NON-MEDICAL USE OF METHYLPHENIDATE IN MEDICAL STUDENTS IN THE MEDITERRANEAN REGION OF TÜRKİYE: A QUALITATIVE RESEARCH

Abstract

Objective he misuse of methylphenidate is an important issue in the relevant literature. The abuse of these drugs for success, especially by high school and university students, is quite common at the international level. Young people consider these drugs as a savior in order to be successful in the exams and to sustain with their social life. It is possible that medical education is very hard and stressful for students in the world. The students feel too much pressure to succeed. So, this situation directs students towards alternatives that will reduce the pressure, stay awake and focus more. This study aims to understand the process and usage habits that direct medical students to methylphenidate. Material and Method The study was designed as a qualitative research method with an anthropological perspective. Medical students' experiences, thoughts, and observations on the illicit use of methylphenidate were collected by researcher, using the in-depth interviews. The study started with face-to-face interviews at the end of 2019. Due to the coronavirus pandemic, the negotiations were completed in February 2022, after a long break. The opinions of 17 volunteer students who participated in the study were evaluated with a descriptive approach. Results According to our research findings, medical students are positive about the non-medical use of methylphenidate to save the day, despite its side effects. The use of the drug increases especially during exam periods. It is seen that drugs are as an easy alternative for students. The medicines are mostly provided from other friends who still use them. In addition, the drug is also used for weight loss. It is a fact that its effects are exaggerated and advertised among non-prescription users. The results of our research are similar with international ones. Conclusion There are very few studies on the illicit use of psychomotor stimulants in our country. The findings prove that medical students need healthy and sustainable alternatives to cope with the stress and pressure on them. It is thought that this study will be a basis for determining the long-term negative effects of misuse of the drugs and taking precautions. The research is a preliminary assessment to explore the current situation. It is clear that there is a need for more information, quantitative and qualitative data in the field.

Keywords

• Addiction
• Academic success
• İllicit use of stimulant
• Medical anthropology
• Pressure

TÜRKİYE’DE AKDENİZ BÖLGESİNDE EĞİTİM GÖREN TIP ÖĞRENCİLERİNDE METİLFENİDATIN TIBBİ OLMAYAN KULLANIMI: NİTEL BİR ARAŞTIRMA

Abstract

Amaç Metilfenidatın reçetesiz kullanımı son yıllarda uluslararası yazında ilgi duyulan bir konu haline gelmiştir. Özellikle lise ve üniversite öğrencilerinin başarı için bu ilaçları kötüye kullanımları önemli bir araştırma konusu olmuştur. Gençler, hem derslerinde, girdikleri sınavlarda başarılı olmak hem de sosyal yaşamdan kopmamak için bu ilaçları bir kurtarıcı olarak görmektedir. Dünyada tıp eğitimi, öğrenciler açısından zor ve streslidir. Öğrenciler başarılı olmak için üzerlerinde çok fazla baskı hissetmektedir. Bu koşullar öğrencileri, üzerlerindeki baskıyı azaltacak, uyanık kalmalarını ve uzun süre odaklanmalarını sağlayacak alternatiflere yöneltmektedir. Bu çalışma, tıp eğitimi alan öğrencileri metilfenidat içeren ilaçlara yönelten süreci ve kullanım alışkanlıklarını anlamayı amaçlamaktadır. Gereç ve Yöntem Çalışma, antropolojik bakış açısı ile tasarlanmış nitel bir araştırmadır. Tıp eğitimi alan öğrencilerle derinlemesine görüşmeler yapılarak, metilfenidatın reçete dışı kullanımı üzerine deneyimleri, düşünceleri ve gözlemleri derlenmiştir. Çalışmaya 2019 yılı sonlarında yüz yüze görüşmelerle başlanmıştır. Koronavirüs pandemisi nedeniyle verilen uzun bir aranın ardından görüşmeler Şubat 2022’de tamamlanmıştır. Çalışmaya katılan 17 gönüllü öğrencinin görüşleri, betimleyici bir yaklaşımla değerlendirilmiştir. Bulgular Araştırma bulgularımıza göre tıp öğrencileri yan etkilerine rağmen geçici ve hızlı bir çözüm olarak metilfenidatın reçete dışı kullanımına olumlu bakmaktadır. İlacın kullanımı özellikle sınav zamanlarında artmaktadır. Öyle gölünüyor ki ilaç öğrenciler için kolay bir alternatiftir. İlaçlar büyük oranda yine kullanan diğer arkadaşlardan temin edilmektedir. Ayrıca ilacın zayıflamak için de kullanıldığı görüldü. Metilfenidatın olası etkilerinin yine reçete dışı kullanan öğrenciler tarafından övüldüğü ve diğer öğrencilere tanıtıldığı söylenebilir. Çalışmanın bulguları çeşitli ülkelerde yapılmış araştırma bulguları ile büyük oranda paralellik göstermektedir. Sonuç Ülkemizde psikomotor stimülanların reçetesiz kullanımları üzerine yapılmış çok az sayıda araştırma bulunmaktadır. Bulgular, tıp öğrencilerinin üzerlerindeki stres ve baskı ile baş edebilmeleri yolunda sağlıklı ve sürdürülebilir alternatiflere ihtiyaç duyduklarını ka- nıtlar niteliktedir. İlaçların reçetesiz, kötüye kullanımlarının uzun vadede yaratacağı olumsuz etkilerinin belirlenebilmesi ve önlem alınabilmesi açısından, bu çalışmanın bir temel oluşturacağı düşünülmektedir. Araştırma, mevcut durumu keşfetme amaçlı bir ön değerlendirme niteliğindedir. Alanda daha çok bilgiye, nicel ve nitel veriye ihtiyaç olduğu açıktır.

