School settings are perceived as particularly vulnerable for abuse because schools store attention disorder drugs for students needing medication while at school. Few Incidents of Diversion or Abuse of Attention Disorder Drugs Identified by Schools

Based on our survey, an estimated 8 percent of principals in public middle schools and high schools in the United States reported at least one incident of diversion or abuse of attention disorder drugs during the current 2000-2001 school year. Most Schools Dispense Attention Disorder Medications and Follow Drug Security Procedures

Most school officials reported that attention disorder medications are administered to students during the school day, most often by a nurse. Medication Administration

Nationally, an estimated 90 percent of schools have school staff administering attention disorder medication to some students on a typical day, according to principals we surveyed. Cabinet and door locks school B Almost all (96 percent) of the school principals in schools that administer medications reported that students are observed when they are administered medication to assure that it is taken. We analyzed provisions in the 37 states and the District of Columbia based on five common statewide requirements for administering medication at schools: (1) whether schools must obtain authorization from the student’s parent or guardian to administer medication, (2) whether schools must obtain written orders or instructions from the student’s physician or other licensed medication prescriber to administer medication, (3) whether schools must receive and store prescription medication in an original container with proper pharmaceutical labeling, (4) whether schools must provide storage for medication that is secure and inaccessible except to authorized school personnel, and (5) whether schools must document the administration of medication to the student in a medication log. Only seven states have no applicable statutes, regulations, or policies (discretionary or mandatory) addressing the administration of medication in schools. Finally, the development of nonstimulants for attention disorders and increasing use of once-a-day stimulant medications may reduce the potential for diversion or abuse at school by reducing the need for the medications to be administered during school hours. For example, a nurse administers medications at an estimated 59 percent of the middle and high schools.
What GAO Found

Children diagnosed with attention deficit disorders are often treated with stimulant medications, such as Ritalin or Adderall. These drugs are controlled substances under federal law because of their high potential for abuse. Many of these stimulant drugs must be taken several times a day to be effective, so children need medication during the school day. Concern has arisen that the increasing use of these medications in school might provide additional opportunities for drug abuse. No data exists on the extent to which attention disorder drugs have been diverted or abused at school, or the extent to which state laws or regulations guide local school officials in safely administering these drugs. Middle and high school principals reported little diversion or abuse of attention disorder drugs. For the first seven to nine months of school year 2000-2001, about eight percent of principals in public middle and high schools reported that attention disorder drugs had been diverted or abused at their school. Most of the principals reported that school officials administer attention disorder medications, with about two percent of the school's students on average being administered attention disorder drugs on a typical day. Medications are given by nurses in about 60 percent of the schools, and by non-health professionals, such as secretaries, in most of the remaining schools. Medications are kept locked in almost all (96 percent) of the schools, according to the principals, and students are observed while taking their medications. Thirty-seven states and the District of Columbia have either statutes, regulations, or mandatory policies addressing the administration of medication to students. State provisions require schools to obtain written parental authorization to administer medication, ensure that the medication is securely stored, and store prescription medication in the original pharmacy container.