Differentiating Between Methylphenidate Use and Misuse: Clinical Insights From University Students and Academic Staff in Türkiye

BACKGROUND Methylphenidate (MPH) is widely prescribed for attention deficit hyperactivity disorder (ADHD), but non-medical use is increasing, particularly in academic settings, for cognitive enhancement. This study aims to distinguish individuals using MPH for ADHD treatment from those misusing it by analyzing clinical and behavioral characteristics. MATERIAL AND METHODS This retrospective study was conducted at a university-affiliated psychiatric outpatient clinic in Türkiye. Data were collected from structured psychiatric evaluations by a single psychiatrist between January and December 2024. A total of 135 individuals who requested MPH were included. Misuse was defined as use without an ADHD diagnosis, exceeding the prescribed dose, or use through non-oral routes. Participants were categorized into 4 groups based on diagnosis and misuse patterns. Data on demographics, psychiatric history, MPH use, and follow-up attendance were analyzed using descriptive and comparative methods. RESULTS Of the 135 participants, 3% were ADHD-diagnosed misusers, 33.3% were ADHD-diagnosed non-misusers, 11.9% were non-ADHD misusers, and 51.8% were non-ADHD non-misusers. Non-ADHD misusers were older (mean age 25 vs 22 years, P<0.001), had later MPH initiation (23 vs 15 years, P<0.001), more often held a PhD (Doctor of Philosophy) or an equivalent higher degree (23.3% vs 2.0%, P<0.001), had lower follow-up attendance (32.6% vs 93.9%, P<0.001), and preferred short-acting MPH (73.3% vs 20.4%, P<0.001). ADHD-diagnosed individuals were more likely to have a family psychiatric history (69.4% vs 21.0%, P<0.001). CONCLUSIONS Misuse patterns differ significantly from medically indicated use. Strengthening diagnostic accuracy and implementing effective monitoring protocols in academic settings are essential for preventing misuse and supporting ADHD treatment.