Insight
on the News - Cover Story
Issue: 6/28/99
Doping Kids
By Kelly Patricia O'Meara
Just three weeks after Eric Harris and Dylan Klebold went on their April 20
killing spree at Columbine High School in Littleton, Colo., President Clinton
hosted a White House conference on youth violence. The president declared it a
strategy session to seek "the best ideas from people who can really make a
difference: parents and young people, teachers and religious leaders, law
enforcement, gun manufacturers, representatives of the entertainment industry
and those of us here in government."
There was, however, complete silence from the president when it came to
including representatives from the mental-health community, whom many believe
can provide important insight about the possible connection between the
otherwise seemingly senseless acts of violence being committed by school-age
children and prescription psychotropic drugs such as Ritalin, Luvox and Prozac.
There are nearly 6 million children in the United States between the ages of 6
and 18 taking mind-altering drugs prescribed for alleged mental illnesses that
increasing numbers of mental-health professionals are questioning.
Although the list of school-age children who have gone on violent rampages is
growing at a disturbing rate - and the shootings at Columbine became a national
wake-up call - few in the mental-health community have been willing to talk
about the possibility that the heavily prescribed drugs and violence may be
linked. Those who try to investigate quickly learn that virtually all data
concerning violence and psychotropic drugs are protected by the confidentiality
provided minors. But in the highly publicized shootings this spring, information
has been made available to the public.
* April 16: Shawn Cooper, a 15-year-old sophomore at Notus Junior-Senior High
School in Notus, Idaho, was taking Ritalin, the most commonly prescribed
stimulant, for bipolar disorder when he fired two shotgun rounds, narrowly
missing students and school staff.
* April 20: Harris, an 18-year-old senior at Columbine High School, killed a
dozen students and a teacher before taking his own life. Prior to the shooting
rampage, he had been under the influence of Luvox, one of the new selective
serotonin reuptake inhibitor, or SSRI, antidepressants approved in 1997 by the
Food and Drug Administration, or FDA, for children up to the age of 17 for
treatment of obsessive-compulsive disorder, or OCD.
* May 20: T.J. Solomon, a 15-year-old at Heritage High School in Conyers, Ga.,
was being treated with Ritalin for depression when he opened fire on and
wounded six classmates.
Two other high-profile cases from last year show a similar pattern:
* May 21, 1998: Kip Kinkel, a 15-year-old at Thurston High School in
Springfield, Ore., murdered his parents and then proceeded to school where he
opened fire on students in the cafeteria, killing two and wounding 22. Kinkel
had been prescribed both Ritalin and Prozac. Although widely used among adults,
Prozac has not been approved by the FDA for pediatric use.
* March 24, 1998: Mitchell Johnson, 13, and Andrew Golden, 11, opened fire on
their classmates at Westside Middle School in Jonesboro, Ark. Johnson had been
receiving psychiatric counseling and, although information about the
psychotropic drugs that may have been prescribed for him has not been made
public, his attorney, Val Price, responded when asked about it: "I think
that is confidential information, and I don't want to reveal that."
A great deal has been written about all of these cases. There have, however,
been no indications that all of these children watched the same TV programs or
listened to the same music. Nor has it been established that they all used
illegal drugs, suffered from alcohol abuse or had common difficulties with
their families or peers. They did not share identical home lives, dress alike
or participate in similar extracurricular activities. But all of the above were
labeled as suffering from a mental illness and were being treated with
psychotropic drugs that for years have been known to cause serious adverse
effects when given to children.
At the top of the list of so-called "mental illnesses" among children
is attention-deficit/hyperactivity disorder, or ADHD, which is diagnosed when a
child meets six of the 18 criteria described in the Diagnostic and Statistical
Manual of Mental Disorders, or DSM-IV, published by the American Psychiatric
Association, or APA.
ADHD was determined by a vote of APA psychiatrists to be a "mental"
illness and added to the DSM-IIIR in 1987. By definition, children with ADHD
exhibit behaviors such as not paying attention in school, not listening when
spoken to directly, failing to follow directions, losing things, being easily distracted
and forgetful, fidgeting with hands or feet, talking excessively, blurting out
answers or having difficulty awaiting turn. The most common ADHD remedy among
pediatricians and representatives of the mental-health community is, as noted,
Ritalin.
