data in millions of daily doses
As can be seen from the graph
below, the use of Ritalin increased nearly exponentially over the course
of the 1990's, from 75 million daily doses in 1990 to nearly 360 million
daily doses in 1998, in the U.S.A. alone. By comparison, the rest
of the world reached 95 million daily doses in 1998, about 25% of the U.S.
consumption.
Using some basic arithmetic,
some conclusions about actual numbers can be drawn, even from the limited
data available to the general public.
Worldwide production of Ritalin:
8.5 tons per year. Because Ritalin is internationally controlled,
this is a quota, and therefore is probably equal to the expected consumption.
The U.S. uses approximately
85% of this total. Round this down to 80% to make the math easier
and to account for non-ADHD uses of Ritalin such as for treatment of narcolepsy.
Thus, the total usage by the U.S. for ADHD is 6.8 tons per year (rounded
to 7 tons for simplicity's sake). 1 pound~456 grams, so the total
consumption in the U.S. is about 7*2000*456=6,384,000 grams per year
The recommended average dose is 20-30
mg per day. Assuming 30 milligrams per person per day, the average
patient consumes about 11 grams of Ritalin per year. This results
in a net total of
data in millions of daily doses
Chart from DEA testimony
This estimate is based on production data and a number
of assumptions, and should in no way, shape, or form be considered definitive.
More frightening than the simple numbers is a report presented to the U.N. in 1995 concerning this rapid growth. In it the following was stated:
United States investigators found divergent prescribing practices among physicians, only 1 per cent of whom were responsible for the majority of all methylphenidate prescriptions issued....That first sentence is the most telling of all: one percent of physicians account for >51% of prescriptions. While this number could be (and certainly is) skewed -- more than likely, the term "physicians" encompasses all physicians, not just psychiatrists and psychologists, the implications are clear: Ritalin is being dispensed by some physicians with little or no thought for possible effects, and with no chance to accurately determine if AD(H)D is the actual cause of the reported symptoms. (INCB)The Board is also concerned that, contrary to labeling, some doctors prescribe stimulants to children under the age of six and, in many cases, other recommended forms of treatment are not applied. The duration of treatment with methylphenidate, which in many countries is restricted to three years, tends to be much longer in the United States and many children remain on it into adolescence and even adulthood. No information on possible side-effects of such long-term treatment with methylphenidate is currently available... (INCB 1995)
The other major cause of this rapid
increase in Ritalin prescriptions lies in its prescription as a diagnostic
tool. In some cases, Ritalin is prescribed immediately upon the reporting
of the symptoms, in order to assess if it will cause an improvement.
However, the nature of Ritalin dictates that most of the population will
enjoy an increase in focus and concentration while on the drug (hence its
popularity on college campuses as a black-market study aid). Assuming
that a patient who is improved by Ritalin is automatically ADHD is dangerous
and foolish, not to mention completely in error.
References:
Livingston, Ken. The Public Interest, 127
(Spring 1997), pp. 3-18 ©1997 by National Affairs Inc. Link
DEA Congressional Testimony:
Terrance Woodworth, Deputy Director, Office of Diversion
Control, Drug Enforcement Administration.
Before the Committee on Education and the Workforce:
Subcommittee on Early Childhood, Youth and Families, May 16, 2000. Link
UNITED NATIONS Information Service
INCB ANNUAL REPORT 1995
28 February 1996
link