After returning to school from a long weekend earlier this year, Tim Jarboe entered the nurse’s office at the Georgia middle school where he is the principal to do the weekly medicine count. He gasped when he saw the medicine cart with its lock cut off and drawers of pills pried open.
“Oh, no,” Mr. Jarboe remembers thinking. “Not again.”
In the second such incident since September, the medication bottles of 16 students were missing from Coile Middle School in Athens, Ga. That meant that more than 430 pills of Ritalin and Adderall, two stimulants commonly used to treat students with attention deficit hyperactivity disorder, were in the wrong hands.
Following the latest incident over Presidents’ Day weekend last month, Mr. Jarboe put a silent alarm system in the nurse’s office. And now he is looking into installing video cameras outside that office to keep watch after hours.
“You hate to spend tax dollars that we could be using to buy textbooks,” Mr. Jarboe said. “But we feel like we have to. It’s a big responsibility handling these drugs that are used as street drugs.”
As evidence mounts that the abuse of controlled substances used to treat ADHD is on the rise, growing numbers of school administrators are feeling the weight of that responsibility. More abuse has meant more schools victimized by thefts of such drugs—especially methylphenidate, the generic name for Ritalin. And that has prompted more administrators to take precautions similar to those at Coile Middle School.
A school district in Pennsylvania has put motion detectors outside the nurse’s office to record activity after hours.
The Maine legislature passed a law last year mandating that noncertified school medical workers have a certain number of hours of training before they can distribute drugs.
And schools nationwide are no longer keeping drugs in a nurse’s desk drawer or unlocked wooden cabinets, but are instead resorting to sturdier medicine cabinets, restricting keys to nurses’ offices to their nurses and principals only, and counting pills daily to keep better track of them.
Security Needs Grow
The role of schools in the identification of students with attention problems, and in the use of medications such as Ritalin to treat them, have embroiled educators in controversy over the past decade. School officials have been caught up in clashes over such issues as whether attention deficit disorder and ADHD are overdiagnosed, whether medications are overprescribed, and whether schools are pushing parents to medicate their children unnecessarily.
But many educators and school nurses, regardless of their personal feelings about medications such as Ritalin, agree that the need for secure policies and storage of those substances is paramount.
Between 1990 and 1997, the production of Ritalin increased 650 percent, according to the U.S. Drug Enforcement Administration. It is also among the top 10 drugs in pharmaceutical theft, the DEA reports.
Doctors prescribe drugs such as Ritalin, Adderall, and a new extended-release medication called Concerta to students with attention disorders to help them focus and control their impulses. But when crushed and snorted—or crushed, mixed with water, and injected—the same stimulants provide a moderate, “cocaine-like” high, experts say. A study released last month by the Massachusetts Department of Health showed that 12.7 percent of high school students surveyed reported having used Ritalin as a recreational drug at least once in their lives. The Massachusetts study shows Ritalin abuse peaking in the 10th and 11th grades.
Around the country, methyl-phenidate pills are being sold on the street for $2 to $20 each, authorities say. Students report using the drugs to help them stay up late and study, and refer to the pills as “Vitamin R” or “Smarties.” Most Ritalin hits the black market because students with prescriptions give away pills or sell the drug to students without prescriptions.
Schools Seek Help
One national consultant on school security said school administrators used to balk at being asked how they were protecting their nurses’ offices.
“Now that the issue is more high-profile, schools are hungry for information,” said Kenneth S. Trump, the president of National School Safety and Security Services, a Cleveland-based consulting firm.
School officials should assess the security of their medicine supplies by looking at the types of cabinets in which they are secured, and the locations of the cabinets in relation to doors and windows, Mr. Trump said. When school districts design new buildings, he added, officials should consider placing the nurse’s office away from windows or outside doors for security reasons.
In one school whose security arrangements he assessed, Mr. Trump said, medications were kept in the main office in a small cabinet on the wall next to the windows.
“It was kind of an advertisement: ‘Look what we have here,’” he recalled.
Mr. Trump said a lock on the medicine cabinet doesn’t guarantee security. “You could lift the cabinet off the wall and take it with you,” he noted.
At the Center Drive School in the 440-student Orrington school district in eastern Maine, security measures for controlled substances started with the very design of the school building, said Debi Blank, the school’s nurse.
“The nurse’s office is centrally located and opens with a different key than what opens any other room in the building,” she said.
Robin Fox, the nursing supervisor in the Souderton, Pa., school district, said that in her 6,400-student district, motion detectors have been placed outside the school nurses’ offices.
