Exploring Patterns of Methylphenidate (Ritalin) Consumption: An Epidemiological Study in Northwestern Iran (Urmia City, 2022)

Exploring Patterns of Methylphenidate (Ritalin) Consumption: An Epidemiological Study in Northwestern Iran (Urmia City, 2022) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Patterns of Methylphenidate (Ritalin) Consumption: An Epidemiological Study in Northwestern Iran (Urmia City, 2022) Elham Moharamzade, Sima Oshnouei, Mohammad Heidari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4555815/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The prevalence of methamphetamine consumption among youth in Iran is high, but there is a lack of information in provincial level. Therefore, this study aimed to investigate the epidemiology of methamphetamine use in city of Urmia in the Northwest of Iran. Method Data of study was collected from patients referred to the Food and Drug Administration of Urmia University of Medical Sciences between December 2021 and May 2022. We calculate the prevalence of legal Ritalin use in the city and describe the characteristics of the patients. The ordinal logistic regression model was employed to explore the moderating effects of studied factors on drug consumption levels. Analysis was done in STATA 15. Results A total of 473 individuals sought Ritalin, with 314 (66.3%) being male. The prevalence of legal Ritalin use in Urmia during the first six months of 2022 was 85.3 per 100,000 people. The majority of individuals were under 20 years old 305 (64.4%). There was a significant difference in the age distribution between male and female (P< 0.001). The most common reason for referral was ADHD & ADD, with 354 individuals (74.8%), and the majority of visitors had an elementary and middle school education 226 (47.7%). University students mainly 34 (55.7) use Ritalin to focus on studding. Conclusion Students are in high-risk groups for Ritalin misuse. Considering the cultural and social conditions of Iran, the actual prevalence of drug consumption are likely to be much higher than reported, to accurately estimate the volume of this problem, more extensive studies using more accurate methods are needed. Epidemiology Ritalin Methylphenidate Drug Misuse Iran Urmia Figures Figure 1 Figure 2 Background The youth is the main population at risk for substance abuse in each country [ 1 ]. Between 162 and 324 million individuals globally have used illicit substances like heroin, cannabis, cocaine, and amphetamine-type stimulants within the past year. Notably, methamphetamine (METH) is a highly addictive psycho-stimulant and poses a significant health concern in Iran [ 2 ]. It is a global epidemic among young people and can have negative effects on their education and professional lives [ 1 ]. The prevalence of substance abuse is estimated to be between 2% and 3% [ 3 , 4 ], this prevalence is not a fixed number and changes each year, requiring annual studies in this field. The prevalence of METH dependence is less than 1% in the general population of Iran. Various reports have revealed that the prevalence of METH use in Iran has increased among methadone maintenance treatment (MMT) patients [ 5 ]. The reported rate of drug-related deaths in Iran is approximately 38.2 per million population [ 6 ]. The most significant contributing factors are anxiety, stress, occupational challenges, academic pressure, and sleep disorders [ 7 ]. Amphetamine-type stimulants (ATS) are a major health concern after cannabis worldwide [ 8 ]. The use of methylphenidate (MPH) is globally increasing [ 9 ] while MPH is considered safe when taken as prescribed, it has the potential for abuse due to its focus-enhancing, appetite-reducing, and euphoric effects [ 10 , 11 ]. MPH is commonly preferred and well-tolerated in the treatment of children and adolescents. However, certain side effects may occur during treatment, including nausea, lack of appetite, weight loss, and sleep disturbances [ 12 ]. In addition to these common side effects, MPH has also been reported to cause rare side effects such as skin eruptions [ 13 , 14 ], inappropriate sexual behavior [ 15 ], obsessive-compulsive symptoms[ 16 ],hallucinations, pain[ 17 ], full muscle cramps[ 18 ] and excessive and frequent menstrual bleeding. Gynecomastia is a rare side effect during MPH therapy [ 19 ]. Students using methylphenidate can experience numerous side effects, such as hallucinations, anxiety, dry mouth, and visual disturbances [ 20 ]. Withdrawal symptoms can include fatigue, disturbed sleeping patterns, and depression, while the use of high doses can result in cardiovascular failure or lethal seizures [ 21 ]. In 2009, after reviewing the available research evidence, the Committee for Medicinal Products for Human Use (CHMP) concluded that the ratio of benefit-to-risk for MPH when used for authorized indications, such as