What Is Concerta?
Concerta is a trademark of methylphenidate, a widely researched drug for patients suffering from attention deficit hyperactivity disorder (ADHD). The drug is an extended-release formula, meaning it remains in the body for a long time. All methylphenidate brands are central nervous system stimulants. However, each brand is available in different quantities and formulations. (1)
When ingested, Concerta increases norepinephrine and dopamine levels in the brain. Dopamine produces feelings of reward and motivation, while norepinephrine raises the brain’s ability to concentrate. Concerta boosts the activities of these chemicals in the brain. (2)
The drug is designed to have an extended-release formula because methylphenidate is a short half-life drug since it is metabolized by the body quickly. Patients using a drug that has a short half-life are required to take several doses daily to achieve consistent results. This may be difficult for individuals suffering from ADHD, especially children who have a problem recalling the number of pills taken during the day. This results in inconsistencies of the drug intake, which limits the productiveness of the treatment. (2)
This inspired the development of Concerta’s extended-release formulation that addressed the inefficiencies of methylphenidate. Concerta has two shells, the outer shell and the inner shell. When an individual consumes the pill, the outer shell melts, enabling quick distribution of the drug. Over time, the inner shell of the pill melts slowly, releasing the medication at a steady rate. (2)
Brand names for Concerta
Most substances can be referred to by various names. Some of the brand names for Concerta include Ritalin, QuilliChew ER, Aptensio XR, Ritalin LA, Jornay PM, Metadate ER, Methylin, Quillivant XR, Ritalin SR, Cotempla XR-ODT and Metadate CD. Individuals may use any of the above names to acquire the drug from their local pharmacies. (3)
Legal Status (UK)
The Misuse of Drugs Act of 1971 prohibits possession of the drug without a physician’s prescription. Supplying it is also considered illegal. Possession may put a person behind bars for a period of five years with or without a fine. A person found supplying methylphenidate could face up to a 14-year jail term, an unlimited fine or both. (4)
Under the Misuse of Drugs Act, methylphenidate is classified as a Class B drug, which is a designation for drugs that are recognized to have a certain degree of medical value but are highly likely to be abused. Internationally, the Convention on Psychotropic Substances classifies methylphenidate as a schedule II drug.
The National Institute for Health and Care Excellence (NICE) has licensed administration of methylphenidate in oral and solid dosage forms. According to NICE guidelines, the drug is only licensed for medicinal purposes, especially for the treatment of attention deficit hyperactivity disorder (ADHD) in children over 6 and adolescents, as well as treatment of narcolepsy in adults.
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Routes of Administration
Concerta should be taken wholly with the aid of liquids. Patients are advised not to chew, divide or crush the tablets. The tablets can also be administered without food daily in the morning.
The drug is covered by a shell that enables the medication to move around the body at a controlled rate. The tablet shell and some insoluble ingredients are not absorbed and are eliminated from the body; thus, patients are told not to worry when they observe tablet-like substances in their stool. (5)
After oral administration, methylphenidate is rapidly absorbed in the body, leading to a rise in the levels of plasma methylphenidate concentrations in the body. In less than an hour, the concentrations reach a maximum level and continue increasing over the next five to nine hours, after which they start reducing.
All doses of Concerta take six to 10 hours to reach the maximum concentrations. However, Concerta qd is associated with the instantaneous release of methylphenidate, which functions by reducing the fluctuations between high and low concentrations. (6)
Approximately 80% of the drug is removed from the body in urine form. However, methylphenidate residues are not cleared via the renal route; thus, it has little influence on the overall effects of Concerta in the body. (6)
Pharmacological Actions of Concerta
Methylphenidate is prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and narcolepsy in adults. Pharmacological actions of this psychoactive drug are explained by understanding its pharmacodynamics and mechanisms of actions.
Mechanism of action
Studies reveal that methylphenidate may have the potential to act as a norepinephrine and dopamine reuptake inhibitor (NDRI), raising the levels of these neurotransmitters and extending their functions. Higher doses of methylphenidate lead to an increase in the flow of norepinephrine and dopamine in the brain, causing harm to perception- and movement-activating effects. (7)
In contrast, low methylphenidate doses particularly trigger the neurotransmission of norepinephrine and dopamine in the prefrontal cortex. This results in enhanced clinical effectiveness and helps curb side effects. (7)
The psychoactive drug is a racemic combination of D- and l-isomers. Studies have revealed that the D-isomer is more pharmacologically dynamic compared to the l-isomer.
