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Various states have documented the diversion and trafficking of MPH in recent years. Nebraska investigative services for the state reported that MPH ranked among the top three pharmaceutical drugs most frequently submitted to crime laboratories for analysis from 1991 through 1993 and MPH ranked 6th among drugs involved in incidents of forged or altered prescriptions from April 1992 through January 1995. In Ohio, from March 1979 to January 1994, MPH ranked second among pharmaceutical drugs reported for false or forged prescriptions and the Ohio Board of Pharmacy reported 18 separate eases involving pharmacists that were diverting this drug. Except for one case of insurance fraud, all other cases involved Ohio pharmacists that were drug trafficking and diverting MPH for self-abuse. One pharmacist was even videotaped crushing MPH and snorting the powder. From 1992 to 1995, the Washington State Board of Pharmacy identified 10 pharmacy technicians and pharmacists who were diverting MPH for their own use. A number of other medical professionals have diverted MPH for profit or personal use. For example, a physician in Ohio was writing fraudulent prescriptions to enable him to bill welfare for office visits. In another case in Illinois, a physician was supplying multiple prescriptions to a group of individuals involved in a multi state drag trafficking ring. In total, from January 1990 through May 1995, DEA initiated nearly 200 MPH cases involving physicians and pharmacists. Cases ranged in severity from relatively minor infractions of the CSA to diverting large quantities of MPH to known drug abusers and drug traffickers.

Although diversion, trafficking and abuse of methylphenidate have been documented throughout the U.S. with some instances of a severe nature, the incidence of these activities in the adult population has remained relatively stable. This is consistent with what the DEA would expect of a substance with a high abuse potential but no clandestine production, limited prescription to adults, and stringent regulatory controls applied to its production, distribution and prescription. However, diversion and misuse/abuse of MPH medication intended for the treatment of ADHD is escalating and of particular concern to the DEA. Data relating to this will be reviewed in the next section.

Issues Related to MPH Medication for ADHD

There are very few articles in the ADHD-treatment literature that address the abuse
potential of MPH and only a limited number of case reports have documented MPH abuse within
the context of ADI-ID treatment.43,45,70 In point of fact, the vast majority of articles in these professional journals fail to address this issue or will often comment that MPH is a mild psychostimulant that is not associated with drug abuse. However, a significant amount of data from school surveys, emergency room reports, poison control centers, adolescent drug treatment centers and law enforcement encounters all indicate a growing problem with the abuse of MPH among school children.
Since 1990, there has been a six-fold increase in the number of estimated drug abuse emergency room (ER) visits associated with the use of MPH in the Department of Health and Human Services Substance Abuse and Mental Health Services Administration (DHHS-SAMHSA) Drag Abuse Warning Network (DAWN): in 1990 it was estimated that there were 271 ER visits while in 1996 the estimated number was 1,725. When these DAWN mentions are compared to other potent psychostimulants like methamphetamine (MAMP) and cocaine (COC), the total number of mentions for MPH pales in comparison (Figure 4). To a large extent, this disparity reflects the much greater availability of MAMP and COC. However, if DAWN data are examined for children ages 10-14 years of age, a group that has much easier access to MPH as a result of the expanded use of MPH for ADHD treatment, an entirely different profile emerges for these drugs (Figure 5). In 1995 and 1996, 10-14 year old patients were just as likely to mention MPH use as cocaine in a drug abuse DAWN ER episode. Eighty five percent of the MPH cohort reported no other drug used in combination with MPH and in nearly 75 percent of the episodes patients reported drug use for psychic effects (44%) or recreational use (30%).
Survey data also indicate that a growing number of adolescents are misusing/abusing MPI-I. Monitoring the Future, a national school survey conducted by the Institute of Social Research at the University of Michigan, indicate that about 1 percent of all 1994 and 1995 high school seniors used Ritalin without a doctor's order during the previous year. In 1997, that percentage increased to 2.8. While 1997 statistics show a significant increase in illicit use, the percentages of high school seniors that have used Ritalin/MPH illicitly may be much higher. As explained by the authors,TM 12th graders are asked about their use of Ritalin only if they answer that they used "amphetamines" non-medically in thc prior 12 months. Failure to recognize that Ritalin is an amphetamine would mean that they would not respond to a question about Ritalin use and therefore not be counted. Indiana's drug use survey may reflect a more accurate prevalence. In 1997, Indiana University Prevention Resource Center Survey, representing a sampling of 44,232 students in 137 different schools, added questions relating to non-medical use of Ritalin in the general drug use section. Nearly 7 percent of all high school students reported using Ritalin non-medically at least once in the previous year and 2.5 percent reported using it on a monthly or more frequent basis.