Failed attempts at intranasal abuse of Concerta.

The treatment of substance-abusing adolescents who have comorbid attention-deficit/hyperactivity disorder (ADHD) involves the achievement of abstinence. In addition, medication is often needed for the ADHD symptoms to allow the adolescent to function better at school and participate more fully in groups and meetings. Abuse of stimulants (methylphenidate and amphetamines), especially by the intranasal route, is fairly common with nonADHD adolescents and, although rare, is a risk with substanceabusing ADHD adolescents (Garland, 1998; Jaffe, 1991). Recently I treated three dual-disorder adolescents with comorbid ADHD who attempted to “snort” Concerta (once-daily extended-release tablets). These adolescents were treated in a residential adolescent substance abuse program. The first two adolescents cut the Concerta pill into three parts and snorted two of them. They reported that the usual stimulant high did not occur. The third adolescent cut the Concerta pill into small pieces, which he then crushed. Intranasal use did not yield the usual high. The first teenager subsequently was treated with Concerta, 72 mg/day, with marked improvement in his ADHD symptoms. At his discharge interview with me, after successfully completing the 9-month residential program, he shared that at the time of admission, he had requested methylphenidate in order to abuse it intranasally. I would appreciate other mental health professionals sharing their experiences in this area with me. If other cases confirm that Concerta cannot be abused intranasally, it could be extremely helpful in the treatment of adolescents who have substance use disorder with comorbid ADHD.