Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature

Wilens, Timothy E.; Adler, Lenard A.; Adams, Jill; Sgambati, Stephanie; Rotrosen, John; Sawtelle, Robert; Utzinger, Linsey M.; Fusillo, Steven J.

doi:10.1097/chi.0b013e31815a56f1

Cited by 698 publications

(557 citation statements)

References 45 publications

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“…The psychostimulant methylphenidate hydrochloride (MPH) is an effective firstline treatment for children with attention-deficit hyperactivity disorder (ADHD) (Buitelaar and Medori, 2010). However, 30% of children with ADHD do not respond to MPH (Wilens et al, 2008) and experience no benefit or only adverse side effects (Cho et al, 2007;Rapport et al, 1994). Moreover, although positron emission tomography studies of MPH exposure suggest that catecholamine dysfunction at least partially mediates the behavioral and cognitive features of ADHD (Hannestad et al, 2010;Krause, 2008;Volkow et al, 2002), how MPH affects the nervous system remains unclear, especially over long periods.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging-Aided Prediction of the Effect of Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Ishii-Takahashi

Takizawa

Nishimura

et al. 2015

Neuropsychopharmacol

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Although methylphenidate hydrochloride (MPH) is a first-line treatment for children with attention-deficit hyperactivity disorder (ADHD), the non-response rate is 30%. Our aim was to develop a supplementary neuroimaging biomarker for predicting the clinical effect of continuous MPH administration by using near-infrared spectroscopy (NIRS). After baseline assessment, we performed a double-blind, placebo-controlled, crossover trial with a single dose of MPH, followed by a prospective 4-to-8-week open trial with continuous MPH administration, and an ancillary 1-year follow-up. Twenty-two drug-naïve and eight previously treated children with ADHD (NAÏVE and NON-NAÏVE) were compared with 20 healthy controls (HCs) who underwent multiple NIRS measurements without intervention. We tested whether NIRS signals at the baseline assessment or ΔNIRS (single dose of MPH minus baseline assessment) predict the Clinical Global Impressions-Severity (CGI-S) score after 4-to-8-week or 1-year MPH administration. The secondary outcomes were the effect of MPH on NIRS signals after single-dose, 4-to-8-week, and 1-year administration. ΔNIRS significantly predicted CGI-S after 4-to-8-week MPH administration. The leave-one-out classification algorithm had 81% accuracy using the NIRS signal. ΔNIRS also significantly predicted CGI-S scores after 1 year of MPH administration. For secondary analyses, NAÏVE exhibited significantly lower prefrontal activation than HCs at the baseline assessment, whereas NON-NAÏVE and HCs showed similar activation. A single dose of MPH significantly increased activation compared with the placebo in NAÏVE. After 4-to-8-week administration, and even after MPH washout following 1-year administration, NAÏVE demonstrated normalized prefrontal activation. Supplementary NIRS measurements may serve as an objective biomarker for clinical decisions and monitoring concerning continuous MPH treatment in children with ADHD.

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Section: Introductionmentioning

confidence: 99%

Neuroimaging-Aided Prediction of the Effect of Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Ishii-Takahashi

Takizawa

Nishimura

et al. 2015

Neuropsychopharmacol

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“…Thus, the action of MPH in the striatum would be clinically related with improved attention and decreased distraction. 24 There is evidence that the action of MPH on the prefrontal cortex would be related primarily with noradrenergic modulation, 15 thus promoting cognitive enhancement in working memory and associative learning. 25 In the nucleus accumbens, the increase in dopamine seems to be related with increased motivation and consequently an improved task performance.…”

Section: Mechanism Of Action and The Neurobiology Of Mph Abusementioning

confidence: 99%

“…Epidemiological data from different studies point to an increased use of psychostimulant drugs among students with the aim of improving academic performance. 8,15,37,38 Learning and memory are defined as the ability to acquire new information and retain them via the combined action of multiple cognitive and neural systems. Despite the fact that there are no independent operations in the memorization process, there are some specific areas, e.g.…”

Section: Evidence Of Neurocognitive Enhancementmentioning

confidence: 99%

“…Approximately one in five of those patients were approached at least once over a 5-year period and asked to sell, give away, or somehow share the medication. 15 The present literature review aimed to review the scientific literature and collect data on non-medical uses of MPH. The main neurobiological aspects underlying the use of MPH are discussed, as well as the mechanism of action and other pharmacological characteristics of the drug.…”

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confidence: 99%

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Non-medical use of methylphenidate: a review

Freese¹,

Signor²,

Machado³

et al. 2012

Trends Psychiatry Psychother.