According to Radioligand binding studies, the linkage of methylphenidate is confined in the prefrontal cortex part of the brain, which is a dopamine-rich area. The prefrontal cortex plays a critical function in ADHD pathophysiology. Research conducted on animals revealed that methylphenidate causes stereotypic behaviours and improves locomotor activities. (7)
Chemical formula – C14H19NO2
The molecular formula C14H19NO2 (molar mass: 233.30 g/mol, exact mass: 233.141579) refers to methylphenidate. The drug’s unique chemical formula makes it possible to administer orally. It can even be applied to the skin in some cases. The drug is found in various formulations that have different durations of effect, keeping in mind that it is a stimulant. (8)
The formula indicates that methyl phenyl (piperidine-2-yl) acetate is a part of piperidine, which is a beta-amino acid ester as well as a methyl ester. (9) The psychoactive drug has a uni hydrogen bond donor count, triple hydrogen bond acceptor count and quadruple rotatable bond count. (8)
Common Concerta and Other Drug Combinations
Certain medications can be accidentally or intentionally be combined to interact with Concerta. Consequently, this may affect the efficiency of the medication or raise the likelihood of adverse reactions.
Individuals under Concerta medication are advised to inform their doctors about any drugs they are taking. Patients are advised to avoid alcohol and excessive quantities of caffeine. They should also take the drug on an empty stomach, that is, an hour before or two hours after meals.
Dangerous effects may occur when Concerta is combined with MAO inhibitors. Clients using MAOI antidepressants are advised to avoid taking Concerta at all costs because there is a high risk of experiencing high blood pressure, which could eventually result in a stroke. In many cases, hypertension might occur two weeks after the patient stops using the MAOI. (10)
Vasopressor agents are drugs that boost low blood pressure. Clients taking vasopressor medication are advised to be extra cautious when taking Concerta because it may also lead to high blood pressure.
Lastly, patients taking antidepressants, selective serotonin reuptake Inhibitors and coumarin anticoagulants are required to lower the dosage of these drugs if they take them while using Concerta. This is because the psychoactive drug may likely inhibit the breakdown of the drugs into the body. Doctors should monitor patients’ plasma drug concentrations before they begin and after they stop using Concerta. (10)
What Is the Mechanism of Concerta Addiction?
Medical studies stress the potential for Concerta abuse and severely warn clinicians about the drug. However, the warning is often ignored because most patients using the drug have reported a positive therapeutic response.
Research points out that methylphenidate abuse is similar to using cocaine when the psychoactive drug is used intranasally because it produces the same receptor effects. When absorbed by the body, the drug quickly releases dopamine which produces a feeling of instant ‘high’ and extremely thrilling euphoria. Therefore, there is no major difference between prescription Concerta abuse and that of cocaine. (11)
it functions through various administration routes. For instance, when methylphenidate is administered intravenously, individuals experience highs similar to those of cocaine.
How addictive is Concerta?
Concerta is very helpful in the treatment of disorders like ADHD and narcolepsy. However, its addictive potential has been of great concern. The chemical makeup of Concerta is similar to amphetamines and cocaine, which is what makes the psychoactive drug addictive.
A person using Concerta for recreational purposes without a doctor’s prescription and an individual taking more than the prescribed dosage are equally at high risk of developing a Concerta addiction. However, the chances of addiction may be higher for users who abuse the drug by crushing the tablet or by removing the contents from the capsule and injecting or snorting them to get an immediate high, as opposed to the extended release.
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Risk Factors for Concerta Abuse
- Family History of Addiction: A person coming from a family that abuses drugs may end up becoming an addict. This may be attributed to a person’s genetic predisposition. For instance, a person who has a blood relative with drug addiction problems may be at a higher risk of becoming addicted.
- Mental Health Disorder: Mental health disorders like post-traumatic stress disorder, depression or attention-deficit hyperactivity disorder are likely to increase a person’s chances of Concerta addiction. The abuse of the psychoactive drug is done mainly to cope with painful feelings like loneliness, stigma, anxiety and depression.
