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OTC & Prescription Drugs

Methylphenidate

Methylphenidate is a stimulant that acts on the central nervous system. It is a chemical cousin to cocaine, but not as strong. No one is sure how methylphenidate works.1 American doctors are currently prescribing methylphenidate to over five million children with attention deficit disorder/hyperactivity. Although it is a stimulant, methylphenidate has an opposite effect on hyperactive children and somehow calms them down, although no one is sure how it does that either.2

Most people think that methylphenidate or Ritalin ® is a safe, mild drug because so many children are taking it. However, the government classifies it as Schedule II, along with cocaine and morphine, because it is highly addictive. Besides addiction, methylphenidate has many other serious side effects. It can cause sudden death in people with heart conditions.3

Forms and Brands
The most common brand of methylphenidate is Ritalin ® . Other brand names are Ritalina ®, Rilatine ®, Attenta ®, Methylin ®, Penid ®, Rubifen ® . The sustained-release tablets are Concerta ®, Metadate ® CD, Ritalin ® LA, and Ritalin-SR ® and Focalin ® . Daytrana ® is a small light blue patch that delivers methylphenidate.

• Adderall ® is commonly prescribed for ADHD; however, it is not methylphenidate but a pill that contains amphetamine and dextroamphetamine.
• Concerta ® is a white oval tablet made by McNeil, with the black lower case inscription "aiza 36" or "aiza 18" on one side only. The numbers indicate whether the pill contains 18 or 36 milligrams of methylphenidate.
• Generic methylphenidate is produced by Watson Laboratories. The pills are small, round, scored and range in size from 6 mm for the 5mg to 9mm for the 20mg. The 5mg is a purple pill with "DAN5" and "5882" written on it. The 10mg is 7mm and green with "DAN 10" and "5883;" the 20 mg is 8 mm and peach with "DAN 20" and "5884." The extended release version is unscored, white and mottled, 9mm in size, and inscribed with "WPI" and "3111." 4
• Mallinckrodt makes a white pill with a stylized "M" on one side and a scored back with the number "20." This pill contains 20 mg of methylphenidate. Their other pills are all marked "MD" on one side. The 5 MG pill is lime with "531" on other side; the 10 mg is light purple with "532," and the 20 mg is peach-colored with "532."
• Metadate ® is also in capsule form. The top half is white and inscribed with the strength of the pill, for example "10mg." The 10 mg is half-green with "UCB 579" on it; the 20mg is half-blue and says "UCB 580;" the 30mg is half-brown with "UCB 581" on it; the 40mg is half-yellow with "UCB 582;" the 50mg is half-purple and says "UCB 583;" and the 60 mg is completely white with "UCB 584."
• Ritalin ® comes as small round pills with "CIBA" on one side. The 5 mg is lime-colored with a "7" on the other side; the 10 mg is light green with a "3;" the 20 mg is bright yellow with a "34;" and the 20 mg time-released tablet is a white coated pill with the inscription "CIBA 16" in black on one side. Made by Norvartis, these pills are extremely common.
• Ritalin ® LA is a white capsule with a red inscription "NVR R20" on it.
• Strattera is also a common prescription for ADHD, but it is not a stimulant and does not contain methylphenidate.

Concerta ® , Ritalin ® LA and Metadate ® are time-released versions of methylphenidate in strengths ranging from 10mg to 72mg.

Effects and Use
Doctors prescribe methylphenidate to treat Attention Deficit Hyperactivity Disorder and narcolepsy. However, methylphenidate can have a very strong stimulating effect on people who use it for non-medical reasons. Because the drug increases the brain chemicals of norepinephrine and dopamine, users feel pleasure, self-confidence and a sense of well-being.5 As one addict said, "At first I felt I could take on the world and do anything."6 People do things they normally fear, such as climbing mountains. They can go without sleep for days.

Older teenagers and college students are the ones most likely to abuse this drug, according to the Drug Enforcement Agency. They use it to lose weight, to enhance academic performance, and to stay awake when driving long distances. A recent study published in Nature found that one in five university professors use pills to enhance their concentration, and their most popular choice is Ritalin ® .7

A college student may try it during finals week, and end up taking it repeatedly. Some use it recreationally, mixing a crushed pill into water and then injecting it into their veins. This causes an adrenaline "rush" or "slam" that users describe as euphoric and powerful, like bungee jumping.8

Dangers and Risks
One problem with methylphenidate is that it is so highly addictive that many countries like Sweden have banned it completely.9

A recent report from the Drug Enforcement Agency expressed these concerns about methylphenidate:

