Use Of Medications At Schools To Be Reviewed Nurses Board Against School Secretaries Dispensing Powerful Drugs Such As Ritalin

Growing concern over powerful prescription drugs given at schools has prompted the Idaho Board of Nursing to assign a task force to see if greater supervision is needed.

The task force holds its first meeting Monday in Boise, and may eventually address a host of medical procedures in schools. Initially, medication is the main issue.

The most common prescription drug in school is Ritalin, which controls Attention Deficit Disorder (ADD). The disorder is marked by an inability to concentrate or pay attention.

“Our charge is to protect the public and ensure safe nursing practices,” said board member Charles Moseley. “We’re not specifically looking at Ritalin.”

The distribution of all medications will be examined by the task force.

“We have been getting more and more questions,” said Leola Daniels, director of the nursing board. “There’s been a proliferation of medications and treatments in the schools.”

The growing number of children lining up in school offices for their noon dose of Ritalin or other drugs disturbs some school staff members. Idaho has ranked No. 1 in the nation for the per capita consumption of Ritalin since 1991.

Production of the drug in the U.S. has more than doubled since that time. Ritalin is heavily regulated because it is considered highly addictive.

Utah used to have the distinction of being the top consumer of Ritalin, but many doctors there have turned to other drugs. Some alternatives include more dangerous drugs, such as the anti-depressant Tofranil (imipramine).

In a widely publicized 1993 case, Tofranil was blamed for the death of a 7-year-old boy in Eugene, Ore. A psychiatrist prescribed the drug to control behavior problems.

Imipramine and a related drug, desipramine, are suspected to have caused at least 80 deaths among children in the last two decades, according to the Food and Drug Administration.

It worries some school nurses that unqualified individuals are distributing such potent medication in the schools.

“There’s so many children on the medication, it’s a safety issue,” said Janet Shackelford, a school nurse in Boise. “Somebody has to educate the school district on the medication, its side effects, and keeping it under lock and key.”

Parents and law enforcement officials in North Idaho and Boise have reported instances where students have shared their Ritalin pills with others.

Although nearly every school district has a policy that governs the use of medication in school, few North Idaho schools can afford nurses to monitor medical procedures. Of the approximately 50 school nurses in Idaho, 25 work in Boise, according to the School Nurse Association of Idaho.

In North Idaho, most school districts contract with the Panhandle Health District to provide part-time nursing services. Some districts, such as Kellogg, have no nurses at all.

Susan Thomas, school nurse coordinator for Panhandle Health District, said that services for the eight school districts she works with are “minimal.”

“I would love to see a nurse in each school,” she said.

In Washington, most school districts have school nurses, but they do not necessarily work full-time in one school. Spokane School District nurses are responsible for about 3,000 students each.

In most Idaho schools and many Washington schools, the school secretary doles out the daily dose of pills.

“Those are things that should not be handled by a paraprofessional,” said task force member Tamara Collins, who is co-president of the School Nurse Association of Idaho. “They should not be put in the responsibility of a secretary.”

Panhandle Health District nurses train the school secretaries, but “they don’t feel they have the medical background to assess this,” Thomas said. “They’re excellent about calling when they come to the edge of their knowledge base.”

Because school policies require that the medication include specific instructions from the doctor, many school officials don’t consider their procedures to be problematic.

Most schools lock the medication in a drawer or cabinet and keep tabs on who is taking the medication and when.

“If there’s a problem, it’s more in the realm of the physician and the medical community,” said Ted Marshall, Coeur d’Alene School District psychologist who questions the widespread use of Ritalin. “Most school districts do what’s directed by the doctor.”

School nurses also are concerned about the growing number of children placed on powerful medication, Collins said.

“The increased number of kids taking medicine at school is scary to me,” she said. “Do they (parents) want quick fixes? Do we believe their grades will improve? Are they truly attentiondeficit?

“I don’t know what all the questions are. I know the years I’ve been a school nurse, the numbers have quadrupled.”

Although the task force cannot necessarily change doctors’ practice of prescribing drugs to children, “My goal is at least to raise an awareness that this is a tremendous problem for schools,” Collins said.

The recommendations of the task force will be presented to the Board of Nursing, which in turn may forward them to the Legislature or other agencies in the state.

, DataTimes MEMO: This sidebar appeared with the story: The drug Ritalin controls Attention Deficit Disorder (ADD). The disorder is marked by an inability to concentrate or pay attention.