- Peer Pressure: A large percentage of young people begin the abuse and misuse of drugs because of peer pressure.
- Lack of Family Involvement: Modern busy lifestyles have left very little time for parents to supervise and guide their kids. Such difficult family situations increase teenagers’ risk of addiction.
- Early Use: People who start taking drugs at an early age may end up altering their brain development and increase their chances of drowning further in drug addiction.
How Concerta Addiction and Abuse Affect the Brain and Body
Concerta abuse and addiction lead to a rapid increase in dopamine activity in the brain. Dopamine affects the part of the brain that is responsible for learning, locomotion, attention and pleasure.
Concerta abuse and addiction are likely to alter the user’s brain. The results of this alteration could be manifested in several ways, such as anxiety, mania, aggression, hallucinations, compulsive behaviour, delusions, disorientation and mood swings, among other symptoms. Memory problems and permanent brain damage may also occur. (12)
The addiction also affects the body of the user and could cause vomiting, decreased appetite, skin rash, vision problems and weight loss. In the event of an overdose, the user may suffer from dangerously irregular heartbeats, increased blood pressure, high body temperature and even heart failure.
An abnormal heart rate that leads to a heart attack may occur due to persistent abuse of the drug. Short-term effects such as increased breathing, increased blood sugar, opened-up breathing passages and decreased blood flow are some of the physical symptoms a user may experience. (12)
Most users abuse the drug by injection, and this leads to collapsed veins and heart valves. It could even weaken a person’s body immune system and ultimately cause seizures. Sharing needles further exposes the user to the risk of contracting diseases such as HIV and hepatitis. (12)
Short-term effects of Concerta on the body
Frequent usage of Concerta exposes the user to several precarious short-term effects. Such effects vary from one person to another and are dependent on the amount of dosage consumed, a person’s immune system and lastly on the quantity of the drug in the body. (12)
The user may experience short-term effects like irritability, insomnia, anxiety, raised blood pressure, stomach pain, vomiting, headaches, dry mouth, dizziness, agitation, skin rash, dry mouth, loss of appetite, hyperhidrosis, nausea and xerostomia. Children and adolescents are likely to experience upper abdominal pain. Short-term effects usually reduce with time to a bearable level and are easily treatable. (12)
Long-term health consequences of abusing Concerta
Unlike short-term effects of Concerta that are easily treatable by medication or even diminish on their own, long-term consumption is extremely dangerous, and users may end up with permanent body damage. Sometimes the long-term effects may become life-threatening and even lead to fatality. (12)
The user could experience some of the following long-term effects as a result of substance dependence: violent behaviour, hallucinations, delusions, weight loss and paranoia. In most cases, the user ends up with a serious addiction if they use the drug for a long period. (12)
Concerta Addiction Signs and Symptoms
The American Psychiatric Association identifies the following addiction signs and symptoms in individuals abusing Concerta: (13)
- An individual regularly consumes the drug for recreational purposes.
- The person uses the drug in larger amounts than required.
- The user cannot stop using the drug despite its negative impact on his or her career or personal relationships.
- A person abandons significant duties due to substance dependence.
- The person spends most of his time acquiring Concerta, consuming it or recuperating from its effects.
- An individual cannot resist the urge to consume Concerta regularly.
- The person becomes reckless and repeatedly uses Concerta in dangerous situations like driving.
- The person starts taking higher doses of Concerta as a result of increased tolerance levels.
- An individual starts experiencing withdrawal symptoms once he or she stops using Concerta.
- A person uses illegal means to obtain Concerta.
- The user consumes Concerta by grinding, snorting or ingesting larger amounts than would be prescribed or combining it with other drugs and alcohol.
- The user becomes defensive and furious when anyone tries to talk to about their Concerta use.
- The user suffers from regular nosebleeds, runny nose and redness in the nostrils as a result of snorting Concerta.