First approved by the FDA in 1955, Ritalin (methylphenidate) had become widely
used for behavioral control by the mid-1960s. It is produced by the Swiss
pharmaceutical company Novartis. According to the Drug Enforcement
Administration, or DEA, the United States buys and uses 90 percent of the
world's Ritalin. A U.N. agency known as the International Narcotics Control
Board, or INCB, reported in 1995 that "10 to 12 percent of all boys
between the ages of 6 and 14 in the U.S. have been diagnosed as having ADD
[attention-deficit disorder, now referred to as ADHD] and are being treated
with methylphenidate."
But opponents are concerned about evidence they say confirms a close
relationship between use of prescribed psychotropic drugs and subsequent use of
illegal drugs, including cocaine and heroin. While the United States has spent
more than $70 billion on the war on drugs, says Bruce Wiseman, president of the
Citizens Commission on Human Rights, a California-based organization that
investigates violations of human rights by mental-health practitioners,
"if you think the Colombian drug cartel is the biggest drug dealer in the
world, think again. It's your neighborhood psychiatrist ... putting our kids on
the highest level of addictive drugs."
This complaint is not new and there is a lengthy list of government agencies
connecting the prescribed psychotropic drugs to use of illegal substances.
Twenty-eight years ago the World Health Organization, or WHO, concluded that
Ritalin was pharmacologically similar to cocaine in its pattern of abuse and
cited Ritalin as a Schedule II drug - the most addictive in medical usage. The
Department of Justice followed the WHO by citing Ritalin in Schedule II of the
Controlled Substances Act as having a very high potential for abuse. As a
Schedule II drug, Ritalin joins morphine, opium, cocaine and the heroin
substitute methadone.
According to a report in the 1995 Archives of General Psychiatry, "Cocaine
is one of the most reinforcing and addicting of the abused drugs and has pharmacological
actions that are very similar to those of Ritalin." In the same year the
DEA also made the Ritalin/cocaine connection, saying, "It is clear that
Ritalin substitutes for cocaine and d-amphetamine in a number of behavioral
paradigms," expressing concern that "one in every 30 Americans
between 5 and 19 years old has a prescription for the drug."
Despite decades of warnings about the potential for abuse of Ritalin, experts
continue to argue that the benefits far outweigh the consequences. Yet the INCB
has reported that "Methylphenidate's [Ritalin] pharmacological effects are
essentially the same as those of amphetamine and methamphetamine. The abuse of
methylphenidate [Ritalin] can lead to tolerance and severe psychological
dependence. Psychotic episodes [and] violent and bizarre behavior have been
reported."
These are, in fact, some of the same symptoms exhibited by Eric Harris.
David Fassler, a child and adolescent psychiatrist and chairman of the APA
group on Children, Adolescents and Their Families, says he is unaware of any
research to suggest a correlation between the recent cases of violent behavior
in school-age children and the widespread prescription of psychotropic drugs.
Fassler argues that the number of school-age children suffering from mental
illnesses such as depression is "more than earlier believed and it is
important that there be a comprehensive evaluation by a mental-health clinician
trained in this area." He stresses that "treatment should be
multimodal - not left to medications alone."
Mike Faenza, president and chief executive officer of the National Mental
Health Association, the country's oldest and largest mental-health group, notes
that "there is little known about how the drugs affect brain
function." Faenza adds that "we do know that a hell of a lot of kids
commit suicide because they aren't getting the help they need. It's
irresponsible not to give them the help just because we don't know what causes
the mental illness."
Opponents are quick to capitalize on this admission. "There is no such
thing as ADHD," declares Wiseman. "It's not a deficiency of `speed'
that makes a kid act out. If you look at the criteria listed in the DSM-IV for
ADHD, you'll see that they are taking normal childhood behavior and literally
voting it a mental illness. This is a pseudoscience, entirely subjective.
Unlike medical conditions that are proved scientifically, with these mental
illnesses the only way you know you're better is if the psychiatrist says
you're better. That's not science."
