Fri, 11 Mar 2005
Parents and public health policy makers have cause for concern about the finding of a study conducted at the University of Texas, MD Anderson Cancer Center. WebMD reports that all 12 children who were enrolled in a Ritalin trial "experienced an increase in chromosome abnormalities three months after starting Ritalin."
The children were about 8 years old and had been prescribed Ritalin at normal therapeutic doses (20-54 mg/day). The children's blood was tested before they took the drug and after three months.
"It was pretty surprising to me that all of the children taking [Ritalin] showed an increase in chromosome abnormalities in a relatively short period of time," said Randa El-Zein, the lead author.
Chromosome damage may be a signal for an increased risk of cancer. Animal studies have repeatedly shown a cancer link. But this finding collides with current practice guidelines which rely heavily on Ritalin and other psychotropic drugs for children's bad behavior - and it poses a threat to manufacturers of psychostimulants - not just Ritalin.
While this study may not be definitive, it should raise red flags and a reassessment of the risk/ benefit rationale for prescirbing a potentially cancer producing drug for children.
Characteristically, experts from organizations with financial ties to drug manufacturers, and the media, are downplaying the disturbing finding. But parents surely need to know about the possibility of an increased cancer risk for children taking drugs such as Ritalin - so that they can make informed decisions affecting the welfare of their children.
The Los Angeles Times reports that prescription pills have become a societal force. Prescription drug abuse has supplanted illicit drug abuse. Thanks to the pharmaceutical industry's influence on physicians prescribing practice, Americans are hooked on addictive drugs: "Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug."
This drug dependency is fortified and reinforced by direct-to-consumer drug marketing which, the LAT points out "adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications."
Today's middle and high school students are experimenting with prescription drugs prescribed by physicians: Their drugs of choice: Ritalin, referred to as "kiddie cocaine." "After amphetamines such as Ritalin, they're turning to painkillers such as Vicodin and Percocet, then sedatives and tranquilizers."
According to data from the federal Drug Abuse Warning Network, visits to hospital emergency departments "increased significantly from 1994 to 2002 for overdoses of drugs such as narcotic prescription pain relievers and other medications. Although the data isn't broken down by age group, overdoses of hydrocodone, or Lortab, for example, rose 170 percent; overdoses of oxycodone, or OxyContin, increased 450 percent; and overdoses of benzodiazepines such as Valium and Xanax rose 41 percent. Data also show that many were using more than one drug."
Contact: Vera Hassner Sharav
Little pills can lead to big problems
'Ritalin generation' has discovered prescription drugs as a new high
By DANIEL COSTELLO
Los Angeles Times
Originally published Thursday, March 10, 2005
Ryan Smith remembers the night, during his junior year of high school, when a friend gave him his first Vicodin. "It felt so incredible. I remember thinking, 'I am going to do this for the rest of my life,'" he says.
Over the next year, Smith, now 22, and his friends moved on to other pills -- Xanax, Valium, OxyContin and the attention deficit disorder medication Adderall, called "kiddie cocaine" for its ability to be crushed and snorted. "At the time, it felt like I knew more kids who were doing pills than who weren't," he says of his Utah high school days.
Daniel Smith, his younger brother, began using prescription drugs the same way when a friend offered him Vicodin while watching a school football game during his sophomore year. By that summer, he began taking "weak painkillers" such as Lortab and Percocet. Finally, he turned to highly addictive OxyContin, using it several times a week.
Although the brothers eventually went through an addiction program, they never considered themselves "druggies." They were using pills safe enough to be used by millions of Americans, drugs both legal and easy to get. Each generation typically finds a new illicit drug to make its own: LSD in the '70s, cocaine in the '80s and Ecstasy and heroin in the '90s. Today's middle and high school students are experimenting with prescription drugs.
Their drugs of choice are those often preferred by adults. After amphetamines such as Ritalin, they're turning to painkillers such as Vicodin and Percocet, then sedatives and tranquilizers.
Nationwide, prescription pills have become a societal force. Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug.
Meanwhile, direct-to-consumer drug marketing that touts new and expanded uses has become widespread. Adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications.
