Letters to the Editor
Reply: Characteristics of Methylphenidate in a University Student Sample
Dear Editor: We thank Dr Oyemade and Dr Patel for their comments on our article. As these authors point out, methylphenidate misuse among college students appears to be a widespread phenomenon, and strategies are clearly needed to curb the inappropriate use of this prescription medication. Although studies that have examined prevalence of methylphenidate misuse among college students have reported variable rates across institutions (2% to 16%), these findings are difficult to interpret, owing to relatively modest levels of participation among those invited to participate (ranging from 20% to 64%) (1,2). Nevertheless, a recent study examining past-year illicit prescription stimulant use across 119 American colleges from geographically diverse regions documented stimulant medication misuse in over 83% of the institutions examined (3). This suggests that the inappropriate use of methylphenidate is a widespread problem.
We also agree with Dr Oyemade and Dr Patel’s suggestion that the competitive nature of colleges might contribute to the propensity for methylphenidate abuse in college students. In our sample, 30% of those who reported inappropriately using methylphenidate reported doing so exclusively for study. Although we did not systematically record all possible motives for methylphenidate use among recreational users, several of these participants spontaneously reported the use of methylphenidate for both recreational and study purposes. In addition to the competitive scholastic pressures facing many college students, there are also numerous reports of high rates of binge drinking and drug experimentation among college students (4,5), and this too might contribute to their propensity to misuse methylphenidate. Anecdotal evidence suggests that many college students may deliberately mix methylphenidate and alcohol to prolong their drinking sessions (6) or to achieve desirable subjective effects (7). In our study, alcohol-methylphenidate mixing was reported as a relatively common practice among recreational users.
Given that illicit methylphenidate may be in high demand for multiple reasons in a college setting and given the potential social stigma involved with taking psychiatric medications (8), individuals with legitimate prescriptions for methylphenidate may experience considerable pressure to divert their medication as a means of belonging. Moreover, because many college students may live away from home, their prescription adherence is unlikely to be closely monitored. While we agree with Dr Oyemade and Dr Patel that increased education is likely key to curbing the problem of prescription diversion, such efforts might prove most effective if directed toward physicians, pharmacists, and patients alike.
References
1. Teter CJ, McCabe SE, Boyd CJ, Gutherie SK. Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors. Pharmacotherapy 2003;23:609–17.
2. Babcock Q, Byrne T. Student perceptions of methylphenidate abuse at a public liberal arts college. J Am Coll Health 2000;49:143–5.
3. McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 2005;100:96–106.
4. Lange JE, Clapp JD, Turrisi R, Reavy R, Jaccard J, Johnson MB, and others. College binge drinking: what is it? Who does it? Alcohol Clin Exp Res 2002;26:723–30.
5. Rimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am 2005;52:307–19.
6. Weiner AL. Emerging drugs of abuse in Connecticut. Conn Med 2000;64:19B23.
7. Barrett SP, Pihl RO. Oral methylphenidateBalcohol co-abuse. J Clin Psychopharmacol 2002;22:633–4.
8. Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, and others. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med 2005;61:133–55.
Sean P Barrett, PhD
Halifax, Nova Scotia
Christine Darredeau, PhD Candidate
Robert O Pihl, PhD
Montreal, Quebec
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