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Lebanese students abusing prescription drugs to boost concentration.

Summary: Omar, a 23-year-old LAU banking and finance graduate, doesn't suffer from Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder -- but he does admit to taking Ritalin.

BEIRUT: Omar, a 23-year-old LAU banking and finance graduate, doesn't suffer from Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder -- but he does admit to taking Ritalin, a brain stimulant commonly prescribed for such disorders. He got hold of the drug, which is strictly controlled by the Lebanese government, by buying a box from a friend who had a legitimate prescription. All he wanted, he says, was some help concentrating.

"It really helped me study," Omar told The Daily Star. "I could sit for hours and study without losing patience. The medicine is like a miracle worker."

The five circular white pills contained in a rectangular cardboard box with two baby blue stripes on the sides and the word "Ritalin" written in bold letters across it, make something so small look almost scary.

It is one of two medications available in Lebanon to treat ADD and ADHD. The other, which is not as common, is Concerta.

"ADD and ADHD can be diagnosed in the early stages of childhood," explained Samira Dabbous, a Lebanese American University psychology professor.

"When a student is unable to focus on a task, and is easily distracted, he or she tends to have ADD or ADHD."

Teachers usually notice the symptoms early on, and a diagnosis should be made before the age of 7 by a psychologist or psychiatrist.

The Health Ministry strictly regulates the medication and patients must go through a long process to get hold of it.

First a prescription must be obtained from a psychiatrist, who performs a number of tests on the patient to confirm the diagnosis. The prescription form then needs to be stamped by the ministry, who in turn issue the parent or guardian with a green booklet that must be signed by the consulted psychiatrist.

The patient can then get the medication from one of the 20 pharmacies in Lebanon that are allowed to stock it. Tellingly, one of them, Mazen Pharmacy in Corniche al-Mazr, sold over 1,000 boxes last year. The ministry closely monitors every prescription and every box sold in order to keep distribution under control.

The reasons for the heavy restrictions on its usage are well-publicized.

Side effects of Ritalin include a fast and/or uneven heart beat, high blood pressure, nausea, vomiting, sweating, numbness and tingling in the hands and feet.

But ministry restrictions have given students with legitimate prescriptions an opportunity to make a profit by selling the drug, which has a reputation for helping with intense bursts of studying or exams, on to friends.

A box of Ritalin or Concerta at a pharmacy costs anywhere between $20 and $100. Student dealers can sell Ritalin at a maximum price of $10 per pill and Concerta for $30 per pill.

Ryan, an American University of Beirut business student, was diagnosed with ADD at the age of 11. He has been taking Concerta since high school and upon starting at AUB, began providing Concerta to others.

"I sell to my friends and anyone who wants them," Ryan explained. "It is an easy way to make money, and it helps students study and [get] good marks during exams."

Lamees, an LAU education graduate, tried Ritalin twice after getting hold of a few pills from friends.

"My attention span is very low, I get distracted easily," she said. "After taking the pill my concentration levels increased and I started writing down notes so fast that I started shaking."

Ramzi Haddad, a child psychiatrist, believes that ADD and ADHD are over-diagnosed in Lebanon: "Doctors and parents see it as an excuse to help their children concentrate."

"Children who can't sit for long [periods] are diagnosed with ADD or ADHD and given medicine."

Haddad conducted a survey among 100 LAU and AUB students into use of drugs for the disorders. Results showed that 6 percent had or knew someone who had been diagnosed; 43 percent took Ritalin or Concerta; 32 percent knew that the medication was addictive; and 4.7 percent knew someone who was addicted to it.

Elias, a 19-year-old LAU pharmacy student, was diagnosed with ADHD in 2011 and takes Concerta. He takes one pill every morning, and on the days he has exams, he takes two pills to keep his concentration levels high.

"I knew it was ADHD from my lack of concentration," Elias explained. "After receiving professional help, I started taking the medicine and raised my GPA [Grade Point Average] from 2.8 to 3.5."

But not everyone is convinced such medication is the perfect fix for cramming situations.

A study published this June by the U.S. National Bureau of Economic Research found "little evidence of positive effects on academic outcomes or schooling attainment," although it added the caveat that "many children use medication in a haphazard manner."

Questions also remain over Ritalin's long-term effects.

Back in 2001, scientists at New York's University of Buffalo conducted research on rats that suggested the drug had "the potential for causing long-lasting changes in brain cell structure and function."

There could be "cardiovascular problems or neurological effects if taken in large doses" over an extended period, Haddad added.

Some academics also take issue with the attitude behind the behavior.

"The large-scale medication of children feeds into a societal view that all of life's problems can be solved with a pill," L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development, wrote in the New York Times in January 2012.

"I believe in the power of the mind/brain to control the body," agrees Dabbous. "Medication should be reserved to extreme cases."

Firas, an AUB business student who was diagnosed with severe ADD two years ago, started off taking Concerta but switched to Ritalin after he suffered negative side effects.

"I became obsessive," Firas said. "Concerta was too much for me to handle, I got depressed and at one point, I became so obsessive that I had to finish a pack of cigarettes before leaving the house."

Firas said he gave some of his friends Ritalin when they needed it.

"I make sure that I only give my friends who ask for it," he said.

"I give them one or two pills for the week to keep them under control. I don't want to feel guilty if anything happens to them."

But Haddad says those not prescribed the drug are at much greater risk of suffering adverse side effects:

"It is not recommended for people who are not ADD or ADHD to take the medicine because they can become addicts, and they are subject to depression, nervousness, and stability."

Haddad also said that a small percentage of people addicted to Ritalin tended to abuse other substances, such as cocaine and speed. In some instances, addiction can begin with soft drugs such as Ritalin and then shift to harder drugs over time.

Hamzeh, a Jordanian business student in his fifth year at LAU, knows that he has ADHD but refuses to seek professional help because his parents are in denial of his diagnosis.

"I refuse to take medicine even from friends," he explained. "I know myself, and if I try it I will get addicted. ... Also my father disapproves of the medicine."

*Some of the names have been changed for the safety of participants.

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Publication:The Daily Star (Beirut, Lebanon)
Geographic Code:7LEBA
Date:Jul 25, 2013
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