Methylphenidate

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abuse. A survey of 161 children receiving the medication found none who believed they were at risk of becoming abusers (a belief sustained by general experience nationwide), although about 25 had encountered situations where someone wanted access to their drug supply. The oral format has little ability to produce euphoria. The drug has been called a more potent hallucinogen than LSD, but support for that claim seems nonexistent in scientific journals.

Adults suffering from ADHD are routinely found to be cocaine abusers. An experiment showed methylphenidate effective for improving both problems, but the treatment was also accompanied by several weeks of individual counseling, which in itself might have been a major factor in any improvement. Some drug abuse treatments seek to switch abusers from one drug to another. Results of an experiment were unencouraging for shifting cocaine abusers to methylphenidate but had intriguing findings nonetheless. For example, cocaine addicts are generally considered particularly susceptible to addictive properties in other drugs, but methylphenidate had little appeal to subjects in this experiment. The experiment also found mental effects of methylphenidate to include irritability, worry, sadness, and a general mood of dissatisfaction. Physical effects included quivering and accelerated pulse rate. Still, even though these cocaine users found methylphenidate unappealing, methylphen-idate is not recommended for any medical treatment in persons with a history of substance abuse.

Experimenters using methylphenidate to help smokers give up tobacco found the results encouraging.

Methylphenidate abusers sometimes grind up oral tablets and inject the material. A preparation designed to go through the digestive system can have untoward consequences in the circulatory system. The talc in oral methyl-phenidate can lodge in small blood vessels, cutting off blood flow to portions of the lungs, eyes, or brain. Respiratory difficulty, vision damage, and crippling paralysis can result. Studies of such injuries sometimes refer to autopsy results; such reference implies that this type of drug abuse is dangerous indeed.

Tolerance has been noted from illicit usage. Intense depression can emerge when an abuser stops using the drug.

Drug interactions. Apparently methylphenidate interacts with valproic acid, a substance used to treat epilepsy in ADHD children; the interaction can cause teeth grinding and interfere with body movement. Interaction with serotonin reuptake inhibitors found in some antidepressants is suspected of causing heartbeat irregularity in a teenager, and methylphenidate is not recommended for persons taking monoamine oxidase inhibitors (MAOIs, found in some antidepressants). High blood pressure can occur if tricyclic antidepressants are used with methylphenidate, and methylphenidate also seems to reduce time needed for tricyclic antidepressants to show results; lower doses of those drugs are advised when a person is taking methylphenidate. Interactions with phenobarbital have been observed. Methylphenidate has allowed terminal cancer patients to tolerate higher doses of opiates, thereby improving pain management.

Cancer. Scientists looking for evidence that methylphenidate causes cancer in rats and humans have instead found lower-than-normal incidence of the disease. In one experiment mice developed liver tumors after receiving many times the therapeutic dose, but the strain of mice used is prone to such tumors, so scientists are uncertain about what the experiment means.

Pregnancy. An experiment using mice found the drug to have no effect on reproduction. Studies of pregnant women abusing methylphenidate find no birth defects associated with the drug, but babies tend to be small and premature. A one-year follow-up found the infants to be in the normal range of development, although some were at the low end of normal. In one study all the pregnant women abusing methylphenidate were cigarette smokers; some were alcoholics; some had sexually transmitted disease; few received much prenatal care. In another study the methylphenidate-abusing mothers' situations were so grim that over half the infants were put into immediate foster care after delivery and did not go home with their mothers. Such confounding factors cloud any conclusions about the drug's effect on fetal development. Whether levels in breast milk are safe for infants is unconfirmed.

Additional scientific information may be found in:

Cox, D.J., et al. "Effect of Stimulant Medication on Driving Performance of Young Adults with Attention-Deficit Hyperactivity Disorder: A Preliminary DoubleBlind Placebo Controlled Trial." Journal of Nervous and Mental Disease 188 (2000): 230-34.

Crutchley, A., and J.A. Temlett. "Methylphenidate (Ritalin) Use and Abuse." South

African Medical Journal 89 (1999): 1076-79. Debooy, V.D., et al. "Intravenous Pentazocine and Methylphenidate Abuse during Pregnancy. Maternal Lifestyle and Infant Outcome." American Journal of Diseases of Children 147 (1993): 1062-65. Efron, D., F.C. Jarman, and M.J. Barker. "Child and Parent Perceptions of Stimulant Medication Treatment in Attention Deficit Hyperactivity Disorder." Journal of Paediatrics and Child Health 34 (1998): 288-92. Jadad, A.R., et al. "Treatment of Attention-Deficit/Hyperactivity Disorder." Evidence Report/Technology Assessment, no. 11 (1999): 1-341. Issue no. 11 is available online at: http://hstat.nlm.nih.gov/ftrs/dbaccess/adhd Llana, M.E., and M.L. Crismon. "Methylphenidate: Increased Abuse or Appropriate

Use?" Journal of the American Pharmaceutical Association 39 (1999): 526-30. Parran, T.V., Jr., and D.R. Jasinski. "Intravenous Methylphenidate Abuse. Prototype for Prescription Drug Abuse." Archives of Internal Medicine 151 (1991): 781-83. Scarnati, R. "An Outline of Hazardous Side Effects of Ritalin (Methylphenidate)." International Journal of the Addictions 21 (1986): 837-41.

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