Keywords

• Akademik başarı
• Bağımlılık
• Stres
• Tıbbi antropoloji
• Uyaranların reçetesiz kullanımı

References

1. 1. FDA. Methylphenidate hydrochloride [Internet]. FDA. 2022 [cited 01 March 2021]. Available from: https://www.fda.gov/drugs/ drug-safety-and-availability/methylphenidate-hydrochloride-extended- release-tablets-generic-concerta-made-mallinckrodt- and-kudco
2. 2. FDA. Questions and Answers Regarding Methylphenidate Hydrochloride Extended Release Tablets (generic Concerta) made by Mallinckrodt and UCB/Kremers Urban (formerly Kudco) [Internet]. FDA. 2022 [cited 01 March 2021]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/ questions-and-answers-regarding-methylphenidate-hydrochloride- extended-release-tablets-generic)
3. 3. Kudlow PA, Naylor KT, Xie B, McIntyre RS. Cognitive enhancement in Canadian medical students. Journal of Psychoactive Drugs. 2013;45(4):360–365. https://doi.org/10.1080/02791072 .2013.825033
4. 4. McNiel AD, Muzzin KB, DeWald JP, McCann AL, Schneiderman ED, Scofield J, Campbell PR. The nonmedical use of prescription stimulants among dental and dental hygiene students. Journal of Dental Education. 2011;75(3):365–376.
5. 5. Tuttle JP, Scheurich, NE, Ranseen J. Prevalence of ADHD Diagnosis and Nonmedical Prescription Stimulant Use in Medical Students. Academic Psychiatry. 2010;34(3):220-223. https:// doi.org/10.1176/appi.ap.34.3.220
6. 6. Webb JR, Thomas MW, Valasek MA. Contemplating Cognitive Enhancement in Medical Students and Residents. Perspectives in Biology and Medicine. 2010;53(2):200-214. https://doi. org/10.1353/pbm.0.0154
7. 7. Webb JR, Valasek MA, North CS. Prevalence of stimulant use in a sample of US medical students. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists. 2013; 25(1):27–32.
8. 8. Cohen YG, Segev RW, Shlafman N, Novack V, Ifergane G. Methylphenidate use among medical students at Ben-Gurion University of the Negev. Journal of Neurosciences in Rural Practice. 2015; 6(3) 320–325. https://doi.org/10.4103/0976-3147.158749

