Ritalin is a highly addictive and sometimes dangerous amphetamine-like substance which tops the "most abused prescription drugs" list in the United States, alongside pain-killer OxyContin. Methylphenidate (MPH) is a prescription stimulant commonly used to treat Attention-deficit hyperactivity disorder, or ADHD. It is also one of the primary drugs used to treat the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome. The drug is seeing early use to treat cancer-related fatigue.
As always there is a flip-side to these prescription drugs, and in the case of Ritalin, substance abusers have found various ways to ingest the drug recreationally, which gives an effect similar to cocaine or amphetamine so the use of ritalin is to be closely monitored.
Training
The new guidelines, which cover England, Wales and Northern Ireland, say parent training and education programmes should be offered as a first-line treatment for ADHD, both for pre-school and school age children.
The programmes teach parents how to create a structured home environment, encourage attentiveness and concentration, and manage misbehaviour better.
But what happens when this training doesn't work? Nor the drugs?
Doctor Tod Hiro Mikuriya (September 20, 1933 – May 20, 2007) was a psychiatrist and an advocate for the legalization of the use of marijuana for medical purposes.
Until his death in May 2007, he continued in private psychiatric practice limited to cannabis clinical consultation. He approved marijuana for medical purposes in over nine thousand patients, not solely in terminal cases, but also alleviation of physical and emotional pain in non-terminal cases and one such case was that of teenager "Alex P".
Alex P, accompanied by his mother, first visited Dr Mikuriya's office in February 2005. Alex was aged 15 years, 6 months.
At that time he had been prescribed and was taking Fioricet with codeine (30 mg, 3x/day); Klonopin (1 mg, 2x/day); Ativan (1 mg, 2x/day); and Dilaudid "as needed" to treat migraine headaches (346.1), insomnia (307.42), and outbursts of aggression to which various diagnoses -including bipolar with schizophrenic tendencies- had been attached by doctors in the US (Kaiser) Healthcare system.
Alex had previously been prescribed Ritalin, Prozac, Paxil, Maxalt, Immitrex, Depacote, Phenergan, Inderal, Thorazine, Amitriptaline, Buspar, Vicodin, Seroquel, Risperdal, Zyprexa, Clozaril, Norco, and Oxycodone.
The mother described Alex as a healthy baby who was "never a good sleeper."
Although Alex showed facility communicating verbally, his reading and writing skills disappointed his teachers and prior to going to middle school he was evaluated for an Individual Educational Plan.
According to his mother, "They didn't say he was dyslexic, they said he 'had trouble processing things.'
He wasn't acting wild in school. He was always well behaved. But they said he had ADD because he couldn't "concentrate and process things."
At age 11, Alex was prescribed Ritalin for attention deficit disorder.
In middle school Alex befriended some 13- and 14-year-olds, with whom he was caught stealing a car (and with whom he had shared his ritalin medication, and who introduced him to marijuana). Thus began a four-year sojourn through institutions of the Central Valley juvenile justice system and Kaiser-affiliated hospitals and clinics.
According to mom, "At this stage Alex was prescribed drugs which made it impossible for him to sleep at night" This led to exhaustion and caused Alex to have rampaging bouts of violent behaviour, leading to fights with his dad and siblings, and physical assualts on his mother.
He couldn't remember afterwards what he actually did. He seemed like a completely different person. I don't think that's because of who he is. I think it was because of the medications he was taking." Barbara P. expresses remorse that she obeyed court orders to force Alex to take his prescribed medications.
Alex had known since age 11, when he first smoked cannabis with his older friends, that it had a calming effect. Many of his encounters with the juvenile justice system were for marijuana possession.
His mother says, "He was aware that it helped him not feel stressed out and not have headaches. It helped him concentrate. It helped him sleep. All the things he needed. But I wasn't for smoking it." She reports feeling social pressure from her Central Valley community and pressure from her husband to oppose Alex's attempts to obtain and use marijuana.
"Alex went through three rehabs--two inpatient and one outpatient, all court-ordered, all for marijuana. He could not do inpatient and I told them that. It's not that Alex wanted to be out there doing drugs, he wanted to be home! He had a thing where he didn't want to be put in an institution where he didn't know anybody. That would drive him more crazy. He ended up running from one rehab house and getting kicked out of another."
