Illicit Methylphenidate Use in an Undergraduate Student Sample: Prevalence and Risk Factors

Christian J. Teter, Pharm.D., Sean Esteban McCabe, Ph.D., Carol J. Boyd, Ph.D., Sally K. Guthrie, Pharm.D.

Disclosures

Pharmacotherapy. 2003;23(5) 

In This Article

Implications for Future Practice

Physicians and pharmacists must balance the risks and benefits of psychostimulant pharmacotherapy carefully when diagnosing, treating, and monitoring their patients. "Health care providers must cooperate in detecting abuse and minimizing diversion."[33] School social workers, nurses, and administrators should consider several prevention strategies when dealing with abusable prescription drugs; clearly, enhanced screening and assessment can lead to early identification of potential methylphenidate abusers.

Clinicians should be familiar with nonpsychostimulant alternatives for the treatment of ADHD and other disorders. For example, the Food and Drug Administration recently approved atomoxetine, a nonstimulant norepinephrine reuptake inhibitor that has been shown to be safe and effective for treatment of ADHD in children, adolescents, and adults.[36] Alternatively, the use of pharmaceutical delivery systems that are not easily manipulated for injection or inhalation might help limit the abuse of methylphenidate and other prescription psychostimulants. For example, at least one published report describes failed attempts at abusing Concerta (methylphenidate; McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, PA) by the intranasal route.[37] Concerta uses an osmotic pressure delivery system to deliver methylphenidate at a controlled rate. This system may be difficult to use by alternate routes of administration, due to its physical make-up and insoluble components. Finally, inappropriate use of prescription psychostimulants may be hindered by the use of centralized prescription databases, such as the newly introduced Michigan Automated Prescription System.[38] This system, which allows clinicians to access patients' prescription records, allows for more thorough monitoring and detection of drug-seeking behaviors, such as doctor shopping or the use of multiple pharmacies to obtain controlled substances.

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