ReageraMera

90. The worldwide use of methylphenidate, a substance in Schedule II of the 1971 Convention, increased from less than 3 tonnes in 1990 to more than 8.5 tonnes in 1994 and continued to rise in 1995. The global trend largely reflects developments in the United States, which accounts for approximately 90 per cent of total world manufacture and consumption of the substance. Methylphenidate is increasingly being used in the United States for the treatment of attention deficit disorder (ADD) in children. Some other countries have also reported increases in the use of methylphenidate for this purpose, but at a markedly lower rate 

91. At present, 3-5 per cent of all schoolchildren in the United States have reportedly been diagnosed as suffering from ADD and are treated with methylphenidate, frequently without the benefit of other forms of assistance recommended in treatment guidelines. According to some reports, ADD may be diagnosed too often as other causes of attention and behavioural problems might be overlooked. An investigation by the competent authorities of the United States revealed divergent prescribing practices for methylphenidate among primary-care physicians, as a very small percentage of such physicians issued the majority of the prescriptions for methylphenidate. Many children remain on methylphenidate treatment for longer periods of time, frequently into adolescence and even adulthood. The abuse of methylphenidate in the United States has increased and cases have been reported of serious damage to health as a result of such abuse. Methylphenidate is mainly abused by adolescents who illegally obtain the substance in tablet form from children undergoing treatment for ADD.
92. The competent authorities of the United States have informed the Board of their concern at the sharp increase in the use of methylphenidate, especially the preparation sold under the trade name Ritalin. Treatment of ADD with Ritalin is being actively promoted by an influential "parent association" that has received significant financial contributions from the leading manufacturer of this preparation in the United States.

93. The Board is concerned about this situation. It therefore requests the authorities of the United States to continue to carefully monitor future developments in the diagnosis of ADD in children and the extent to which methylphenidate and other stimulants (such as dexamfetamine and pemoline) are used in the treatment of ADD, in order to ensure that these substances are prescribed in accordance with sound medical practice as required under article 9, paragraph 2, of the 1971 Convention. In addition, the Board invites the authorities of the United States to review whether article 10, paragraph 2, of the 1971 Convention, prohibiting the advertisement of controlled substances to the general public, is not being undermined by the activities of "parent associations" advocating the use of methylphenidate.
94. The Board requests all Governments to exercise the utmost vigilance in order to prevent "overdiagnosing" of ADD in children and medically unjustified treatment with methylphenidate and other stimulants. The Board invites WHO to evaluate, as a matter of priority, the prevalence of ADD in various parts of the world, the diagnostic criteria for ADD, and the use of methylphenidate and other stimulants and any other forms of treatment of that disorder in children. The Board also invites WHO to bring the results of the evaluations to the attention of national public health authorities.

Vi återkommer, som sagt, den 1 mars med omfattande rapportering om årets rapport.

Torgny Peterson