As prescription drug sales have soared -- up nearly 400 percent since 1990 -- prescription medication has become the fastest-growing category of drugs being abused, with the biggest growth of abuse among people ages 12 to 24, according to the federal Substance Abuse and Mental Health Services Administration. After marijuana, prescription drugs are the drugs most commonly abused by teenagers, the federal agency says.
Nationally, an estimated 14 percent of high school seniors have used prescription drugs for non-medical reasons at least once in their lifetime, according to a 2004 University of Michigan survey that tracks drug trends among middle and high school students.
"It's a major concern to us that young people have the impression they can use medicine as a party drug," says Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment at the Department of Health and Human Services.
The rise in prescription abuse --or "pharming" as young people and drug counselors sometimes call it -- worries treatment counselors and drug research experts. A national push to reduce drugs such as marijuana, cocaine and heroin has started to pay off, with overall drug use among young adults declining slightly in recent years. But abuse of prescription drugs -- especially among younger people often dubbed the "Ritalin generation" -- has been growing and could grow further as drug sales continue to increase.
"Pills are more seductive to kids because they see them as cleaner, safer and less illegal," says Carol Falkowski, a drug researcher at Hazelden, a nationally known treatment center in Center City, Minn.
Many younger users don't know what many of the drugs are for or which pills are more addictive than others, Falkowski says. Nor do they have much sense of what dosages are truly dangerous or how separate drugs interact. Are four Percocets worse than two Vicodin? Can Valium be mixed with Xanax? Treatment counselors say some young users take a fistful of different drugs at once.
Data from the federal Drug Abuse Warning Network show that visits to hospital emergency departments increased significantly from 1994 to 2002 for overdoses of drugs such as narcotic prescription pain relievers and other medications.
Although the data isn't broken down by age group, overdoses of hydrocodone, or Lortab, for example, rose 170 percent; overdoses of oxycodone, or OxyContin, increased 450 percent; and overdoses of benzodiazepines such as Valium and Xanax rose 41 percent. Data also show that many were using more than one drug.
In face-to-face and telephone interviews with students at several middle and high schools in California, students say prescription drug use is frequently talked about at school but rarely discussed elsewhere.
Prescription drugs are often more attractive than other drugs, they say, because the pills don't have the telltale signs of use, such as the smell of marijuana smoke or the disorientation of being drunk.
Girls in particular appear to see the pills as "cleaner" than other drugs. They're less likely to use marijuana or cocaine than boys but equally likely to take prescription medications.
Some students see the pills as a way to enhance sports performance. They say football players at some schools take opiates such as Vicodin before games to blunt the pain.
Many schools have sophisticated black markets with fixed prices for individual drugs and dosages that vary according to supply and demand.
An 18-year-old senior and varsity athlete at Burbank (Calif.) High School says she doesn't consider herself a "big druggie." But about once a month, when she and her friends can find some, they like to take Vicodin, or "vikes," after school or before parties. "I just feel calmer on it. Nothing stresses me out," she says. Her friends are less cautious. They've also tried codeine, Valium, Percocet and Xanax, sometimes mixing several at once.
Students say prescription pills can often be less expensive than other drugs such as marijuana and cocaine. Pain pills such as Vicodin sell for around $5, depending on the dose, while stronger medications such as OxyContin can cost several times that. Ritalin, one of the most widely available drugs, sells for $1 to $2 a pill, students say, but can be more expensive before midterms and finals, when students use them to cram.
Under federal law, it's illegal to possess controlled substances without a prescription. But prosecutions for possession are rare, especially when minors are involved. Many schools bar students from carrying medications without a prescription, but enforcement can be difficult.
Response from state and federal governments and pharmaceutical companies, meanwhile, has been limited. Last year, the Bush administration introduced an effort to control prescription drug abuse, but most of the plan centers on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.
The Food and Drug Administration and the Substance Abuse and Mental Health Services Administration have instituted a new print and television ad campaign, "The Buzz Can Take Your Breath Away," highlighting the dangers of prescription drug abuse among young people. And Purdue Pharma, the maker of OxyContin, has introduced a public campaign about the dangers of abusing the drug after reports of misuse.
