Reports of abuse of the drug Ritalin and other prescription medications continue to increase. Since schools are one of the primary distributors of Ritalin, administrators are taking more steps to safeguard prescriptions. Included: Recommendations for handling, storing, and dispensing prescriptions in schools.

A few years ago, thieves entered Meadowlark School in Sheridan, Wyoming. They broke down doors and pried open cabinets in a storage area of the main office until they found what they wanted.

The intruders' target was not computers, electronic equipment, or money, the school's former principal, Walter Wragge, tells Education World. It was prescription drugs, mostly Ritalin, one of the most commonly prescribed medications for youngsters.

"Whoever got in, knew exactly where they (the medications) were and what they needed to do to get to them," says Wragge. "Most of the medication that we have or had was Ritalin."

Ritalin (generic name methylphenidate) is the academic and social salvation for many youngsters with some form of attention deficit hyperactivity disorder (ADHD). The drug reduces restlessness and allows kids to focus on schoolwork.

Non-ADHD adolescents, though, covet Ritalin for other reasons: the quick and cheap high. Because so many Ritalin prescriptions are written for children and so much Ritalin is stored in schools, it has become one of the easiest narcotics for adolescents -- and sometimes school staff members -- to obtain and abuse.

"Adolescents don't have to rob a pharmacy, forge a prescription, or visit the local drug dealer to acquire methylphenidate -- they have little difficulty obtaining it from a friend or classmate at school," according to Terrance Woodworth, deputy director of the Drug Enforcement Administration's (DEA)Office of Diversion Control. Woodworth gave testimony before a congressional committee on May 16, 2000.

"It is important to note that many schools have more methylphenidate on hand for student daytime dosing than is available in some pharmacies," Woodworth continues. "Although state and federal laws require accountability of controlled substances by licensed handlers, no such requirements are imposed on schools."

A 1996 DEA sampling of school practices for handling prescription medications showed that most schools did not have nurses administering medication, stored pills in unlocked drawers, and kept few records of how much medication was stored and how much was dispensed

AMPLE SUPPLY, EASY ACCESS

The large quantity and often easy availability of Ritalin in schools makes the drug a target for thefts. The DEA has received a "significant number" of reports of Ritalin theft from homes and schools, Woodworth testified in May 2000.

According to reports the DEA received, one student left home with a month's supply of Ritalin and got to school with six tablets, after distributing the rest to other youngsters on the school bus. In some of the theft reports, schools had no idea how much medication was taken and from whom, says Woodworth. "Information from physicians, parents, schools, poison control centers, adolescent treatment centers, and surveys, as well as law enforcement data, suggests that [many] adolescents who are using this drug illicitly obtain it from individuals who have been prescribed this drug for ADHD."

Teens abuse Ritalin because when taken improperly, its effects are similar to cocaine and amphetamines, according to the DEA. The drug suppresses appetite, keeps users awake, increases attentiveness, and creates euphoria.

"Probably the single most disturbing trend is that adolescents do not view abuse of this drug as serious," Woodworth testified. "Reports from states and municipalities indicate that adolescents are giving and selling their methylphenidate to friends and classmates who are frequently crushing the tablets and snorting the powder like cocaine."

From January 1990 to May 1995, Ritalin also ranked among the ten most-frequently stolen drugs from registrants, such as pharmacies, Woodworth explains.

Theresa Anderson, director of research and evaluation for the Massachusetts Department of Health, Department of Substance Abuse Services, says that in a 1999 survey of drug use by middle and high school students in the state, 12.7 percent of high-school students responded that they had abused Ritalin. Recreational use peaked in 10th and 11th grade. Students were told not to say they had used the drug if they had a prescription for it.

"This was the first time we asked about Ritalin," notes Anderson. "We weren't sure what to expect."

Kenneth S. Trump, a school security consultant who is president of National School Safety and Security Services, says he asks principals how they store medication when he is reviewing a school's overall security.

"I've talked to administrators who have had medication stolen -- usually it's Ritalin," Trump tells Education World. "When people talk about substance abuse, they usually don't think of prescription drugs. I am seeing this (thefts) more than in the past. It is one more issue administrators have to be aware of. Now they have to be doctors and nurses."

Judith Harrigan, a spokeswoman for the National Association of School Nurses (NASN), says that at least three school nurses reported drugs stolen near the end of a recent school year. Over the past eight years, she has heard of between two and three dozen prescription drug thefts from schools. Most of those thefts took place more recently and most involved Ritalin.

The NASN adopted a statement in 1993, which was revised in 1997, that said school nurses could administer medication "safely and effectively" under certain guidelines.

See the sidebar for NASN's recommendations for safeguarding medications.

Today, more schools either have taken or are taking steps to prevent medication thefts. "I have found that administrators tend to not consciously give extra attention to this issue until either we mention it during our assessments or until after an incident occurs," Trump says. "I am not saying that they do not think about it all, but I am not sure that they are aware on the whole of the number of theft and abuse incidents we seem to increasingly see across the country, especially in recent years."

Administrators also tend to think that only outsiders are responsible for drug theft, which is not the case, Trump continues.

"I do not believe that they give a lot of thought to the potential for adult school employees to be the perpetrators, which has been the case in a number of incidents across the country," according to Trump. "I suggest ... school administrators should recognize that the potential exists for medicine to be targeted for theft not only by students and outsiders but adult school employees as well."

See the endbar to read Trump's suggestions for safeguarding medications.

Several administrators told Education World that prescriptions in their schools are stored in secure locations and pills are distributed by nurses.

After the break-in at Meadowlark School in Wyoming, administrators changed procedures for storing and handling medications, according to former principal Walter Wragge. Before the theft, medication was kept in a locked file cabinet to which several people had keys, and there were no policies for tracking what was dispensed.

Now all medication is in a locked, fireproof cabinet for which only two people have keys. Pills are handled only by the nurse and a secretary. The school also must have written and signed doctor's orders, co-signed by a parent, to dispense any medication, including cough drops and aspirin, Wragge says.

Other schools report similar procedures. Staff members at Randolph Elementary School in Livonia, Michigan, also store medication in locked cabinets to which access is controlled. "We have never had a theft, but we monitor medication very closely," Principal Helene Lusa explains. "Our sense is that you can never be too cautious."

Administrators at Prairie Point Elementary School in Kansas City, Missouri, go a step further and ask parents to bring in small amounts of medication at one time to limit what is stored so "the medicine cabinet is not so tempting," Principal Jim Singer says. His school has had no medication thefts.

At Hamilton Elementary School in Bridgewater, New Jersey, only the school nurse can dispense prescriptions, which are stored in locked cabinets, says Dr. Lorraine H. Lotowycz, the principal. The nurse counts the pills, and a weekly log of what pills are available and what is dispensed is kept.

Only parents can bring in medication, and the nurse is the only person who can receive it, Lotowycz tells Education World. A mirror on the wall allows staff to see who is entering and leaving the nurse's office. "We feel we have taken many steps to protect our students, their privacy, and the dispensing of medication."