OVERDOSES OF EASY-TO-GET RITALIN SOAR

Calls to CHEO poison centre more than quadruple since 1993.

The number of children and teens accidentally ingesting or
intentionally overdosing on Ritalin has increased significantly -- a
trend doctors say reflects the dramatic growth in the use of the drug
to treat attention-deficit disorders.

The Poison Information Centre at the Children's Hospital of Eastern
Ontario handled 84 calls in 1997 concerning children and adolescents
who had accidentally taken, or intentionally overdosed, on Ritalin, up
from 18 in 1993.

Thirty-nine of the calls involved children under 13, down slightly
from 46 children in the same age group the previous year, but up from
five in 1993.

Forty-five calls involved teens under 18, compared to 29 the previous
year.

The centre received another 47 calls last year involving Ritalin and
adults, up from 28 the previous year. Although the poison information
centre is located at CHEO, it's also responsible for treatment of adults.

In all, 47 calls last year involved accidental overdoses, and the
majority of those involved children under four, said Jill
Courtemanche, a consultant with the poison control centre.

``In most cases, they got into a sibling's (Ritalin), or got into
another child's at school,'' she said. ``Usually it's a child who took
a brother's or a sister's dose that's been left out, or a child takes
his medication to school and some other child gets into it.'' Other
cases have involved caregivers who accidentally gave a child a double
dose of Ritalin.

Of the 55 cases last year that were classified as an ``intentional''
overdoses, 15 were in teens under the age of 18.

``Six of those were definitely classified as abuse -- they took it to
get high,'' Ms. Courtemanche said.

She said it's not clear how many of the remaining intentional
overdoses involved suicide attempts. The poison line handles calls
from ambulance attendants and paramedics, as well as hospital
emergency staff, and Ms. Courtemanche says it's not always made clear
whether the overdose is the result of someone trying to get high, or
trying to commit suicide.

``This could potentially be quite medically serious. If you took
enough (Ritalin), you could end up in intensive care,'' Ms.
Courtemanche said.

While the number of Ritalin-related calls ``have gone way up,'' she
stressed that Ritalin is nowhere near the top of the list of the
drugs, such as acetaminophen (Tylenol) and sweetened children's
medications, that are accidentally ingested by children. And the
Ritalin calls represent less than one per cent of the 15,900
poison-exposure calls the centres handles each year.

``I don't want to be a scaremonger and I don't want parents who have
had their child appropriately assessed to be unduly concerned about
having this prescription for their children,'' Ms. Courtemanche said.
She said that, for children who truly suffer an attention-deficit
disorder, Ritalin can be ``a miracle drug.''

``But parents just need to be aware it's a medication that needs to be
handled with care.''

Dr. Mary Pothos, a pediatrician at CHEO, says the increased number of
Ritalin-related calls to the poison centre reflects the fact that
Ritalin ``is out there'' -- more people are using it, and children
have greater access to it.

In fact, the number of Ritalin prescriptions has increased five-fold
in Canada since 1990. According to IMS Health, a health-care company
that tracks prescription drug use, Canadian pharmacies dispensed
693,000 prescriptions for Ritalin in the 12-month period ending June
1998, up from 138,000 prescriptions in 1990.

The number of children and adults taking Ritalin for attention

deficit-hyperactivity disorder has doubled over the past four years,
according to IMS, from 191,000 patients in 1994 to 385,000 this year.
The number of males on Ritalin outnumber females four to one.

Children with attention deficit-hyperactivity disorder have a short
attention span and are easily distracted.

No one knows exactly what's behind the surge in Ritalin use, but
experts have speculated that it's due to everything from increased
awareness of attention disorders, to teachers and parents becoming
less tolerant of disruptive behaviour. There's also concern that some
doctors aren't doing a thorough enough assessment before prescribing
Ritalin.

According to a snapshot survey last year of students at the former
Carleton Board of Education taking Ritalin, the number of students on
Ritalin ranged from almost 10 per cent of boys at Queenswood Public
School, to none at Katimavik and Lamira Dow Billings elementary schools.

While Ritalin is still primarily being prescribed to children, a
growing number of adults are now taking the drugs. In 1998, seven per
cent of males taking the drug were adults, up from three per cent in
1994. (According to IMS, researchers at the Memorial-Sloan Kettering
AIDS Centre in New York are using Ritalin to treat fatigue in AIDS
patients.)

``Obviously the numbers (of Ritalin-related calls) have gone up
substantially,'' said Dr. Pothos, a pediatrician at CHEO. She said the
numbers should serve as a warning to parents that Ritalin is a
dangerous drug if given in high enough quantities, and that it's used
should be closely supervised.

``Parents need to be aware that (Ritalin) has to be stored cautiously
and has to be out of the reach of vulnerable, younger children.''

The active ingredient in Ritalin is methylphenidate, an
amphetamine-like drug that, when used to treat attention disorders,
helps to control compulsive and hyperactive behaviour.

If a child takes an accidental dose of Ritalin, depending on how much
he or she takes, the drug can increase the child's heart rate and
blood pressure, and make them combative or agitated, Ms. Courtemanche
said.

In most cases, the child is watched until the drug makes its way
through their system. ``It's really just a matter of watching them.''
She said she is not aware of any child having to be admitted to
hospital because of a Ritalin overdose.

She said some of the calls involving intentional overdoses have
involved teens living in group homes.

``Some of these kids are depressed, they're acting out when they take
the medication. It's hard to determine whether or not they wanted to
hurt themselves, whether they wanted attention, or whether they wanted
to get out of the group home.''

She said parents ``have to have a lot of respect for this drug. If you
have a child who is emotionally fragile or given to impulsive acts,
that's a child you want to monitor very carefully the amount of
medication they have access to.''

Checked-by: Rich O'Grady