Physical signs and symptoms of addiction
In many cases, physical dependence on Concerta may not be easily noticeable. Instead, it gradually grows to become a huge problem for the user and their loved ones. Concerta physical signs and symptoms of addiction are clear and apparent. Some of the physical signs of addiction include headaches, twitching, vomiting and convulsions. (6)
Initial physical symptoms that a person may likely suffer once he starts abusing the drug are weight loss and malnutrition. Other physical signs to look out for include sinus arrhythmia, increased heart rate, complaints of nausea, increased blood pressure and dry mouth. (6)
Psychological signs and symptoms of addiction
The psychological signs and symptoms of Concerta addiction are not apparent, but they can be identified because a user usually develops unusual behaviour. Such symptoms are an indication that a person’s brain has been hampered by Concerta abuse. In most cases, psychological symptoms are more dangerous than the physical symptoms and might last longer, even after a person has stopped using the drug.
A person abusing Concerta is likely to exhibit psychological signs and symptoms like compulsive behaviour, psychosis, hallucinations, disorientation, manic-like state, drastic mood changes, aggression, delusions and paranoia. Aggression and disorientation are the most frequent symptoms that a user may exhibit.
Behavioural signs of addiction
Individuals undergoing behavioural addiction as a result of Concerta tend to neglect important work relationships and social relationships because of their addictive behaviour. This results in loss of trust and forces their loved ones to compensate for the difficulties arising from the addiction. (14)
Some of the behavioural signs of Concerta addiction include doctor-shopping, searching for prescriptions from several providers, missing work or school often, poor decision making, disrupted sleep patterns, stealing, acquiring the drug from illicit sources, having problems at work, missing important engagements and financial problems. (14)
Identifying Concerta Abuse in the Elderly
Most medical journals define a senior with a substance use disorder as an adult aged 50 years and above. Generally, there is irrefutable medical evidence that indicates older patients with substance dependence problems have higher rates of medical morbidity compared to younger patients. (11)
Elderly people are likely to abuse Concerta because it is normally prescribed to them and hence is easily accessible. The risk of addiction is even higher because elderly people tend to be sensitive to Concerta effects.
To identify if an elderly person is abusing Concerta, look for several signs like anger issues, hallucinations, malnutrition without any prior illness, compulsive attitude, depressive symptoms, anxiety, confusion, vision problems and psychotic attitude. Concerta abuse may do serious harm to a senior individual if not treated in time, especially because the immune system tends to weaken during that age.
Additionally, Concerta abuse in elderly people is likely to worsen respiratory, neurological and other age-associated diseases. Since the drug is mostly abused through injections, Concerta users may suffer from blood-borne diseases like hepatitis and HIV. (11)
Dangers of Concerta Abuse and Overdose
Concerta overdose occurs when a person takes a large dose of Concerta. This results in an increase in toxic levels in the body and may lead to overstimulation of the central and sympathetic nervous systems. A patient who has taken an overdose of Concerta faces issues like convulsions, excessive sweating, agitation, vomiting, muscle twitching, hallucinations, increased heart rate and excessive sweating.
The drug may be used by students who need to improve
their academic performance at school and even adults who need to improve their work performance. Some abuse the drug in big doses to feel euphoric effects. This results in rapid escalation of dopamine levels in the brain and results in addiction.
Concerta is usually abused by injection to get spontaneous high feelings, ignoring the fact that this might increase the likelihood of a psychotic episode. Users who crush or inject the pill raise the chances of suffering from heart risks like seizures and stroke because the insoluble fillers in the pills might block small blood vessels when misused for a long period.
Malnutrition, decreased appetite, feelings of hostility and paranoia are some of the dangers associated with Concerta abuse. Chronic Concerta abuse causes a person to become psychologically dependent on the drug and experience drug withdrawal symptoms like depression, insomnia and fatigue when they stop taking the drug. (10)
Detoxing from Concerta Addiction
Alcohol and drug detoxification involve the removal of drugs or alcohol from the body while managing the withdrawal symptoms. A user recovering from Concerta addiction has to undergo a detoxification process to recover. Users can find detoxification services in rehabilitation centres. (17)
Abandoning Concerta abruptly might cause dreadful psychological withdrawal symptoms. A client suffering from Concerta addiction needs frequent drug uptake to feel normal. The right process for clients is to wean them off the drug under close supervision by a physician.
