Methylphenidate is a central nervous system stimulant drug that is the main ingredient in the medicines Ritalin and Concerta. These drugs are primarily used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy (a sleep disorder), and lethargy or sedation associated with medical conditions or with the use of other drugs that produce sedation. Ritalin is the immediate-release version of methylphenidate; Concerta is the extended-release version. Both drugs contain the same medication.
Methylphenidate was developed in 1944 and marketed in the 1950s for the treatment of chronic fatigue, depression, narcolepsy, and psychiatric conditions or drug-induced conditions that produced lethargy and sedation. The drug remains the primary choice of physicians for the treatment of ADHD.
Its major mechanism of action is an increase in the neurotransmitter dopamine. The increase in dopamine produced by the drug provides the stimulation for use in treating narcolepsy and lethargy, and it provides a paradoxical effect in treating the hyperactivity and attention difficulties in with people who are diagnosed with ADHD. It is hypothesized that people with ADHD have brains that are chronically understimulated. Their hyperactivity, impulsivity, and problems with attention are self-induced compensatory behaviors that occur as a result of this chronic understimulation. Increasing the availability of dopamine in the brain is believed to be therapeutic for individuals with ADHD.
Because methylphenidate has significant central nervous system stimulant effects, any medication containing methylphenidate is classified under the Schedule II category of controlled substances by the United States Drug Enforcement Administration (DEA). This means that the drug has medical uses, but is also a significant potential drug of abuse that may result in the development of physical and/or psychological dependence when abused. Methylphenidate can only be legally obtained or possessed by individuals with a prescription from a physician for the medication.
How Prevalent is Ritalin Abuse?
According to the data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), there has been a slight increase in the reported use of methylphenidate products from 2015 to 2016, and a decrease in the number of people who report misuse of these products.
- In 2015, about 3.5 million individuals over the age of 12 reported some use of methylphenidate products. In 2016, about 3.7 million individuals reported use of these products.
- In 2015, 979,000 individuals were estimated to have misused some methylphenidate product. In 2016, 875,000 individuals were estimated to have misused these products.
SAMHSA and the DEA consistently report that the vast majority of individuals who are prescribed a particular medication do not wind up abusing it, but an increase in prescriptions typically means an increase in abuse because the drug is more available. Data regarding the abuse of Ritalin indicates that the majority of individuals who abuse the drug do not have a prescription for it. Research studies on individuals who abuse Ritalin typically report that they get the drug from a friend or family member who has a prescription for it; they steal the drug; or they illicitly purchase the drug from someone else.
Abuse of methylphenidate may be a bit atypical compared to abuse of other prescription drugs. According to SAMHSA, the major reasons individuals abuse Ritalin products are:
- To lose weight.
- To improve alertness or concentration, or to stay awake.
- For the euphoria or stimulation that the drug can provide.
Many individuals believe that abusing prescription drugs is safer than misusing or abusing illicit drugs. This belief is false. Abuse of prescription drugs comes with the same dangers as abuse of street drugs.
Ritalin and other stimulant drugs used to treat ADHD are often referred to as smart drugs due to the misperception that they can increase a person’s mental faculties or intelligence. Stimulants can help individuals concentrate and pay attention for longer periods of time when taken at low doses, but when abused, they actually interfere with the ability to maintain concentration.
These drugs do not have the effect of increasing a person’s intelligence. In fact, students who regularly abuse Ritalin and other stimulants to enhance their grades often have poorer grades and lower levels of achievement than students who do not abuse these drugs.
What are Signs to Look For?
Research studies have indicated that the effects of methylphenidate are almost indistinguishable from the effects of cocaine when looking at both the physical effects and the action of the drug in the brain. Methylphenidate is released more slowly from the system when used in pill form, whereas cocaine is often snorted or smoked, and this results in a much shorter duration of effects. Of course, snorting Ritalin would decrease its half-life.
The effects of abusing methylphenidate are also very similar to the effects of cocaine abuse. There are very few indicators that could point to a case of Ritalin abuse directly. Most of these indicators would be behavioral signs associated with the possession or abuse of the drug.
