We report a near fatality of a 15-year-old girl who took one 10 mg tablet of methylphenidate supplied to her by a boy who was legitimately receiving it for hyperkinetic disorder. Both were residents in a local secure unit. Later investigation revealed that the boy would accept his supervised dose and then secrete it into his palm. After ingestion of the tablet the girl described seeing birds and stars. She suddenly collapsed and developed cyanosis. Her breathing stopped and artificial respiration was required for several minutes before spontaneous respiration resumed. There was difficulty finding her pulse and her blood pressure and temperature were elevated. She was hospitalised and recovered fully within 24 hours. She was amnesic of the episode but did recall receiving a tablet from the body concerned. Blood investigations were normal. Urine toxicology, including a specialised test requested for methylphenidate, revealed no methylphenidate or other drugs including 3,4-methylenedioxymethamphetamine (MDMA; ‘ecstasy’). This was consistent with a small methylphenidate dose, rather than an overdose, having been taken.

The most comfortable way of interpreting this incident was that it was a dangerous idiosyncratic reaction to methylphenidate and that these do occur. Also, the clinical signs of methylphenidate poisoning (i.e. hyperpyrexia, delirium, respiratory depression, convulsions and cardiac arrhythmias) are similar to those of ecstasy poisoning (Reference SolowySolowy, 1993). The latter was ruled out by appropriate tests.

This incident demonstrates that methylphenidate, contrary to some popular assertions, can be a drug of abuse. Oral misuse has rarely been reported, as this medication is not particularly effective in producing a ‘high’ (Reference GarlandGarland, 1998). However, there have been reports of methylphenidate-induced euphoria in children misusing it (Reference Corrigall and FordCorrigall & Ford, 1996). Increasing use of methylphenidate makes it likely that misuse of this nature will occur. Methylphenidate and ecstasy toxicity have been found to have similar manifestations. Education of clinicians and families in awareness of these risks and the resulting effects is important.