Miracle drug or dangerous?

Whenever Lisa* tries to study, she already knows she’ll fail. It’s the same every time: after a few minutes, she starts getting restless. She checks her phone, ‘even when I put it in a different room’. She knocks on her roommates’ doors, to see if they have anything to distract her. ‘I just can’t focus.’

Until she found a little pill that made it all better.

‘I remember thinking, wow’, she says. ‘Normally, there are so many things going through my head all at once. Ritalin just calms me right down.’ While she was previously unable to focus on just one thing at a time, now she could. ‘I didn’t even notice how hard I was working.’

Lisa’s miracle drug is called methylphenidate, better known as Ritalin, or ‘Rita’ for short. Whenever she takes it, dopamine is released into her brain, which is then turned into norepinephrine. This is responsible for the ‘flow’ she experiences when she manages to focus on a text for three hours without noticing.

Extremely popular

For obvious reasons, Ritalin is extremely popular among students. In reality, it’s medication that is often prescribed to people who have been diagnosed with ADHD or ADD. But they are not the only people who take it.

The Institute for Responsible Use of Medication (IVM) asked four hundred students about their Ritalin use. More than a quarter of them said they occasionally take the drug. The main reason was to focus better, although some students took the drug before going out at night. None of these students were diagnosed with a disorder, nor did they have a prescription for the drug.

So how do they get it?

The right people

From second-year student Floyd, for example. He has ADHD. He is prescribed Ritalin by his GP, and he picks up two boxes of the drug at his pharmacy. He usually takes all the pills himself, but every once in a while, he gives a few to his roommate. ‘I don’t charge him for it; it’s free thanks to my health insurance.’

None of these students were diagnosed with a disorder, nor did they have a prescription for the drug

Obviously, Floyd doesn’t supply all of Groningen. But after some asking around, we find out that there are many students just like him. All the students we approach say they have no problems getting the drug through people they know.

Psychology student Jorrit* gets Ritalin from his roommate, who was diagnosed with ADD. ‘He gives them to me for free, but he occasionally sells them to others. For how much? Three or five euros a pill, something like that?’

‘You need to know the right people’, says Lisa. For her, it was a little harder to find the drug. ‘When I realised how well it worked for me, I started asking around. I got a lot of drug dealers’ numbers at first, but they usually don’t have it.

At last, she found someone selling their own Ritalin. At the start of the academic year, she bought sixty pills from them. They came in packs of fifteen and cost ten euros per pack. ‘It’s enough to last me through the year, because I only use it when I need to study really hard.’ Lisa also sometimes gives pills from her stash to her friends.

Law

Ritalin falls under the opium act. Giving it away, selling it, or possession without a prescription is illegal. To prevent people getting more Ritalin than they need, both GPs and pharmacists strictly monitor its dispensation.

‘A general practitioner can prescribe methylphenidate to people diagnosed with ADHD’, says Mariëlle van Avendonk, senior scientist at the Dutch College of General Practitioners. ‘But our advice is to not prescribe it too easily.’ The College prefers treatment without drugs: therapy or counselling. Only when that doesn’t work should Ritalin be considered.

Finding the right dosage can take a while, and differs per patient. ‘Most first-time drugs are only prescribed for two weeks’, says Ebian Brill, pharmacist at the Hanzeplein pharmacy.  ’This is to prevent too much being thrown away if people don’t take to the drug. Even when the GP has prescribed something for a longer period of time, the pharmacy changes it to two weeks.’

I got a lot of drug dealers’ numbers at first, but they usually don’t have it

After the trial period, pharmacies give people no more than three months’ worth of Ritalin, just like with any other medication. How many pills that amounts to varies per patient. ‘If the GP prescribes one pill per day, that means we’ll give someone ninety pills’, says Brill. ‘As pharmacists, it’s also our duty to monitor supplies. So we pay extra close attention who we give it to, and we’re very strict when it comes to stock control.’

Left-over pills

With all these rules and all that supervision, how to Jorrit, Lisa, and so many other manage to obtain ‘left-over pills’?

‘My roommate is prescribed enough Ritalin to take it every day, but he doesn’t’, Jorrit explains. ‘He doesn’t like it because of the side effects. So he only takes it when he really needs it. And that’s a lot less often than the prescribed dose.’

Floyd suspects it’s all too easy to have your dosage increased. He currently gets two boxes for three months, but that’s not set in stone. ‘I’m pretty sure I could get four or five boxes a month, as long as I can convince my GP.’

Mariëlle van Avendonk is concerned about people giving their Ritalin away. ‘It’s just so dumb. There’s a reason we tell people to be careful: the long-term effects of Ritalin have never been properly studied. When a child is prescribed Ritalin for a few years, we pretty much know how they will be when they’re eighteen. But we don’t know how someone will feel when they’re thirty, or forty.’

Side effects

Contrary to most drugs, Ritalin has mainly been studied for the side effect it has on children. Brill: ‘It’s been shown to work in children, but we don’t know what this medication does for adults.’

And while methylphenidate might help people concentrate, it also comes with a host of side effects. ‘That’s why I never take more than one pill a day’, says Lisa. ‘It can cause headaches, sweaty palms, heart palpitations.’

I’m pretty sure I could get four or five boxes a month, as long as I can convince my GP

The drug also strongly affects people’s mood. One of the students we spoke to stopped using Ritalin for that reason: it was messing up his personality, he felt. ‘Someone who uses a lot of Ritalin becomes emotionally distant’, Jorrit says. ‘You can really tell.’

Lisa remembers all too well that time she popped a pill right before an exam. ‘I’m usually a pretty upbeat person. And this was my last exam. Usually when those are done I feel a sense of euphoria that it’s over. But this time when I left the exam hall I felt nothing. Just nothing at all.’

Parties

So why is Ritalin prescribed so much? Brill: ‘Apparently people put great stock in a drug to treat ADHD children. And it’s not like there’s three other drugs on the market that work just as well.’ There are other sides to the problem as well, says Brill: ‘Why is Ritalin such a problem in the 21st century, when it wasn’t in the twentieth?’ He doesn’t know how to answer this question either.

It can cause headaches, sweaty palms, heart palpitations

In spite of all the drug’s drawbacks, the students we talked to weren’t worried. ‘I only use it every so often, at parties’, says Jorrit. ‘I’m not really prone to addiction, anyway. So I’m not really worried about long-term effects.’

As far as Lisa is concerned, the advantages are worth the risk. ‘I tried to go without. I went to the Student Service Centre, and a psychologist, so see if I could work on my concentration some other way. But I just couldn’t. I can’t study without Ritalin.’

When asked if she will quit the drug when she graduates, she is quiet for a while. ‘I hope so’, she says. ‘It depends on my future job I guess. Whether or not I’ll have to read a lot.’

At the request of the interviewees, the names Lisa and Jorrit are fictional. Their real names are known to the editorial staff.

Dutch