaine comes and goes in a matter of minutes,” says Hanson, whereas the effects of Ritalin may last for hours.

“So, on the one hand, yes, they look the same — they would substitute for each other. If the person was doing cocaine and they couldn’t find any, Ritalin would sort of hold them until they could find some,” he explains, “assuming they were injecting it or snorting it.”

On the other hand, because Ritalin’s effects last longer and it has some “other unique features”, according to Hanson, it is less likely to be abused than cocaine.

“But it certainly is abused,” he says.

The increased heart rate after snorting a line of Ritalin is similar to the sensation that would be experienced by a cocaine user. This is because, according to Hanson, the drugs are both “sympathomimetics”. “[This] means they stimulate the sympathetic nervous system and that’s what controls the cardiovascular system.”

“So if you’ve got somebody who has an underlying cardiovascular problem, they’re inclined towards high blood pressure or arrhythmias where the heart beats irregularly, [and] a drug like Ritalin could set that off and could cause some serious cardiovascular consequences.”

In 2006, the United States Food and Drug Administration (FDA) was advised that stimulant medications should be issued with warnings on the box. According to an article in the Florida-based Sarasota Herald-Tribune on February 10, 2006: “After hearing about 25 deaths among people taking the drugs, federal health advisors recommended … that such a warning be added to labels on Ritalin and other Methylphenidates …  . The FDA said it had evidence suggesting the drugs were linked to an increased risk of sudden death and serious cardiovascular problems, including heart attacks.”

In its online edition, the British publication the Daily Mail reported on November 27, 2007, that 11 children in Britain had died while on Ritalin: “The cause of two deaths was heart-related — one had a heart attack, the other an enlarged heart.”

This is a danger particularly for people with an existing heart condition. However, the drug is often prescribed without a full health evaluation, which may be one of the biggest problems.

The potential complications do not end there. If consumed intra-nasally, the drug may result in symptoms similar to those experienced by cocaine addicts.

“One of the problems may be nasal vessel constriction, leading to a lack of oxygen supply, and eventually necrosis, as is seen with cocaine,” says UKZN’s Andy Gray. Necrosis, in this context, refers to the premature death of cells in the living tissue of the nasal cavity. In extreme cases, this can lead to the complete collapse of the nasal cavity.

People taking extremely high doses of Ritalin, especially if they have an existing psychological problem, are also at risk of becoming mentally unstable, placing themselves and others in danger.

“If you’ve got a person who has underlying psychiatric problems anyway, let’s say that they are bipolar,” explains Hanson, “Ritalin can kick them into a manic episode.”

He also warns that if a person has an anxiety disorder, Ritalin, especially the misuse of the drug, may initiate a panic attack.

“I actually was an expert witness in a case here in the United States against a young man [who] was diagnosed with ADHD, but, as it turns out, was also borderline psychotic or schizophrenic.”

The man was prescribed Ritalin, but began to abuse the drug. “He was accumulating it, using large quantities, grinding it up and snorting it,” explains Hanson.

During this period of deviant drug behaviour, the man had multiple psychotic episodes.

“On one such occasion, he killed his mother and father and seriously injured his siblings while under the influence of Ritalin.”

Hanson says this “incredible tragedy” is an extreme case. “You don’t see that a lot, but it does [show] that it’s possible under some unusual circumstances.”

• This is an edited extract from Snorting Rit and this e-book is exclusively available from MampoerShorts. Read the full e-book now by downloading it from www.mampoer.co.za

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