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Uso não terapêutico do metilfenidato: uma revisãoNon-medical use of methylphenidate: a review Abstract Introduction: Methylphenidate is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder and narcolepsy. However, it has also been used for non-medical purposes, e.g. to produce euphoria, to increase self-esteem, and to achieve the so-called neurocognitive enhancement, decreasing the feeling of tiredness and increasing focus and attention. Objective: To describe, from theoretical and contextual points of view, the potential for abuse and non-medical use of methylphenidate. Method: The PubMed, SciELO and Cochrane databases were searched using the following keywords in Portuguese: metilfenidato, transtorno do déficit de atenção com hiperatividade, facilitadores dos processos cognitivos or agentes nootrópicos, and abuso de substâncias; and in English: methylphenidate, attention deficit disorder with hyperactivity, cognitive enhancement or nootropic agents, and substance abuse. Studies published between 1990 and 2010 were selected for review. Results: Non-medical use of methylphenidate is a relevant topic that raises important ethical and scientific questions in several areas, e.g. pharmacological and neurobiological characteristics, evidence of methylphenidate use, forms of nonmedical use of methylphenidate, mechanisms of action, and therapeutic application of methylphenidate. According to the review, methylphenidate can generally influence performance as a result of its stimulatory effect. Notwithstanding, evidence does not support the conclusion that it can enhance cognitive performance. Conclusion: Health professionals need to acquire expert knowledge and inform patients and their families on the methylphenidate potential for abuse when used with non-medical purposes.

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“…This drug is a stimulant and shares similar neurophysiological mechanisms with cocaine and amphetamine [1]- [6]. A review that includes over 110,000 subjects reported that 5% to 35% of 18 -22-year-old individuals misuse non-prescribed stimulant medication [7]. A recent survey reports that 92% of adult ADHD patients use ethanol while under the influence of prescribed MPD.…”

Section: Introductionmentioning

confidence: 99%

Ritalin Use Modifies Alcohol Effects in Rats

Sonne¹,

Dafny²

2014

JBBS

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Methylphenidate (MPD), known as Ritalin, is a common drug prescribed for those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).There are reports that many MPD users consume alcohol, resulting in toxic effects and hospitalization. The goal of this study was to investigate the effects of ethanol in rats concomitant with acute and repetitive MPD exposure. Rats were divided into four groups, control (saline), 0.6 mg/kg MPD, 2.5 mg/kg MPD, and 10.0 mg/kg MPD groups and lasted for 12 consecutive days. Ethanol was given after repeated MPD administration as follows. On experimental day 1 (ED 1), all animals were treated with saline to establish baseline, on ED 2 through ED 7 either saline or MPD (0.6, 2.5, or 10.0 mg/kg) was given. On ED 11, after three days without treatment (ED 8 -10), rats were treated as they were on ED 2 -7. At ED 12, 1 g/kg ethanol was administered, and one hour of locomotor activity was recorded after alcohol administration, using the open field assay. The data show a dose response characteristic of increased locomotor activity with increasing doses of MPD. Ethanol administration alone depresses locomotor activity. The depressive effect of alcohol was significantly attenuated in animals treated with MPD, in a dose dependent manner. The higher dose of MPD previously administered resulted in a larger attenuation of the ethanol's suppressive effect. These trends demonstrate that chronic MPD exposure directly influences the effects of alcohol in rats. Under these circumstances, it is reasonable to assume that a subject will need to consume an increased amount of ethanol in order to attain the ethanol effect desired. This discrepancy between effects and exposure may be a liability for ethanol toxicity.

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Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature

Cited by 698 publications

References 45 publications

Neuroimaging-Aided Prediction of the Effect of Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Neuroimaging-Aided Prediction of the Effect of Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Non-medical use of methylphenidate: a review

Ritalin Use Modifies Alcohol Effects in Rats

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