Pill popping to pass: The effects of Concerta and Ritalin
STEPHANIE COOKSON AND SHANTÉ KROUKAMP
In July 2017, News24 wrote that “the trend of taking ADHD medication without a prescription has been around for a number of years and is now considered commonplace in universities.” Over a year later, in November 2018, Addiction Centre published an article claiming that one third of college students abuse Concerta and other prescription drugs. It therefore may not come as a surprise that there seems to be an informal illegal trade of Concerta and Ritalin among students at the University of Pretoria. Although this trade may have occurred for a number of years, it has recently become publicised with sellers advertising these schedule six drugs on academic WhatsApp groups. What is worrisome is the potential biological and psychological effects that Concerta and Ritalin may have on students who are not meant to be taking these drugs.
In South Africa, schedule six drugs are defined as substances with a high potential for addiction. Similarly, the Drug Enforcement Administration (DEA) of the United States define schedule II substances, schedule six in South Africa, as dangerous drugs with a high potential for abuse and with use potentially leading to severe psychological or physical dependence. Schedule six drugs can only be obtained with a doctor’s prescription and professional control over the supply of these substances. The dispensing is limited to a 30-day supply at most. Ritalin and Concerta can only be prescribed by a psychiatrist or general practitioner and dispensed by a pharmacist.
Despite apparent strict regulations surrounding Ritalin and Concerta, it seems that these drugs are fairly easy to access. This was suggested during an interview that PDBY conducted with a student who uses their own prescription to sell Ritalin and sells Concerta for others who have a prescription. The student, who wishes to remain anonymous for legal reasons, says that
“you can bull**** your way into getting it, it’s super easy.”
The student, Anonymous A, is on a government grant for Ritalin and says that the process of obtaining a prescription involves mental-health checks. “I have to go to the clinic and they just do […] a [psychological] evaluation asking […] if you don’t hurt yourself, if you’re feeling depressed, if you have suicidal thoughts.” However, Anonymous A says that government evaluations to obtain Ritalin are not as thorough as the evaluations done by private doctors. According to Anonymous A, all that is needed is proof of household income and “they’ll give it to you for free, just like that”.
The accessibility to Ritalin and Concerta is of concern considering that they are both psychostimulant methylphenidates and have the same chemical compilation as that of “uppers” like cocaine and methamphetamine. Ritalin and Concerta are versions of the same drug, called methylphenidate hydrochloride. Therefore, they have the same active ingredient, but with notable differences.
Concerta has a gradual-release pattern and is long-acting, whereas Ritalin has an immediate release pattern, is short-acting and instantly increases dopamine and norepinephrine levels. In short, these stimulants have stabilising effects on the brain and are used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. When Ritalin and Concerta is taken by an individual with ADHD, the resting level of brain activity is increased to a more functional level where these individuals are able to pay attention and concentrate.
To find out more about the effects of Ritalin and Concerta on people who have not been prescribed these drugs, PDBY spoke to Dr Franco Colin, a psychiatrist based in Pretoria. According to Dr Colin, studies have found that when Ritalin and Concerta are used correctly by those with ADHD
“students indicate very clear benefits for concentration and cognitive focus.”
These benefits do not necessarily translate to those who engage in non-medical use of prescription stimulants (NPS). Another study cited by Dr Colin states that “several research studies have observed that NPS most likely does not confer an academic advantage, and is associated with excessive drinking and other drug use.” When asked if Ritalin and Concerta abuse could be linked to higher rates of depression during academically demanding periods, Dr Colin referred to a study published in the Journal of Medical Ethics to confirm that there is a link between NPS and depression.
The study examined the side effects of NPS in comparison with placebo and found that 21% of students experienced depression or sadness due to NPS compared with only 9% of students who were given a placebo. Depression is not the only common side effect of these schedule six drugs. Other common side effects include sleep problems, change in appetite, and anxiety. These side effects were experienced by another student, Anonymous B, who was prescribed Concerta at the age of twelve. According to them, Concerta induced behavioural changes such as worsening of mood and temper. Eventually they were prescribed Ritalin instead of Concerta. However, they said that they “don’t like to take it [Ritalin] for prolonged periods of time because [they] lose [their] appetite, become more anxious and can’t sleep properly”. Anonymous B, who no longer uses a prescription for Ritalin but rather buys from a friend when needed, says they do not like Ritalin as there becomes a heavy reliance “where you feel as if you cannot function without it”.
Lesser known side effects of Ritalin and Concerta include disorientation, paranoia, hallucinations, psychoses, aggression, compulsive behaviour and a manic-like state. Physiological effects may include increased heart rate, convulsions, increased blood pressure, headaches and sinus arrhythmia. Long term use or abuse may lead to addiction as well as permanent changes in the brain’s serotonin levels and frontal cortex activity. Anonymous A acknowledges the multiplicity of side effects that these drugs may have on you, saying that it is “different for every person. You don’t know the effect it’s gonna have on you unless you take it for a long time.” Anonymous A has been taking Ritalin since primary school, and says they understand the effect that it can have on someone. They also experienced loss of appetite which affected their weight and they claim that Ritalin can cause depression in some people. Anonymous A believes that if students feel the need to take such medications just to pass, there is a flaw in the education system rather than in student’s intellectual capabilities. When PDBY asked Anonymous A why they sell concentration medication despite the negative side effects and illegality, they explained that
“at the end of the day, we’re all students and we do **** to get through our stuff, and as I say, if not from me, it’s gonna be from someone else,”
adding that they understand the need for these medications among students. Some, however, believe that students have become too reliant on such drugs. This sentiment was expressed by a staff member at Student Health Services, who wishes for anonymity and to be referred to as “the campus doctor”. The campus doctor said that students view concentration medications as a crutch and are desperate to pass modules which makes them disregard the long-term consequences. The campus doctor adds that these medications can lead to psychological dependency, which is why such medications are schedule six. Whether you believe that students need access to such medication or are too reliant on it, the fact that Ritalin and Concerta use and abuse seems to be the norm reflects pressures felt by students. While it is understandable that some students feel the need to resort to such coping mechanisms, the potential side effects, especially for those who are not prescribed these drugs, beckons whether there is more to be lost than to be gained.
Photo: Ncululeko Ngcobo