Pediatric neurologist Fred Baughman not only agrees that there is no such
illness as ADHD, but says: "This is a contrived epidemic, where all 5
million to 6 million children on these drugs are normal. The country's been led
to believe that all painful emotions are a mental illness and the leadership of
the APA knows very well that they are representing it as a disease when there
is no scientific data to confirm any mental illness."
Peter Breggin, a psychiatrist and director of the International Center for the
Study of Psychiatry and Psychology and author of Talking Back to Prozac, Toxic
Psychiatry and Talking Back to Ritalin, for years has waged a war with the APA
about what he regards as its cavalier diagnoses of mental illnesses.
"Psychiatry has never been driven by science. They have no biological or
genetic basis for these illnesses and the National Institutes of Mental Health
are totally committed to the pharmacological line." He is concerned that
"there is a great deal of scientific evidence that stimulants cause brain
damage with long-term use, yet there is no evidence that these mental
illnesses, such as ADHD, exist."
Breggin points out that the National Institutes of Health, or NIH, admitted as
much at their 1998 Consensus Development Conference on the Diagnosis and
Treatment of Attention Deficit Hyperactivity Disorder. Thirty-one individuals
were selected by NIH to make scientific presentations to the panel on ADHD and
its treatment. The panel made the following observations and conclusions:
"We don't have an independent, valid test for ADHD; there are no data to
indicate that ADHD is due to a brain malfunction; existing studies come to
conflicting conclusions as to whether use of psychostimulants increases or
decreases the risk of abuse, and finally after years of clinical research and
experience with ADHD, our knowledge about the cause or causes of ADHD remains
speculative."
If so, there is little evidence to support a scientific basis for classifying
ADHD as a mental illness. On the other hand, there is an abundance of evidence
that stimulants such as Ritalin can produce symptoms such as mania, insomnia,
hallucinations, hyperactivity, impulsivity and inattention. And the DEA's list
of potential adverse effects of Ritalin includes psychosis, depression, dizziness,
insomnia, nervousness, irritability and attacks of Tourette's or other tic
syndromes.
While Ritalin is the drug of choice for treating ADHD, other mental illnesses
such as depression and obsessive-compulsive disorder, or OCD, from which
Columbine shooter Harris suffered, are being treated with new SSRI
antidepressants. Harris' autopsy revealed that he had used Luvox (Fluvoxomine),
an SSRI, prior to the shooting spree. And days earlier he had been rejected by
the Marine Corps because he was taking the psychotropic drug.
Luvox, a cousin of Prozac, has been approved by the FDA for pediatric use,
although research shows that a small percentage of patients experience adverse
effects such as mania, bouts of irritability, aggression and hostility. But many
physicians still prescribe it to children.
More disturbing to those who believe sufficient evidence exists that
prescription psychotropic drugs may play a role in the violence being carried
out by school-age children is the response of physicians to the issue. Rather
than erring on the side of caution by reducing the number of kids on
mind-altering drugs, physicians instead are prescribing psychotropic drugs even
to infants and toddlers. The warning label states that "Ritalin should not
be used in children under 6 years, since safety and efficacy for this age group
has not been established" and "sufficient data on safety and efficacy
of long-term use of Ritalin in children are not yet available."
A report in the July 1998 issue of the Clinical Psychiatric News revealed that
in Michigan's Medicaid program, 223 children 3 years old or younger were
diagnosed with ADHD as of December 1996. Amazingly, 57 percent of these
children, many of whom are not yet capable of putting together a complete
sentence, were treated with one or more psychotropic drugs including Ritalin,
Prozac, Dexedrine, Aventyl and Syban. Thirty-three percent were medicated with
two or more of these drugs.
But it is Ritalin that is being prescribed to 6 million American children.
Children's Hospital in Washington has been running television advertisements
expressing concern. According to its spokeswoman, Lynn Cantwell, the ads were
part of a series covering many medical issues. "We wanted to advocate that
children get a comprehensive evaluation because we are finding that children
were coming in who were taking Ritalin who actually did not have ADHD."
Wiseman has suggested that the only way to gain control of the situation is to
expose widespread "fraudulent diagnoses" of psychiatrists. "Without
the diagnoses, you can't get the drugs," he says. Baughman's answer isn't
too far from Wiseman's. He says, "A big-time class-action lawsuit needs to
be filed."
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