"In 1999, 165 methylphenidate [Ritalin]-related poison calls were made in Detroit; 419 were reported in Texas, with 114 of those involving intentional misuse or abuse. "

(Source: The National Institute on Drug Abuse, "NIDA Infofax: Methylphenidate (Ritalin) 13555", National Institutes of Health, http://www.nida.nih.gov/Infofax/ritalin.html.)

"The fourth and most obvious reason millions of Americans, most of them children, are now taking Ritalin can be summarized in a single word that crops up everywhere in the dry-bones literature on ADD and its drug of choice: compliance. One day at a time, the drug continues to make children do what their parents and teachers either will not or cannot get them to do without it: Sit down, shut up, keep still, pay attention."

(Source: Mary Eberstadt, "Why Ritalin Rules," Policy Review, April & May 1999, No. 94.)

For 40 years, physicians have been prescribing it.  In the United States alone, it is taken daily by four to six million children, making it one of the most-prescribed pediatric drugs.  We seem to know almost nothing about it.

While prescribed to so many children for so many years, methylphenidate, more commonly known as Ritalin, has remained a mystery to the medical community.  The mechanism of how Ritalin works-or why-and the long-term effects of taking the drug are not known, but Nora Volkow, a psychiatrist at Brookhaven National Laboratory is on the job.

Using advanced imaging technology, Volkow has been able to track the level of dopamine residual in a synapse, which is usually "cleaned up" by transporters.  However, these transporters are blocked by certain drugs, most notably, cocaine: "Earlier research had shown that cocaine blocks about 50% of these transporters, leading to a surfeit of dopamine in the synapse and a hit of pleasure."

It had been assumed that methylphenidate works similarly to cocaine, but is less powerful. Volkow's research, to the contrary, found that, "Instead of being a less potent transport inhibitor than cocaine, methylphenidate was even more potent.  A typical dose given to children, 0.5 mg/kg, blocked 70% of dopamine transporters."

While Ritalin has not been shown to have any addictive qualities, perhaps due to the length of time it takes to raise dopamine levels, it is troubling to know that the most-prescribed psychiatric drug given to children is more potent than cocaine-and that we know so little else about it.

(Brian Vastag, "Pay Attention: Ritalin Acts Much Like Cocaine," JAMA, vol. 286, no. 8 [August 22/29, 2001], p. 905-906, [cf. J Neurosci. 2001; 21:RC121].)