The Colorado State Board of Education recently established a remarkable precedent. On November 11, they passed a resolution expressing serious concern about the exploding rates of psychiatric drug use with children in United States schools, and encouraging educators to emphasize use of proven academic methods to resolve problems in the schools. Board members were influenced by the evidence that the primary diagnosis justifying prescription of psychiatric drugs for children, Attention Deficit Hyperactivity Disorder (ADHD), has never been demonstrated to be a real disease. Last year, the National Institute of Health sponsored a consensus conference (11/18/98), gathering a collection of experts and researchers from across the land in hopes of resolving controversy about ADHD and related psychiatric drug use. The final statement of the conference read: "...we do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction."
This year's tragedy at Columbine High School in Littleton, Colorado, was also a factor. It is not surprising that people in Colorado are impressed by the fact that a remarkably high percentage of the perpetrators of this decade's rash of senseless killings in the schools were taking prescribed psychiatric drugs. Considerable research has shown that agitation, manic psychosis, and violence are well-known effects of certain psychiatric drugs, including Ritalin, and especially Prozac and related selective serotonin reuptake inhibitors (SSRI's). Eric Harris, one of the Columbine killers was taking an SSRI called Luvox.
How big is the problem of psychiatric drug use by children in U.S. schools? The Colorado school board resolution inspired me to do a little research on the subject. In 1970, a best guess was offered that 150,000 children in the United States were taking Ritalin. In 1980, estimates were between 270,000 and 541,000; use roughly doubled in that decade. By 1990, estimates were closer to 900,000, again roughly doubled. There was, according to the Drug Enforcement Agency (DEA), a 700% increase in the production of Ritalin between 1990 and 1997, 90% of which was consumed in the United States. A conservative estimate of United States school-age children on Ritalin in 1997 was 3,500,000; another 1.4 million were estimated to be taking other amphetamines. (See Dr. Lawrence Diller's popular 1998 book, Running On Ritalin, for a thorough review of this data.) Neurologist Fred Baughman, another thorough researcher on this topic, estimates the current number at between 5 and 7 million. IMS Health, a commercial drug survey company, documents the continuing increase in Ritalin prescriptions, 13.9 million for the 1997-1998 school year, with a predicted 42% increase for 1998-1999. The IMS data also reveals that for analeptic class (stimulant) drugs used to treat ADD/ADHD, Ritalin comprised 69% of the U.S. market. Others, including Adderall, Cylert and Dexedrine, made up the balance of 31% of the total prescriptions dispensed. Production data collected by the DEA confirms that any leveling off of methylphenidate production in the last three years has been more than matched by increased production of other amphetamine-type drugs; the total numbers continue to rapidly grow.
Based on this available data, a realistic estimate of the number of school-age children on Ritalin today in the United States is 5,000,000. Since Ritalin represents 70% of the total prescriptions for amphetamine-type drugs, adding the other 30% brings our estimate to over 7,000,000 school children in this country on stimulant drugs. In 1971, when estimates of Ritalin prescription use was under 200,000, our country was alarmed enough that the DEA classified Ritalin and other amphetamines as Schedule II drugs, a category that indicates significant risk of abuse. The number of children on psychiatric stimulant drugs today (7,000,000) is 40 times the 1970 number (175,000). This has got to be a cause for major alarm in all adults concerned for the welfare of our children. Yet even this is not the whole picture. We are not only giving more and stronger amphetamines like adderall and dexedrine to our children, we are also witnessing a dramatic increase in the use of adult antidepressants with the children.
We had a reported 735,000 children ages 6-18 on Prozac and related anti-depressants in 1996, up 80% since 1994. This included a 400% increase in the number of children ages 6-12 on Prozac in just one year, 1995 to 1996 (Arianna Huffington, Chicago Sun Times, 6/17/98). A 1998 article by Kate Muldoon (The Oregonian, 6/1/98) reports the number as 909,000. In a more recent article (Ariannaonline, 5/6/99), Ms. Huffington reports that, despite disturbing evidence of drug-induced manic reactions, the number of antidepressant prescriptions for children continues to soar, reaching 1,664,000 in 1998.
The bottom line is that we are giving stronger and stronger psychiatric drugs to more and more children. Many of our children are taking more than one of these drugs at a time, and many of these drugs were never even tested and approved for children. Probably over 8,000,000 school-age children in the United States are on powerful psychiatric drugs today. Other than our neighbor Canada, no other countries in the world are using psychiatric drugs this way with their children; it is a distinctly North American phenomenon.
DEA data puts Texas at number 31 in a listing of 1998 retail distribution for methylphenidate and d-amphetamine, and number four on dl-amphetamine -- so let's just say we're right in the middle, about average in this country. What does it mean that 8,000,000 children are on psychiatric drugs? U.S. census data reveals that the United States population for ages 6-18 is about 51,473,000; this would indicate that approximately 15% of our school-age children are on psychiatric drugs. Does this seem unbelievable? Two recent research articles clearly demonstrate there are communities, one in Virginia (American Journal of Public Health, September, 1999), the other in the Vancouver, Canada area (The Province, 9/9/99), where the rates of stimulant prescriptions to children is 20%. The International Narcotics Control Board reports that in some American schools, as many as 40% of children in a class are on methylphenidate. A recent Time Magazine (10/25/99) article describing a week in a typical American high school, reported the estimate of the school social worker that as many as 20% of the school's students take psychiatric drugs. There are large disparities from school to school and county to county, but however you slice it, the numbers are amazingly high. Since the population of Texas is approximately 13% of the total United States population, that means that about 1,000,000 of the children in our elementary and secondary schools in Texas are on psychiatric drugs. This is cause for grave concern, and, I think, places on all our shoulders a moral imperative for action.