Illicit use of Methylphenidate: the other side of the medical prescription


  • Sandra Vanessa Dias Pereira Department of Pediatric, Hospital Pediátrico Integrado, Centro Hospitalar de São João.
  • Ana Maria Ferreira Department of Pediatric, Centro Hospitalar Entre Douro e Vouga
  • Ana Azevedo Department of Pediatric, Centro Hospitalar Entre Douro e Vouga
  • Cláudia Barroso Division of Child and Adolescent Psychiatry, Department of Psychiatry, Centro Hospitalar Entre Douro e Vouga
  • Virgínia Monteiro Department of Pediatric, Centro Hospitalar Entre Douro e Vouga



Attention deficit hyperactivity disorder, illicit use, intoxication, methylphenidate, pediatric age


Introduction/Objective: Attention Deficit Hyperactivity Disorder is the most common neurobehavioral disorder of childhood. Parallel to the progress in the diagnosis, the prescription of psychostimulants, namely Methylphenidate (MPH), has also increased. The aim of this review is to promote reflection and debate on this issue, displaying its actual relevance in order to prevent and properly diagnose such cases in Portugal.
Results: In recent years, illicit use or misuse of MPH for recreational purposes or as a cognitive stimulant to improve academic achievement, has become a focus of concern. Easier accessibility, false belief that it is safer than illegal drugs because it’s prescription based as well a less social stigmatization promote this practice. Thus, treatment with MPH requires adequate medical indication and supervision, not only for its potential cardiovascular side effects and exacerbation of psychiatric disorders, but also due to the risk of illicit use and intoxication.
Conclusion: This article reviews the literature concerning MPH misuse. In order to counteract this emerging problem, of still unknown proportions in Portugal, it is crucial to invest in the information and awareness of adolescents, parents, health professionals, and educational community in general.


Download data is not yet available.


Burillo-Putze G, Aldea-Perona A, Rodríguez-Jiménez C, García-Sáiz MM, Climent B, Dueñas A, et al. Emergent drugs (II): the Pharming phenomenon. An Sist Sanit Navar 2013; 36(1): 99-114.

White SR, Yadao CM. Characterization of methylphenidate exposures reported to a regional poison control center. Arch Pediatr Adolesc Med 2000; 154(12): 1199-203.

Klampfl K, Quattländer A, Burger R, Pfuhlmann B, Warnke A, Gerlach M.Case report: intoxication with high dose of long-acting methylphenidate (Concerta(®)) in a suicidal 14-year-old girl. Atten Defic Hyperact Disord 2010; 2(4): 221-4.

Scharman EJ, Erdman AR, Cobaugh DJ, Olson KR, Woolf AD, Caravati EM, et al. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2007; 45(7): 737-52.

Looby A, Earleywine M.Expectation to receive methylphenidate enhances subjective arousal but not cognitive performance. Exp Clin Psychopharmacol 2011; 19(6):433-44.

Sembower MA, Ertischek MD, Buchholtz C, Dasgupta N, Schnoll SH. Surveillance of diversion and nonmedical use of extended-release prescription amphetamine and oral methylphenidate in the United States.J Addict Dis 2013; 32(1):26-38.

Klein-Schwartz W, McGrath J. Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry 2003; 42(3):288-94.

McCabe SE, Teter CJ, Boyd CJ, Guthrie SK. Prevalence and correlates of illicit methylphenidate use among 8th, 10th, and 12th grade students in the United States, 2001. J Adolesc Health 2004; 35(6):501-4.

Kooij JJS. PHDA em adultos: Introdução ao diagnóstico e terapêutica. Coisas de Ler. Lisboa; 2008

Lakhan SE, Kirchgessner A.Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav 2012; 2(5): 661-77.

Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128(5):1007-22.

Jardin B, Looby A, Earleywine M. Characteristics of College Students With Attention-Deficit Hyperactivity Disorder Symptoms Who Misuse Their Medications. J Am Coll Health 2011. 59(5): p. 373-7.

Bruggisser M, Bodmer M, Liechti ME. Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets. Swiss Med Wkly 2011; 141: w13267.

Bruggisser M, Ceschi A, Bodmer M, Wilks MF, Kupferschmidt H, Liechti ME. Retrospective analysis of stimulant abuse cases reported to the Swiss Toxicological Information Centre during 1997-2009. Swiss Med Wkly 2010; 140: w13115.

Kollins SH. ADHD, substance use disorders, and psychostimulant treatment: current literature and treatment guidelines. J Atten Disord 2008;12(2):115-25.

Frauger E, Pauly V, Natali F, Pradel V, Reggio P, Coudert H, et al. Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behavior determined from a reimbursement database: main trends from 2005 to 2008. CNS Drugs 2011; 25(5): 415-24.

Bogle KE, Smith BH. Illicit Methylphenidate Use: A Review of Prevalence, Availability, Pharmacology, and Consequences. Current Drug Abuse Reviews 2009; 2(2): 157-176.

Marti G, Fattinger K, Zimmermann H, Exadaktylos A. Orofacial dyskinesia induced by nasal Ritalin(R) (methylphenidate) sniffing: a rare case report from Switzerland. Hum Exp Toxicol 2013; 32(3): 332-4.

Dupont RL, Coleman JJ, Bucher RH, Wilford BB. Characteristics and Motives of College Students Who Engage in Nonmedical Use of Methylphenidate. Am J Addict 2008; 17(3): 167-71.