Ryan and Daniel Smith both recently completed a rehabilitation program for prescription drug abuse. Now attending college in Arizona, they say they're trying to keep each other from relapsing.
Both have been sober for nearly a year, and they've each started part-time jobs. The two say they occasionally attend narcotics anonymous meetings but don't like going because some of the people who attend depress them.
"We weren't really druggies," says Daniel. "We just fell into something. The pills were all over the place."
Does Ritalin Increase Cancer Risk in Children?
Small Study Suggests Possible Chromosome Damage, but Some Experts Skeptical
By Salynn Boyles
WebMD Medical News
Reviewed By Brunilda Nazario, MD on Tuesday, March 01, 2005
March 1, 2005 - Early research is raising concerns about the drug Ritalin, suggesting that children who take it may have an increased risk of cancer.
All 12 of the children included in the study experienced an increase in chromosome abnormalities three months after starting Ritalin. Chromosome damage has been linked to heightened cancer risk and to other health problems.
While potentially alarming, researchers say much larger studies are needed to confirm the preliminary findings.
"Nobody is saying that because a child takes Ritalin he or she will develop cancer," toxicologist and senior investigator Marvin Legator, PhD, tells WebMD. "There is nothing certain about this yet, but this is potentially a very large risk factor."
50 Years of Use
Ritalin is a stimulant widely prescribed for the treatment of attention deficit hyperactivity disorder (ADHD), with roughly 10 million prescriptions filled each year in the United States. The amphetamine-like drug has been approved for more than five decades. But sales of Ritalin and chemically similar drugs increased by more than 500% in the 1990s.
Several animal studies have suggested a link between Ritalin use and cancer, but there has been no evidence linking long-term use of the drug to human cancers.
The newly published study is the first to examine the chromosome-damaging potential of Ritalin. It will be published in an upcoming issue of the journal Cancer Letters.
Researchers from the University of Texas M.D. Anderson Cancer Center in Houston and the University of Texas Medical Branch at Galveston recruited a dozen children with ADHD for the study. The children were about 8 years old and had been prescribed Ritalin at normal therapeutic doses (20-54 mg/day) but had not begun taking it.
Blood samples were taken from the children before and three months after starting Ritalin. White blood cells were tested for chromosomal damage using several testing methods.
Lead researcher Randa A. El-Zein, MD, PhD, and colleagues found a threefold increase in the level of chromosomal damage in the samples taken after the children were started on Ritalin.
"It was pretty surprising to me that all of the children taking [Ritalin] showed an increase in chromosome abnormalities in a relatively short period of time," El-Zein says.
Why Are Some Experts Skeptical?
Oncologist Herman Kattlove, MD, tells WebMD he remains skeptical about a link between Ritalin and cancer, noting that chromosomal damage and repair is common. Kattlove is a spokesman for the American Cancer Society.
"We all have chromosomal breaks," he says. "That is part of the normal behavior of a cell. But fortunately, we have repair mechanisms which keep us from getting into trouble."
Kattlove says the study does raise questions about Ritalin and other drugs of its class that should be investigated further.
"It is very unlikely that this would be a source of cancer in humans, but since this question has been raised it would be worthwhile to do a clinical study," he says.
Pediatric oncologist Stephen A. Feig, MD, agrees that the risk, if any, is likely to be small.
"We don't know if this is of any clinical significance, because we don't know if the cells are repairing themselves," he tells WebMD. "It seems that in the 50 years that Ritalin has been on the market an increase in cancer risk would be obvious."
SOURCES: El-Zein, R. Cancer Letters, 2005. Randa A. El-Zein, MD, PhD, department of epidemiology, University of Texas M.D. Anderson Cancer Center, Houston. Marvin S. Legator, PhD, professor and director, division of environmental toxicology, University of Texas Medical Branch, Galveston. Herman Kattlove, MD, medical oncologist; spokesman, American Cancer Society. Stephen Feig, MD, professor of pediatrics, division of hematology-oncology, UCLA Jonsson Comprehensive Cancer Center, Los Angeles.
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