9. 9. Finger G, Silva ER, Falavigna A. Use of methylphenidate among medical students: a systematic review. Revista da Associação Médica Brasileira. 2013;59(3):285–289. https://doi. org/10.1016/j.ramb.2012.10.007
10. 10. Caferoğlu Z, Özel HG, Hamidi F, Ertürk G. Dikkat Eksikliği Hiperaktivite Bozukluğu Tanısı Olan Çocuklarda İlaç Tedavisinin Beslenme Durumu Üzerine Etkileri. Beslenme ve Diyet Dergisi. 2015; 42(2):99-107.
11. 11. Durukan I, Erdem M, Kara K, Karaman D. Effects of Psychostimulant Drugs on Developing Brain. Psikiyatride Güncel Yaklaşımlar (Current Approaches in Psychiatry). 2013; 5(4):538-539. https://doi.org/10.5455/cap.20130532
12. 12. Şahin S, Bozkurt H. Epileptic Seizure Following A Switch From Short-acting Methylphenidate to Long-acting Methylphenidate Treatment: A Case Report. Turkish Journal of Child and Adolescent Mental Health. 2016; 26(3):136–139. https://doi. org/10.4274/tjcamh.galenos.2016.2015.09.022
13. 13. Yarıcı U, Görgülü Y, Çınar RK, Sönmez MB. Metilfenidat ile Tetiklenen Afektif ve Psikotik Süreç, Vaka Sunumu. Bağımlılık Dergisi. 2017;1: 25–30.
14. 14. Babcock Q, Byrne T. Student Perceptions of Methylphenidate Abuse at a Public Liberal Arts College. Journal of American College Health. 2000; 49:143-145.
15. 15. Low KG, Gendaszek AE. Illicit Use of Psychostimulants among College Students: A Preliminary Study. Psychology, Health and Medicine. 2002; 7:283-287. https://doi.org/10.1080/13548500220139386
16. 16. Teter CJ, McCabe SE, Cranford JA, Boyd CJ, Guthrie SK. Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. J Am Coll Health. May-Jun; 2005; 53(6):253-62. https://doi.org/10.3200/JACH.53.6.253-262
17. 17. Quintero G, Peterson J, Young B. An Exploratory Study of Socio- Cultural Factors Contributing to Prescription Drug Misuse among College Students. Journal of Drug Issues. 2006; 6:903-931.
18. 18. McCabe SE, West BT, Teter CJ, Boyd CJ. Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots. Addictive Behaviors. 2014; 39(7):1176–1182. https://doi. org/10.1016/j.addbeh.2014.03.008
19. 19. Gahr M, Freudenmann RW, Hiemke C, Kölle MA, Schönfeldt- Lecuona C. Abuse of methylphenidate in Germany: Data from spontaneous reports of adverse drug reactions. Psychiatry Research. 2014; 215(1): 252-254. https://doi.org/10.1016/j. psychres.2013.11.008
20. 20. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975–2009. Vol. II. College Students and Adults Ages 19–50. NIH publication No. 10–7585. Washington, DC: US Department of Health and Human Services, 2010.
21. 21. McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction. 2005; 100(1):96–106. https://doi.org/10.1111/j.1360- 0443.2005.00944.x
22. 22. Steyn F. Methylphenidate use and poly-substance use among undergraduate students attending a South African university: original research. South African Journal of Psychiatry. 2016;22(1):a760.
23. 23. Merier LJ, Liechti ME, Herzig F, Schaub MP. To Dope or Not to Dope: Neuroenhancement with Prescription Drugs and Drugs of Abuse among Swiss University Students. PLoS ONE. 2013; 8(11):e77967. https://doi.org/10.1371/journal.pone.0077967
24. 24. Liakoni E, Schaub MP, Maier LJ, Glauser G-V, Liechti ME. The Use of Prescription Drugs, Recreational Drugs, and “Soft Enhancers” for Cognitive Enhancement among Swiss Secondary School Students. PLoS ONE. 2015; 10(10):e0141289. https:// doi.org/10.1371/journal.pone.0141289
25. 25. Singh I, Bard I, Jackson J. Robust Resilience and Substantial Interest: A Survey of Pharmacological Cognitive Enhancement among University Students in the UK and Ireland. PLoS ONE. 2014; 9(10):e105969. https://doi.org/10.1371/journal. pone.0105969
26. 26. Lengvenyte A, Strumila R, Grikiniene J. Use of cognitive enhancers among medical students in Lithuania. Nordic Studies on Alcohol and Drugs. 2017; 33(2):173-187. https://doi. org/10.1515/nsad-2016-0014
27. 27. Micoulaud-Franchi JA, MacGregor A, Fond G. A preliminary study on cognitive enhancer consumption behaviors and motives of French Medicine and Pharmacology students. Eur. Rev. Med Pharmacol. Sci. 2014; 18(3):1875-8.
28. 28. Abiodun AO, Adelekan ML, Ogunremi OO et al. Psychosocial correlates of alcohol, tobacco and cannabis use amongst secondary school students in Ilorin, Nigeria. West Afr J Med. 1994; 13:213-7.