The client will be allowed to undergo the detoxification process after they stop taking Concerta. The process usually becomes excruciating and agonizing, and the associated withdrawal symptoms make it riskier. An adverse withdrawal symptom could be severely shocking to the client’s nervous system, so clients are advised not to go through the process without medical supervision. (17)
A patient who has used the drug for a long period is advised to undertake the detoxification process in an inpatient rehab centre. This will enable the client to access the highest level of care under a structured and supportive environment. Treatment professionals are available 24/7 to help them to recover and develop new habits and behaviours that help solidify sobriety.
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Stages of Concerta withdrawal
Concerta withdrawal symptoms emerge 24 hours after the client takes the last dose. However, it could even take several days in some people. The withdrawal process takes less than seven days. Post-acute withdrawal symptoms (PAWS) might continue for several months, depending on the individual. (15)
First 24 hours: First withdrawal symptoms are experienced within the first 24 hours after the user stops using the drug. Headaches, weariness, difficulty in concentration and cravings are experienced by the user.
Days 5-14: Withdrawal signs slowly diminish and the individual can easily manage them as their body gets used to the lack of Concerta.
Common Concerta withdrawal symptoms
Concerta withdrawal symptoms, occasionally referred to as ‘Concerta crash’, manifest in numerous ways. However, the symptoms vary depending on the quantity consumed and the length of time the client was addicted to Concerta. Clients who have used the drug for a long duration are likely to undergo painful withdrawal symptoms. (16)
Common Concerta withdrawal symptoms include depression, nightmares, nausea, irregular heart rate, panic attacks, irregular blood pressure, irritability, anxiety, headaches, dysphoria, foggy thinking, increased appetite, extreme fatigue and psychosis.
Users are highly advised to undergo a medically assisted detoxification process under the supervision of a healthcare provider to avoid relapsing and quitting because some Concerta withdrawal symptoms are intolerable and extreme. (16)
Treatment Options for Concerta Addiction
Several treatment options exist for users seeking Concerta treatment. Some of them include:
Outpatient Treatment: This option allows the client to engage in their personal and professional activities while receiving treatment.
12-Step Programmes: These are support group programmes that assist clients to work steadily to become addiction free. They help individuals establish a goal in life and live a drug-free life.
Dual Diagnosis: Rehabilitation centres have noted that the majority of the clients abusing Concerta were prescribed the drug for ADHD treatment. Dual-diagnosis treatment focuses on healing both drug addiction and co-occurring mental disorders like depression or bipolar disorder that contribute to the addiction.
Contingency Management and Cognitive Behavioural Therapy: Contingency management is based on a reward system that encourages the client to adopt drug-free behaviours. Cognitive behavioural therapy focuses on the client’s thoughts by helping them discern and alter dysfunctional thoughts and activities that contribute to substance abuse.
Inpatient vs outpatient rehab
Outpatient treatment option is recommendable for clients with weaker Concerta addiction and mild withdrawal symptoms. This programme allows them to stay at home while receiving treatment and enables clients to carry out their daily activities. Most clients abusing Concerta are teenagers and young adults who are either still in school or working. Therefore, they may not be receptive to the option of abandoning their duties and staying in rehab.
Inpatient addiction treatment is the most rigorous treatment option for Concerta rehab clients. The client usually lives in the rehabilitation centre and has access to 24/7 support and care. This treatment is recommended for clients with a serious addiction to Concerta or clients with co-occurring mental health conditions.
How to Get Help for a Loved One Who Is Misusing Concerta
Help is available for individuals struggling with Concerta addiction, abuse, misuse and dependence. Once it’s determined that a person is struggling with Concerta addiction, it’s recommended to seek help as soon as possible. The treatment available to the person will depend on the seriousness of their addiction.
Few people have sufficient willpower and inner strength to stop excessive Concerta abuse on their own. Most clients need a rigorous rehabilitation plan with stringent supervision to manage the withdrawal symptoms.
In such cases, it is important to identify an active rehabilitation centre that offers inpatient or outpatient treatment. Some things to look out for include a proven recovery track record, plenty of accommodations and friendly staff. Such facilities follow a proven process that involves activities that guarantee successful recovery from an addiction. Some of these benefits of such facilities are;
- Medically supervised detoxification
- Group/individual therapy sessions
- Medical evaluation
- Planning for aftercare, such as transfer to a sober-living facility
- Availability of a great emotional support system and skills training to prevent relapse
- Clinical supervision during drug withdrawal
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