An update on the clinical pharmacology of methylphenidate: therapeutic efficacy, abuse potential and future considerations

ABSTRACT

Introduction

Methylphenidate remains a first-line medication for treating ADHD in children and adults. However, its behavioral pharmacological similarities to methamphetamine and cocaine have historically created concern for its potential as a drug of abuse. In September 2019, the FDA published a docket requesting comments for the development of abuse deterrent formulations for CNS stimulants, emphasizing the abuse of methylphenidate as a public health concern.

Areas covered

We conducted a narrative review of research on the clinical pharmacology, therapeutic efficacy, and abuse potential of methylphenidate.

Expert opinion

Several studies indicate that methylphenidate has at least some abuse potential. Methylphenidate, amphetamine, methamphetamine, and cocaine overlap in their subjective, reinforcing, and discriminative stimulus effects. Regardless, methylphenidate remains an efficacious treatment for ADHD in children and adults when properly adhered to, especially when paired with non-pharmacological treatments. The development of abuse deterrent formulations of methylphenidate is warranted.

KEYWORDS:

• Abuse deterrent formulations (ADFs)
• abuse potential
• attention deficit-hyperactivity disorder (ADHD)
• discriminative stimulus effects
• methylphenidate
• prescription stimulants
• reinforcing effects
• subjective effects

Article highlights

• Methylphenidate is a first line treatment for ADHD in children and adults.

• Concerns have been raised about methylphenidate as a potential drug of abuse because of its pharmacological and behavioral similarities to cocaine and methamphetamine.

• Human laboratory studies of the subjective, reinforcing, and discriminative stimulus effects of methylphenidate indicate that it has at least some abuse potential.

• In September 2019, the FDA issued a Federal Register notice to establish public docket requesting comments from interested parties about abuse-deterrent formulations of central nervous system stimulants.

• Methylphenidate remains an efficacious, first line treatment for ADHD and therefore caution should be taken when considering regulatory action that might limit its therapeutic use.

• Recent successes in the development of opioid ADFs should be used as guidance for future research regarding CNS stimulant abuse deterrence.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.