29. 29. Liu Z, Zhou W, Lian Z, Mu Y, Cai Z, Cao J: The use of psychoactive substances among adolescents in an area in the south west of China. Addiction. 2001; 96(2):247-50. https://doi. org/10.1080/09652140020020973. PMID: 11182869.
30. 30. Cadwalladr C. Students used to take drugs to get high [Internet]. Now they take them to get higher grades. The Guardian. 2015. [Accessed 03 March 2021]. Available from: https://www. theguardian.com/society/2015/feb/15/students-smart-drugs-higher- grades-adderall-modafinil
31. 31. Fallah CF, Moudi S, Hamidia A, Bijani A. Stimulant use in medical students and residents requires more careful attention. Caspian J. Intern. Med. 2018; 9(1):87-91. https://doi.org/10.22088/cjim.9.1.87
32. 32. Teter CJ, McCabe SE, Boyd CJ, Guthrie SK. Illicit Methylphenidate Use in an Undergraduate Student Sample: Prevalence and Risk Factors. Pharmacotherapy. 2003; 23 (5):609-617.
33. 33. Wasserman JA, Fitzgerald JE, Sunny MA, Cole M, Suminski RR, Dougherty JJ. Nonmedical Use of Stimulants Among Medical Students. The Journal of the American Ostepathic Association. 2013; 114 (8):643-653.
34. 34. Franke AG, Bonertz C, Christmann M, Huss M, Fellgiebel A, Hildt E, Lieb K. Non-Medical Use of Prescription Stimulants and Illicit Stimulants for Cognitive Enhancement in Pupils and Students in Germany. Pharmacopsychiatry. 2011;44(2):60-6. https://doi.org/10.1055/s-0030-1268417
35. 35. Partridge B, Bell S, Lucje J, Hall W. Australian university students' attitudes towards the use of prescription stimulants as cognitive enhancers: perceived patterns of use, efficacy and safety. Drug Alcohol Rev. 2013; 32(3):295-302. https://doi. org/10.1111/dar.12005
36. 36. Silveira RR, Lejderman B, Ferreira PE, da Rocha GM. Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil. Trends Psychiatry Psychother. 2014; 36(02):101-106. https://doi. org/10.1590/2237-6089-2013-0065
37. 37. Ram S, Hussainy S, Henning M, Jensen M, Russell B: Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug and Alcohol Review. 2015; 35(3):345-351. https:// doi.org/10.1111/dar.12294
38. 38. Ford JA, Schroeder RD. Academic strain and non-medical use of prescription stimulants among college students. Deviant Behavior. 2009; 30:6-53. https://doi.org/10.1080/01639620802049900
39. 39. Habibzadeh A, Alizadeh M, Malek A, Maghbooli L, Shoja MM, Ghabili K. Illicit methylphenidate use among Iranian medical students: prevelance and knowledge. Drug Design, Development and Therapy. 2011; 5:71-76.
40. 40. Abbasi-Ghahramanloo A, Fotouhi A, Zeraati H, Rahimi-Movaghar A. Prescription Drugs, Alcohol, and Illicit Substance Use and Their Correlations Among Medical Sciences Students in Iran. Int J High Risk Behav Addict. 2015; 4(1), e21945. https:// doi.org/10.5812/ijhrba.21945
41. 41. Peterson MA, Nørgaard LS, Traulsen JM. Going to the doctor with enhancement in mind – An ethnographic study of university students’ use of prescription stimulants and their moral ambivalence. Drugs: Education, Prevention and Policy. 2015; 22(3):201-207. https://doi.org/10.3109/09687637.2014.970517
42. 42. DeSantis AD, Hane AC. Adderall is definitely not a drug: Justifications for the illegal use of ADHD stimulants. Substance Use & Misuse. 2010; 45:31–46. https://doi. org/10.3109/10826080902858334
43. 43. Cicero TJ, Inciardi JA, Muñoz A. Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002- 2004. J Pain. 2005;6(10):662-72. https://doi.org/10.1016/j.jpain. 2005.05.004.
44. 44. Franke AG, Lieb K, Hildt E. What users think about the differences between caffeine and illicit/prescription stimulants for cognitive enhancement. PLoS One. 2012; 7(6):e40047. https:// doi.org/10.1371/journal.pone.0040047
45. 45. Erensoy H, Burhanoğlu S. İntranazal Metilfenidat ve Bupropion Kötüye Kullanımı: Bir Olgu Sunumu. Bağımlılık Dergisi. 2014; 15 (2):102-104.
46. 46. Parran TV Jr, Jasinski DR. Intravenous methylphenidate abuse. Prototype for prescription drug abuse. Arch Intern Med. 1991; 151:781-783.
47. 47. Coetzee M, Kaminer Y, Morales A. Megadose intranasal methylphenidate (ritalin) abuse in adult attention deficit hyperactivity disorder. Subst Abus. 2002; 23:165-169.
48. 48. Le Breton D. Bedene Veda (Orj: L'Adieu au corps, Çev. Aziz Ufuk Kılıç). İstanbul: Sel Yayıncılık; 2014.