- Finding empty prescription bottles of Ritalin when the person does not have a prescription for the drug
- Finding medication residue or drug paraphernalia that point to the abuse of Ritalin, such as ground-up pill residue, mirrors with residue on them, straws, or rolled-up paper money
- Any use of Ritalin in a manner inconsistent with its prescribed use, such as grinding up the medication and snorting it, or mixing it with water and injecting it
- Any use of Ritalin in conjunction with other drugs that is specifically against its prescribed instructions, such as using Ritalin with alcohol, other stimulants, or central nervous system depressants
- A person saying that their Ritalin use improves their performance at work or school, or helps them to stay awake
- Any use of Ritalin for any purpose other than its prescribed use
There are more generalized symptoms of stimulant abuse.
- Periods of extreme hyperactivity, talkativeness, or extreme energy that are later followed by periods of lethargy
- Reduced appetite and weight loss
- Appearing overheated or perspiring profusely
- Dilated pupils in conjunction with some of the above symptoms
- Rapid and shallow breathing and/or a very rapid heart rate
- A reduced need for sleep, often followed by extreme lethargy and extended periods of sleep
- Auditory or visual hallucinations
- Extreme emotional reactivity and/or agitation
- The development of uncharacteristic suspiciousness or even paranoia
- Increased energy followed by apathy and depression
Because of the mechanism of action associated with Ritalin, it is notable that long-term abuse of Ritalin may result in changes in brain structure that may produce symptoms or vulnerabilities that occur later. There are several research studies that have indicated that long-term use of Ritalin results in an exaggerated response to Ritalin in certain parts of the brain, particularly areas dealing with the neurotransmitter dopamine, and a depletion of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). These effects appear more salient in younger people than in adults, but they occur to some extent across all groups.
The long-term ramifications of these structural changes to the brain could result in a person with a history of chronic Ritalin abuse:
- Being more vulnerable to depression, anxiety, and the development of obsessive-compulsive tendencies.
- Having trouble experiencing pleasure from situations that would normally be pleasurable or satisfying to them.
- Being far more likely to engage in compulsive stimulant abuse than someone without a similar history, even with an extended period of abstinence.
- Continually using the drug to deal with perceived stress or other negative situations.
From a diagnostic perspective, abuse of Ritalin could qualify an individual for a diagnosis of a stimulant use disorder, which is a substance use disorder that occurs when an individual abuses a stimulant. Signs of this disorder include:
- Nonmedical use of Ritalin that leads to problems with everyday functioning and/or that results in significant distress.
- Numerous indicators that the person cannot control their use of Ritalin.
- Continued use of the drug even though its use results in problems with health or functioning.
- Frequent drug-seeking behavior and extended drug use.
- Frequent use of the drug in situations where it is dangerous to use it.
- The development of tolerance to Ritalin.
- The development of a withdrawal syndrome associated with not using the drug
The severity of the substance use disorder is determined by the number of symptoms an individual satisfies. Individuals who only satisfy a couple formal diagnostic symptoms would be deemed to have a mild stimulant use disorder, whereas individuals with more symptoms could be diagnosed with a moderate stimulant use disorder or even a severe stimulant use disorder. The more severe the person’s substance use disorder becomes, the more potential issues will typically occur, and the harder and more complicated treatment may be.
What Treatment Entails
Treatment for a stimulant use disorder as a result of Ritalin abuse should be comprehensive and impact all areas of the person’s functioning. The treatment should begin with a formal assessment of the person’s behavior, including a physical evaluation, psychiatric/psychological evaluation, and an evaluation of the person’s social situation/social functioning.
Depending on the severity of the disorder, treatment may involve initial placement in a medical detox (withdrawal management) program where withdrawal symptoms are managed by medications and other behavioral interventions. Substance use disorder therapy is used to help the person understand their substance use disorder, develop coping skills, practice relapse prevention techniques, and focus on remaining abstinent.
Participation in peer support groups (e.g., 12-step groups) allow the person to interact with others who have similar problems, learn from them, contribute their experience to helping others, and maintain long-term involvement in treatment-related activities. Any co-occurring mental health conditions should be treated simultaneously to decrease the risk of relapse. Other complementary interventions that are deemed suitable should be used as needed.