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Methylphenidate: Abuse & Overdose

Instructor: Patricia Jankowski

Patricia has a BSChE. She's an experienced registered nurse who has worked in various acute care areas as well as in legal nurse consulting.

Methylphenidate is a drug prescribed by doctors for the treatment of attention deficit hyperactivity disorder, or ADHD. It has many different brand names and forms. In this lesson, we'll examine methylphenidate abuse and overdose.

Therapeutic Use and Action of Methylphenidate

Methylphenidate is a stimulant that is used to treat ADHD, or attention deficit hyperactivity disorder, in children and adults. Chemically, it is closely related to amphetamine, or ''speed'', and to cocaine. ADHD is a disorder in which the patient has difficulty focusing on tasks or paying attention, has trouble sitting still, and may act impulsively.

When used as directed for a patient who has been diagnosed with ADHD, methylphenidate increases levels of dopamine, a neurotransmitter, or messenger chemical, in the brain. This can ease the patient's thinking and learning ability, and can also make it easier to interact with others. Prescribing physicians start the patient at a low dose and then increase the dose to the therapeutic level once improvement of symptoms is seen, and once it is determined that the patient is tolerating the drug well. All of this is done under close medical supervision.

Abuse of Methylphenidate

The federal government classifies drugs in a schedule system according to the potential of the drug for abuse. The schedules range from Schedule I to Schedule 5, with Schedule I listing the drugs that are most likely to be drugs of abuse, and Schedule 5 listing those that are least likely. For example, heroin is a Schedule I drug. Methylphenidate, more commonly known as Ritalin, has a high potential for abuse and is therefore a Schedule II drug.

Abuse of Methylphenidate in Children

In 2011, eleven percent of children in the United States between age 4 and 17 were diagnosed with ADHD. The average age at which children are diagnosed with ADHD is seven years. However, a report from the International Narcotics Control Board (INCB) says that the global use of methylphenidate has increased 66% in the year 2012 to 2013 alone. Eighty percent of that global consumption occurs in the United States. So, the general consumption of methylphenidate has increased tremendously over the past decade. Why is this happening?

Perhaps it is because children spend long days in schools, sometimes without being allowed adequate time outside to play. Or it may be due to increased marketing of the drug and the potential for profit from increased sales. In any case, whether or not the tremendous increase in the prescribing of methylphenidate constitutes abuse is a question of ethics. As once defined by the President's Council on Bioethics (2002), '' a drug is prescribed for therapeutic use when its purpose is to treat illness or disease or to restore damaged body parts. A drug is used for a non-therapeutic purpose to pacify individuals, enhance performance, or for recreation.'' Prescribing or using a drug for a non-therapeutic purpose is abuse.

Abuse of Methylphenidate in College Students

Since methylphenidate is one of many drugs used to increase focus and enhance performance, it is often abused by college students. Between 2005 and 2010, emergency room visits related to the use of such stimulants tripled. Since methylphenidate can suppress the appetite, it has also been abused for the purpose of weight loss. Students sometimes falsely display symptoms of ADHD so that they can get a prescription from a doctor. The drugs are often sold at a discount at university psychiatric health care centers, and are also sold illegally on campus from one student to another.

However, Dr. Laurence Greenhill, a clinical psychiatrist at Columbia University, said that ''methylphenidate-type stimulants do not actually increase the user's intelligence. They are simply stimulants that keep students awake so that they can cram for exams and study longer.''

Side Effects and Overdose of Methylphenidate

The initial therapeutic dose of methylphenidate for ADHD is 10 mg, taken two to three times daily. The maintenance dose can be increased to a maximum of 60 mg per day. Some patients achieve relief of symptoms at a smaller dose. Concentra is a time-release version of methylphenidate that is taken once daily.

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