1. The drug's chief manufacturer contributes hundreds of thousands of dollars every year to support groups for parents of children with ADHD. In the literature of these support groups, parents and others urge the government to reclassify it as a Schedule 3 drug even though there is much research to indicate that it is highly addictive.
2. The number of prescriptions for methylphenidate keeps increasing. For example, in 1990, production of this drug was less than 1800 kilograms; by 2000, it was up to over 15,000 kg.10
3. Children and teens sell their prescribed methylphenidate to their peers.
4. Teens build up a tolerance to methylphenidate and then move on to stronger stimulants. For this reason, methylphenidate can be a "gateway drug" to cocaine and methamphetamine.11

Side effects of methylphenidate are nervousness, insomnia, loss of appetite, increased heart rate and blood pressure, headaches, irritability, visual disturbances, and dizziness. In some cases, users develop aggression, hostility, seizures, psychosis, and thought disorders. Severe reactions even at normal doses can include heart attack, stroke, and sudden death.12

Signs of Use
Teens and college students who abuse methylphenidate are sometimes high achievers who push themselves as hard as possible. They want to be smarter, more popular, and more accomplished than they already are. They want an edge in the form of extra energy and instant self-confidence that this drug can provide. Many times, they may also be using the drug to lose weight. In any event, many who abuse methylphenidate have problems with self-acceptance and limitations.

Users often suffer from non-diagnosed depression. Once they build up a tolerance to methylphenidate, their depression often worsens. The drug may put them on a roller coaster of emotions that leads toward suicide. As one teen wrote, "Even as I loaded up on Ritalin, I sunk into depression. I was getting hallucinations and I was wired, paranoid and jumped at any noise. Everyone irritated me."13

Teens who are using methylphenidate may seem irritable and hostile. They might be overly responsive to noise and minor problems, or show inappropriate anger. They may be overly emotional, nervous, and suffer from insomnia or weight loss. They may develop grandiose ideas about their own capabilities and "talk big." Some will develop skin rashes or boils and other infections if they are injecting the drug.14

Parents often find out about their child's drug addictions when they notice money and personal items are missing. The teen in question often sells his clothing and other possessions first, and then he sells household items, runs up parents' credit cards, and steals money from parents and relatives. Teens often buy this drug from younger children, not dealers.

Overdose
Teens overdosing on methylphenidate may vomit, sweat and flush. They may show agitation, euphoria, confusion, hallucinations and delirium. An overdose may look like a psychotic reaction, not drunkenness. They need to go to an emergency room where they can be restrained so as not to be a danger to themselves and others, and then receive medical treatment.15

Withdrawal and Treatment
Teens who are addicted to methylphenidate often have built up a tolerance to their drug. This means they have to increase the amounts they take in order to achieve the same effect of pleasure, well-being, energy and confidence. When taken at doses that are not medically recommended, methylphenidate damages internal organs, particularly the heart and kidneys. The addict will need medical intervention as well as drug rehabilitation.

Withdrawal symptoms can include depression, fatigue, loss of interest or pleasure in daily activities, insomnia, delusions, suicidal thoughts, and suicide attempts.16

A teen who enters a residential drug treatment center usually has to go through detoxification or physical withdrawal from methylphenidate. Often a teen who is addicted to methylphenidate is suffering from depression and needs psychological counseling and drug therapy. At a therapeutic boarding school or wilderness treatment program, a teen learns to understand why he became addicted to methylphenidate and how to deal with future cravings and relapses. He undergoes daily individual and group counseling and learns new ways of dealing with everyday stress. Aftercare usually involves continued counseling and participation in group support meetings.

1"Methylphenidate, A Drug Monograph," presents pharmacology, warnings, etc, see http://www.mentalhealth.com/drug/p30-r03.html
2Walker, Pam and Ellen Wood. Stimulants (San Diego: Thomson-Gale Books, 2004), pg. 23.
3"Methylphenidate," in Physicians Desk Reference, 61st Edition 2007.
4Descriptions of the pills come from the pharmaceutical companies' websites.
5Colvin, Rod. Prescription Drug Abuse (Omaha, NB: Addicus Books, 2002), p.16.
6Aretha, David. Methamphetamine and Amphetamines (Berkeley Heights, NJ: Enslow Books, 2005), pg. 14.
7"Scientists use pill enhancers," The Boston Globe, April 9, 2008, at http://www.boston.com/news/health/blog/2008/04/move_over_jose.html
8Colvin, op cit. p.32.
9"Methylphenidate, A Background Paper," The U.S. Department of Justice, Drug Enforcement Agency, posted at http://www.methylphenidate.net/.
10Statistics on Stimulants Use, "Frontline", Public Broadcasting System http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html
11"Methylphenidate, A Background Paper," op cit.
12Physicians Desk Reference, op cit.
13Colvin, op cit, p. 14.
14Aretha, David, op cit.
15Physicians Desk Reference, op cit.
16Calvin, op cit, pg. 16.