But while motion detectors and video cameras are being employed more frequently to combat drug thefts in schools, they are still not in widespread use for that purpose, Mr. Trump said.
Mr. Jarboe said he never thought he would have to resort to such measures. There are still no suspects in the two incidents in his Clarke County, Ga., middle school.
“We were stumped by all of this,” said Mr. Jarboe, who said he now refers to the nurse’s office as “the vault.”
“You kind of realize schools aren’t built to be a secure facility,” he added. “In our school, we encourage the public to use our gym and facilities. Our driveways and parking lots are always open. It’s a real challenge.”
Camera Stirs Complaints
A video camera mounted in the hallway outside the nurse’s office helped William Tennent High School in Warminster, Pa., identify a student as a suspected Ritalin thief. In January, the student allegedly stole 300 Ritalin pills after tampering with the locks in the nurse’s office.
But in Tacoma, Wash., an elementary school principal provoked criticism when she installed a hidden camera after some Ritalin disappeared from the nurse’s station. Members of Jefferson Elementary School’s staff, joined by the American Civil Liberties Union, complained that the principal had violated privacy laws by installing the camera.
Last October, the school removed the camera, which had been aimed at the locked medicine cabinet through a hole poked in an eye chart.
“If you want advice on how to catch a Ritalin thief, the video-camera idea didn’t work very well for us,” said James Shoemake, the superintendent of schools in Tacoma. “We are not a real good example.”
Mr. Shoemake said that when the video camera was installed in the school nurse’s lounge area, the camera’s audio function was turned on inadvertently.
“It was in a nurse’s lounge where a certain level of privacy was expected,” Mr. Shoemake said. “Now the main security we are using is lock and key. It seems obvious, but we are just limiting the number of keys.”
Other districts have limited the number of people who have access to medications and who can distribute them to students.
“Some schools allow non- nurses to hand out medicines, or nurses delegate, but not in our district,” said Ms. Fox of the Souderton district in southeastern Pennsylvania.
Some states, including Illinois and New Jersey, require only certified nurses to distribute medications. But even in such states, policies differ on whether schools are exempt from the law, and some have policies requiring that certified nurses dispense drugs except in “emergencies.”
Administrators say there aren’t always enough nurses to go around. So some districts delegate the duty to health technicians or even trusted secretaries. A study conducted last year by the Maine legislature showed that 63 percent of school staff members in the state who distributed drugs had had two hours of training or less in dispensing the pills. In response, the legislature passed a measure require schools to train staff members who have not received instruction in properly distributing medication.
Late last year, the Texas board of education passed a series of suggestions for schools on the distribution of medications such as Ritalin. The board recommended, but did not require, that each school come up with policies and procedures for storing psychotropic drugs. The board also suggested limiting the role of distributing the drugs to nurses only.
At the time, Children and Adults with Attention Deficit/Hyperactivity Disorder, a national advocacy group known as CHADD, said the Texas board had violated the rights of students with ADHD.
“The terms proposed present a severe crisis to children attending schools in many rural settings where a medical practitioner may not be on the school premises,” Beth A. Kaplanek, the national board president of CHADD, said in a letter to the Texas state board. “Schools must facilitate rather than interfere with the administration of appropriately prescribed medications where such indications are necessary for a child to benefit from education.”
Keeping Count
Schools around the country say they usually have systems for tracking the distribution of medications, much like the arrangements in hospitals or pharmacies.
Many school nurses say they will not accept pills delivered to them by students, for example. Instead, a parent must bring any prescription medications to the nurse. Pills are often counted in front of parents at the time of delivery.
“We are required to count all controlled substances, such as Ritalin, just as we do in the hospitals at the end of shifts with narcotics,” said Diane G. Armstrong, a nurse at Bernardsville Middle School in Bernardsville, N.J. “The parent and the nurse count together and sign that the count is accurate and date it.”
And if any pills are left at the end of the school year?
John McClure, a nurse at Monger Elementary School in Elkhart, Ind., said his school district has discovered a way to wash its hands of the problem. When disposing of unused medication at the end of the year, he will flush the medicine down the toilet. “With witnesses and two signatures,” he added.
New forms of methylphenidate that are released in the body over time allow students to avoid taking a midday dose at school altogether. If such time-released formulas grow in popularity, they may help ease schools’ responsibility for handling controlled substances, some experts and school officials say.
“I think the situation will improve with the new sustained-release formulas,” Ms. Fox said. “Parents give it to their kids before they get to school. That cuts out the school.”
