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Most doctors that prescribe Ritalin today caution patients to talk with them prior to discontinuation, and most will use a tapering system to wean patients from the medication so they do not experience withdrawal symptoms.
What I would like to see presented in the DSM-V work group committee members is a change in language so that Ritalin is classified as an agent that can result in dependency, misuse and abuse. This is especially true given the fact that it is often used as a street "drug" that has an amphetamine like reaction in individuals that use it without the need for it. People that use Ritalin that have a justified need for it may feel nothing except they are better able to concentrate, if the medication is working properly; however the medication is not tolerated the same in all people that use it. The work group committee members need simply to read and review the dozens of studies available that link misuse and abuse of Ritalin. The U.S. Department of Health and Human services note that even people that are legitimately prescribed a drug can develop physiological dependence especially when the medication is used over the long-term. Psychological dependence is more likely of individuals that have a history of addiction or related problems (U.S. Department of Health and Human Services, 2006, p.3). Some people realize they need an escalating does to increase their productivity or any sense of "euphoria" a drug may create.
Others may want to misuse the drug as an appetite suppressant, a habit that can be especially dangerous because Ritalin stimulates the central nervous system. Overuse of this medication by individuals that have or do not have a prescription may result in cardiovascular problems including heart attacks or stroke (U.S. Department of Health and Human Services). Doctors have an obligation to monitor patients for these effects. However, the DSM V and membership committee also have a duty to inform doctors of the danger of clinical dependency because many doctors including psychiatrists rely on the DSM-IV for information regarding a drug's uses. If doctors recognize the potential for harm they are less likely to prescribe the medication unless there is ample evidence the patient needs it to sustain the quality of their life.
Doctors also must have this information...
If they are not fully aware or fully informed, the industry may suffer as patients are more likely to enter into litigation if their health declines because of a perceived "misdeed" on the part of the prescribing physician. Prescribing physicians must first examine the patient's history to determine if they have a history or dependency, chronic pain or other conditions that may lead to dependency before they can prescribe the medication (U.S. Department of Health and Human Services, 2006). Should this information not be presented in the DSM-V, the work group committee members are at risk for litigation that may stem from the illicit use of a drug that should be carefully monitored and prescribed. As it stands now, this medication is far to easy to get, thus the work group committee has a duty to the patients and doctors it works for to define and categorize Ritalin accordingly.
References
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision.
Washington, DC: American Psychiatric Association, 2000.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC:
American Psychiatric Association, 1994.
Misuse, abuse, dependence, and addiction. Substance abuse treatment advisory. 5(2):1-5. Available: http://kap.samhsa.gov/products/manuals/advisory/pdfs/Prescription-Meds.pdf
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