Insight on the News
June 28, 1999, Monday
SECTION: COVER STORY; Pg. 10
Doping Kids
By Kelly Patricia O'Meara; INSIGHT
SUMMARY: Though shocked by bizarre shootings in schools,
few Americans have noticed how many shooters were among the 6 million kids
now on psycotopic drugs.
TEXT: 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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