Hondebrink L, Rietjens SJ, Hunault CC, Pereira RR, Kelleci N, Yasar G, et al. Methylphenidate intoxications in children and adults: exposure circumstances and evidence-based dose threshold for pre-hospital triage.Clin Toxicol (Phila) 2015;53(3):168-77.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington; 2013.

Setlik J, Bond GR, Ho M. Adolescent Prescription ADHD Medication Abuse Is Rising Along With Prescriptions for These Medications. Pediatrics 2009; 124(3): 875-880.

Barrett SP, Darredeau C, Bordy LE, Pihl RO. Characteristics of Methylphenidate Misuse in a University Student Sample. Can J Psychiatry 2005; 50(8): 457-61.

Burton CL, Nobrega JN, Fletcher PJ. The effects of adolescent methylphenidate self-administration on responding for a conditioned reward, amphetamine-induced locomotor activity, and neuronal activation. Psychopharmacology (Berl) 2010; 208(3):455-68.

Bagdure DN, Bhoite GR, Reiter PD, Dobyns EL. Dexmedetomidine in a child with methylphenidate intoxication. Indian J Pediatr 2013;80(4):343-4.

Chéron-Blümel A, Grall-Bronnec M, Victorri-Vigneau C, Péron E, Bétaud C, Jolliet P, et al. Prescription of methylphenidate for children: importance of recommendations to limit misuse. Arch Pediatr 2014; 21(8):852-9. [homepage da internet]. Portugal: Autoridade Nacional do Medicamento e Produtos de Saúde I.P.; [consultado 2015 Mar 6]. Disponível em:

DeSantis AD, Webb EM, Noar SM. Illicit Use of Prescription ADHD Medications on a College Campus: A Multimethodological Approach. J Am Coll Health 2008; 57(3): 315-24.

Ozdemir E, Karaman MG, Yurteri N, Erdogan A.A case of suicide attempt with long-acting methylphenidate (Concerta). Atten Defic Hyperact Disord 2010; 2(3): 103-5.

LoVecchio F, Ozimek J, Sawyers B, Thole D. Outcomes after accidental pediatric ingestions of (dextro)amphetamine and methylphenidate. Am J Emerg Med 2009; 27(8): 933–934.

Sussman S, Pentz MA, Spruijt-Metz D, Miller T. Misuse of "study drugs:" prevalence, consequences, and implications for policy. Subst Abuse Treat Prev Policy 2006; 1:15.

Clemow DB, Walker DJ. The potential for misuse and abuse of medications in ADHD: a review. Postgrad Med 2014;126(5): 64-81.

Hill SL, El-Khayat RH, Sandilands EA, Thomas SH. Electrocardiographic effects of methylphenidate overdose. Clin Toxicol (Phila) 2010; 48(4): 342-6.

Sumnall HR, Woolfall K, Cole J, Mackridge A, McVeigh J. NICE guidance on ADHD. Diversion and abuse of methylphenidate in light of new guidance. BMJ 2008; 28: 337: a2287.

Wilens TE, Gignac M, Swezey A, Monuteaux MC, Biederman J. Characteristics of Adolescents and Young Adults With ADHD Who Divert or Misuse Their Prescribed Medications. J Am Acad Child Adolesc Psychiatry 2006; 45(4): 408-14.

Garnier-Dykstra LM, Caldeira KM, Vincent KB, O'Grady KE, Arria AM. Nonmedical use of prescription stimulants during college: four-year trends in exposure opportunity, use, motives, and sources. J Am Coll Health 2012; 60(3): 226-34.

Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47(1):21-31.

Rabiner DL, Anastopoulos AD, Costello EJ, Hoyle RH, McCabe SE, Swartzwelder HS. The misuse and diversion of prescribed ADHD medications by college students. J Atten Disord. 2009; 13(2):144-53. Folheto Informativo: Informação para o utilizador [homepage da internet]. Portugal: Autoridade Nacional do Medicamento e

Produtos de Saúde I.P.; [consultado 2015 Mar 6]. Disponível em:

Teter CJ, McCabe SE, Cranford JA, Boyd CJ, Guthrie SK. Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. J Am Coll Health. 2005; 53(6):253-62.

Gahr M, Freudenmann RW, Hiemke C, Kölle MA, Schönfeldt-Lecuona C. Abuse of methylphenidate in Germany: data from spontaneous reports of adverse drug reactions. Psychiatry Res 2014; 215(1):252-4.

Poulin C. From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: connecting the dots. Addiction 2007; 102(5):740-51.

Riggs PD, Winhusen T, Davies RD, Leimberger JD, Mikulich-Gilbertson S, Klein C, et al. Randomized Controlled Trial of Osmotic-Release Methylphenidate with CBT in Adolescents with ADHD and Substance Use Disorders. J Am Acad Child Adolesc Psychiatry 2011; 50(9):903-14.

Chatterjee A. Is it acceptable for people to take methylphenidate to enhance performance? No. BMJ 2009; 338: b1956.




How to Cite

Pereira SVD, Ferreira AM, Azevedo A, Barroso C, Monteiro V. Illicit use of Methylphenidate: the other side of the medical prescription. REVNEC [Internet]. 2018Jul.13 [cited 2024Apr.21];27(2):98-104. Available from:



Review Articles

Most read articles by the same author(s)