Ritalin Addiction and Withdrawal


Ritalin is the brand name of the immediate release formulation of methylphenidate, a medication that’s used for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults.1-3Concerta is the brand name of extended release methylphenidate.2 Methylphenidate is also used as a second-line treatment for narcolepsy in adults and has seen off-label use as a treatment for fatigue associated with cancer.3

How Does Ritalin Work?

Methylphenidate is a central nervous system stimulant. Its effects are more intense than caffeine but less potent than amphetamine, which is another drug used to treat ADHD and narcolepsy.4 People misuse these medications for the effects that they produce, including wakefulness, euphoria, increased focus, and appetite suppression.1,5

Ritalin stimulates the central and sympathetic nervous system by enhancing the release and blocking the reuptake of two neurotransmitters, dopamine and norepinephrine.3 It is pharmacologically similar to cocaine and radiographic studies have found that Ritalin and cocaine both bind to dopamine receptors in the same area of the brain.5,6 It works quickly and increases the concentration of both norepinephrine and dopamine almost immediately.3

Who Abuses Ritalin?

Stimulant use is on the rise in the United States. According to the 2018 National Survey on Drug Use and Health, an estimated 5.1 million people aged 12 or older misused prescription stimulants in the past year.7

The U.S. Drug Enforcement Administration states that the primary abusers of methylphenidate are younger than 25 years of age. Similar to Adderall, another prescription stimulant prescribed to treat symptoms of ADHD, young people often obtain Ritalin or Concerta from a friend or classmate and use this drug as a study aid or to party.5,8

People who abuse Ritalin often obtain it from peers, friends, or family members who have a legitimate prescription for it. Individuals may abuse Ritalin by crushing the tablets and snorting the powder to deliver a powerful high. Some people who abuse the drug also dissolve the tablets in water and inject the solution directly into a vein.

According to the 2019 National Monitoring the Future Survey, use of Ritalin in the past year among 8th, 10th, and 12th graders combined has gone from 3.5% in 2006 to only 0.9% in 2019.9

When taken orally at the prescribed dosage, methylphenidate (Ritalin or Concerta) is relatively safe and effective as a medication for those with ADHD or narcolepsy. When taken beyond its therapeutic dose intranasally or intravenously, its receptor effects are similar to those of cocaine and users report a “high” that’s similar to cocaine or amphetamines.6

Side Effects and Dangers of Ritalin

Although relatively safe and effective to improve focus and attention for those with ADHD, Ritalin and Concerta also has some potential side effects:10,11

  • Headache.
  • Dry mouth.
  • Insomnia.
  • Rapid/exaggerated changes in mood.
  • Nausea/vomiting.
  • Nervousness.
  • Palpitations.
  • Elevated blood pressure.
  • Rapid heart rate.

Ritalin also carries with it a risk of experiencing some serious adverse effects:6,10,11

  • Increase in blood pressure and may cause hypertension.
  • Increased heart rate.
  • Hallucinations.
  • Delusional thinking.
  • Paranoia or confusion.
  • Mania.
  • Aggression.
  • Priapism, which is a prolonged, painful erection of the penis.
  • Blurred vision.
  • Seizures.
  • Stroke.

Most of the above would be considered medical emergencies, and the manufacturer recommends that the prescribing doctor should be informed.10,11 Adverse events such as those above can occur even at therapeutic doses, and are even more likely to occur when a stimulant is used in excess doses.6,10,11

Using and especially misusing simulant drugs such as Ritalin (as well as Concerta, Adderall, and other amphetamines) all increase the risk of experiencing or exacerbating psychosis; causing or worsening anxiety, tension or aggression; decreasing circulation in the fingers and toes; and may even cause sudden death.10-12

Ritalin Dependence and Withdrawal

Ritalin, especially at doses larger than clinically indicated (i.e., greater than 10-60 mg/day) can be habit-forming. Ritalin use can result in the development of physical dependence, an adaptation of the body to a substance which results in experiencing a withdrawal syndrome when reducing use significantly or stopping use.6,12 Ritalin withdrawal symptoms may be similar to those seen during withdrawal from illicit stimulants, such as cocaine and amphetamine.6,12

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the formal diagnostic criteria for acute stimulant withdrawal, which includes the following symptoms:13

  • Fatigue.
  • Problems sleeping or sleeping too much.
  • Troubling and/or very vivid dreams.
  • Psychomotor agitation or retardation.
  • Increased hunger.
  • Slowed heart rate.
  • Dysphoria (low mood).

The drug labels for Ritalin and Concerta also indicate that severe depression may result from Ritalin withdrawal.10,11 Withdrawal from stimulant medications may not result in immediate or direct harm to individual health; however, the depression and anhedonia that a person in withdrawal may experience could result in suicidal ideation or suicide attempts, arguably the biggest risks associated with stimulant withdrawal.13

Treatment for Ritalin Abuse

Individuals who have chronically misused stimulant medications such as Ritalin or Concerta, or regularly take illicit stimulant drugs such as cocaine or methamphetamine, should consult with a physician or addiction treatment specialist to discontinue use. This is because stopping the drugs may lead to complicated issues that include cravings, mood swings, physical withdrawal symptoms, etc., that often drive individuals who are attempting to remain abstinent from them to relapse.

Polysubstance users may be at further risk of harm, since there could be multiple withdrawal syndromes at play. Stimulant withdrawal itself is not particularly dangerous, but if someone is also dependent on another drug, such as depressants like benzodiazepines or opioids, may be at risk for seizures or other problems requiring medical attention.14

Withdrawal management is only the first step in recovery. After medical detox, further addiction treatment may be beneficial for continued abstinence. This is because any issues that contributed to the misuse of Ritalin in the first place are likely to remain and could promote relapse if not addressed.14

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. National Institute on Drug Abuse. (2018). Prescription Stimulants DrugFacts.
  3. Verghese, C., & Abdijadid, S. (2020). Methylphenidate. In StatPearls. StatPearls Publishing.
  4. Wood, S., Sage, J. R., Shuman, T., & Anagnostaras, S. G. (2013). Psychostimulants and cognition: a continuum of behavioral and cognitive activationPharmacological Reviews, 66(1), 193–221.
  5. Diversion Control Division; United States Drug Enforcement Administration. (2019). Methylphenidate.
  6. Morton, W. A., & Stockton, G. G. (2000). Methylphenidate Abuse and Psychiatric Side Effects. Primary Care Companion to the Journal of Clinical Psychiatry, 2(5), 159–164.
  7. Substance Abuse and Mental Health Services Administration. (2020). Treatment of Stimulant Use Disorders.
  8. Chen, L. Y., Crum, R. M., Strain, E. C., Martins, S. S., & Mojtabai, R. (2015). Patterns of concurrent substance use among adolescent nonmedical ADHD stimulant users. Addictive Behaviors, 49, 1–6.
  9. National Institute on Drug Abuse (2019). The Monitoring the Future Study: Table 6: Trends in Annual Prevalence of Use of Various Drugs for Grades 8, 10, and 12 Combined. Ann Arbor: Institute for Social Research, The University of Michigan.
  10. Food and Drug Administration. (2013). Drug Label: Ritalin.
  11. Food and Drug Administration. (2017). Drug Label: Concerta.
  12. National Institute on Drug Abuse. (2018). Prescription Stimulants.
  13. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  14. Substance Abuse and Mental Health Services Administration. (2015). Treatment Improvement Protocol (TIP) Series No. 45: Detoxification and Substance Abuse Treatment.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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