feussner5

Incidents that involve diversion of MPH medication intended for ADHD treatment have
been reported to DEA by a wide variety of sources. State and local law enforcement cases have identified four different types of illicit activities: 1). adults who divert children's medication for their own personal use or to sell or trade it for other drugs; 2). children who selfgive their own/siblings medication to friends and classmates; 3). adolescents who abuse their own medication or obtain it from friends or classmates; and 4). theft of school-held supplies of MPH.

Parents who "doctor shop" or abuse their children's medication is not a particularly new type of diversion as the earlier discussion on the "ADD scam" in Missouri documents. Recent law enforcement cases involving doctor shopping for MPH have been reported in Ohio, New York, Kentucky, Louisiana and Virginia. While Missouri has considerably less documented abuse of methylphenidate than in the 1980s, seven drug treatment centers reported that they had clients who were using their children's MPH prescriptions (documented in a 1995 survey on Ritalin conducted by the Missouri Department of Health).
As a result of DEA inquiries about adolescent misuse/abuse of MPH during the 1995 review, the DEA received numerous reports of students that gave, sold, traded and/or abused their own MPH medication or that of a sibling, friend or classmate. State and local law enforcement cases involving high school students in Iowa, Missouri, Michigan and Virginia were reported to DEA. In 1995, MPH was a contributing cause of death of a college freshman in Mississippi and the cause of death of a teenager in Virginia. In both instances MPH tablets were supplied by someone who had a legitimate prescription for the drug and the MPH tablets were crushed and snorted. Police reports of interviews with teenagers who were snorting MPH indicated that these youngsters did not view this activity as dangerous. Adolescent drug treatment centers in Michigan and Missouri reported having several clients who were abusing
MPH, but very few clients who identified MPH as their primary drug of abuse. The vast majority of incidents brought to DEA's attention involving students that were using MPH illicitly (selling, giving, trading, abusing) at school were not reported to law enforcement authorities at all but were handled by school officials and parents. Penalties frequently involved suspension or expulsion from school.
Schools in Connecticut, Michigan and Virginia reported break-ins and thefts of school-held supplies of MPH. In addition, law enforcement case files have documented the theft of this medication by school personnel. For example, a highly respected teacher was videotaped stealing MPH from the nurse's office the evening of an awards ceremony that was honoring him as "teacher of the year." In another incident, a school nurse who was responsible for safeguarding school supplies of medication, stole the children's MPH medication. In a school that required a student to provide proof of medication need (a doctor's prescription), the principal was discovered taking the MPH prescriptions and having them filled by pharmacies throughout the state for his own personal use. It is important to note that many schools have as much, if not more, MPH stored on a daily basis than many pharmacies but without the safeguards and accountability required of registered handlers.

At the conclusion of DEA's review in 1995, there was little doubt that children were diverting and using MPH illicitly. However, due to a number of factors including privacy issues relating to children and the lack of a formalized method to obtain state or local law enforcement data, it was difficult to determine how widespread this problem actually was. In other words, was this a random problem in certain areas or was it a more pervasive problem that was not being reported/captured by traditional sources of information?. 1TI order to address these questions, the DEA conducted a survey in three states: Indiana, South Carolina and Wisconsin. These states shared two characteristics: ARCOS data indicated that all three states were considered high users of MPH and the DEA had not received a single anecdotal or law enforcement case involving illicit use of MPH by adolescents from these states. The high use criteria was made to eliminate any doubt about not finding cases because too few children were being treated with MPH. The second criteria was selected because it was felt a fair assessment required not knowing whether any ADHD-related MPH diversion or abuse would be found. Because it was postulated that traditional data sources like law enforcement case files, forensic laboratory reports and state controlled substances authorities could not provide the information sought, a number of non-traditional sources of information were explored. Interviews were conducted with physicians, adolescent treatment center personnel, school officials, nurses and teachers. Where available, poison control data and MPH prescription data were obtained. No effort was made to do a randomized sampling of the various sources of information. However, an effort was made to obtain information from communities of varying populations and locations within each state and the physicians who were interviewed were pediatric specialists for ADHD and child psychiatrists. Data were collected over a one week period in each state by this author and a trained DEA diversion investigator from each state. No attempt was made to do an exhaustive search of all possible cases related to MPH diversion as resources and time did not permit that type of investigation. The results were reported at a 1996 DEA conference on Stimulant Use in the Treatment of ADHD72 and will be summarized herein.