Perceiving that Alex's mental state was worsening, and in response to his repeated requests to be allowed to smoke marijuana, Barbara did research on the internet that alerted her to similarities between cannabis and Marinol (dronabinol), a legally prescribable drug. Her request that a Kaiser physician prescribe Marinol for Alex was rejected.
Through the internet she identified Doctor Todd Mikuriya MD as a specialist in cannabinoid therapeutics and arranged an appointment for Alex.
A prescription was written in February 2005 for Marinol (10 mg), along with a recommendation to use cannabis by means of a vaporizer. Alex has consistently maintained he prefers smoking cannabis to ingestion by other means, due to rapidity of onset and ability to titrate dosage. ("It works great and you can use just as much as you need," he says.)
When a drug test ordered by the Probation department turned up positive for cannabinoids, Alex had a hearing at which a Superior Court judge declared that because Marinol use could mask marijuana use, he would not allow it. He explicitly refused to recognize the validity of a specialist in the field of cannabis therapeutics and ordered Alex to take only drugs prescribed by Kaiser.
Barbara P. says: "I guess judges have authority over anything. He thought Alex had a drug problem with marijuana because he had smoked it before." At a subsequent hearing another judge rescinded the order. When Alex's Probation ended in May, 2005, he began medicating exclusively with smoked cannabis.
Dramatic improvement
Alex and Barbara P. were seen by the Dr Mikuriya at a follow-up visit in February 2006.
Alex reported dramatically improved mood and functionality with only one migraine attack in the past year, not severe enough to require a trip to the hospital for a Dilaudid injection.
He is in an independent study program at a small public school and getting straight As and Bs. "They love me at school," Alex asserts.
His teacher is aware that he medicates with cannabis with a physician's approval. He smokes approximately one ounce per week and would use 50% more if it were cheaper to obtain.
His mother reports: "We knew after about three months on Marinol that he was going to be okay. He started doing a lot better. He sleeps well, he's not on any of the other medications, I haven't had to take him to the emergency room for migraine since he first went on Marinol.
He's been totally fine. He walks the dog, cleans up his room, does chores for the family. And I know that he's going to be okay.
Before, I never knew what was going to happen. I couldn't picture him getting a job."
Alex's father has relented in his disapproval of Alex's cannabis use, having seen its effects on the household.
In a previous era, psychologists would have put more emphasis on examining the family constellation.
An adequate work-up would have identified Alex's insomnia as the likely cause of his poor scholastic performance. Failing an adequate work-up, the quasi-diagnosis "inability to process" led to a prescription of methylphenidate, (Ritalin), a stimulant, for an 11-year-old with persistent insomnia.
The resulting disinhibition led in turn to trouble with law enforcement, a cycle of extreme anxiety and distress, and the prescription of more drugs, irrationally chosen to counteract drug-induced symptoms.
As a result of the federal prohibition, there exist no official guidelines governing when and how cannabis should be used by patients suffering from a given condition.
The Institute of Medicine Report of 1999 acknowledges the feasibility of cannabis being used to treat certain conditions when all pharmaceutical options have failed.
The case of Alex P. suggests that employing pharmaceutical stimulants, antidepressants and anti-psychotics exposes children gratuitously to harmful side effects in violation of Hippocratic principles.
The first-line treatment for any condition, efficacy being equal, would be the drug or procedure least likely to cause harm.
Given the benign side-effect profile of cannabis, it should be the first-line of treatment in a wide range of childhood mental disorders, including persistent insomnia.
Physicians and parents both face stigma and take risks in authorizing cannabis use by children, but the risks are legal and social rather than medical. The case of Alex P. exemplifies this reality.
So while the United Kingdom struggles to get to grips with what is becoming a massive problem in British classrooms, the United States have successfully treated adolescents using cannabis instead of pharmaceutical drugs, with dramatic improvements in the life of the patient as well as those surrounding him or her. Canna Zine Comment
Isn't it time we put a stop to the reclassification of cannabis and pressed for more research of the beneficial side of cannabis use? If only one person can benefit from using cannabis surely we have no rights to stop them if, as was proven with the case of Alex P, using cannabis can improve the quality of the patients life. SOURCE Canna Zine - Daily zine for the global cannabis scene - Join us. |