Attention deficit hyperactivity disorder (ADHD), was favorable (European Medicines Agency, 2007). However, they also noted that more data were needed on long-term effects in children and young adults, including neurological and psychiatric effects. In particular, the CHMP noted a range of psychiatric adverse events, including aggression, psychosis, mania, irritability, and suicidality, and suggested that methylphenidate may play a causative role in the development of serious psychiatric disorders [ 22 ]. Students are taking methylphenidate for academic purposes, calling it a 'smart drug' or 'study drug’. A previous systematic review of 21 studies showed that 5%-9% of grade school and high school-age children, as well as 5%-35% of college-age students, misused stimulants such as methylphenidate and amphetamines. In addition, children and adolescents take methylphenidate to stay up for parties and experience euphoria [ 23 ]. Due to the potential for misuse of methylphenidate, numerous countries classify and regulate the drug legally [ 9 ]. While it is true that certain college students may require psychiatric medications, it is important to acknowledge that some individuals may engage in the unauthorized use of these medications. It has been suggested that certain individuals perceive psychiatric medications as performance-enhancing substances that could potentially address severe psychiatric symptoms and enhance productivity, efficiency, and relaxation. According to the national survey reports on drug use and health in 2006, almost one-third of individuals aged 18 to 25 have engaged in the illicit use of prescription drugs [ 24 ]. Moreover, it is worth noting that some individuals who do not suffer from ADHD may illicitly utilize methylphenidate for weight control, alleviating sleeplessness, boosting energy levels, enhancing concentration, and improving educational, occupational, or athletic performance [ 10 , 25 ]. This study is the first to explore the use of ritalin in Urmia city, a location in northwestern Iran. The goal is to increase knowledge about the prevalence of Ritalin use in this region, which has not been studied before. Methods The present study employed a cross-sectional design to gather data from patients between December 2021 and May 2022 who visited the Food and Drug Administration of Urmia University of Medical Sciences. The study variables included age, gender, educational level, reason for drug use, and daily consumption of Ritalin, which were obtained from official documents. The frequency of drug use was expressed as a percentage, and the statistical significance of its relationship with other variables was assessed using the Chi-square (Fisher's exact) tests. An ordinal logistic regression model was employed to investigate the moderating effects of age and gender on drug consumption levels. A significance level of less than 0.05 was considered statistically significant, and all analyses were conducted using the STATA version 15 statistical software. Results During six months, 473 individuals were referred to the Food and Drug Administration of Urmia University of Medical Sciences to obtain Ritalin, of which 314 (66.3%) were male. The prevalence rate of legal ritalin use in Urmia in six months of 2022 was 85.3 per 100,000 people which the rate in men was more than double that women (Fig. 1 ). Most of the individuals were under 20 years of age with 305 (64.4%) falling in this age group, while the lowest number of individuals was in the age group of 21–30 years, with 65 (13.7%). There was a significant difference in the age distribution of male and female visitors (P < 0.001), with 224 (71.3%) males and 81 (50.9%) females under 20 years of age. In the 21–30 age group, 35 (11.1%) males and 30 (18.9%) females were referred (Fig. 2 ). The most common reason for referral was ADHD & ADD, with 354 individuals (74.8%) referred for this reason, followed by 61 individuals (12.9%) for concentration in studying. The least common reason was depression, with 45 individuals (9.5%). Although ADHD & ADD were the most common reasons for referral in both genders, but the referral for depression was more than twice as high in females than males, with 24 (15.1%) compared to 21 (6.7%) in males (P = 0.003). Table 1 the distribution of age, education and monthly use of Ritalin by the courses Factor ADHD & ADD Depression Control To Focus On Studying To Reduce The Stress P.value N 354 45 61 13 Age (%) 0–20 Years 282 ( 79.7) 1 ( 2.2) 22 ( 36.1) 0 ( 0.0) 30 Years 43 ( 12.1) 41 ( 91.1) 9 ( 14.8) 10 ( 76.9) Education (%) Illiterate 47 ( 13.3) 4 ( 8.9) 0 ( 0.0) 0 ( 0.0) < 0.001 School Student 223 ( 63.0) 1 ( 2.2) 2 ( 3.3) 0 ( 0.0) University Student 15 ( 4.2) 1 ( 2.2) 34 ( 55.7) 1 ( 7.7) National Entrance Exam 9 ( 2.5) 0 ( 0.0) 21 ( 34.4) 0 ( 0.0) Unknown 60 ( 16.9) 39 ( 86.7) 4 ( 6.6) 12 ( 92.3) Monthly Use (%) 30 Tablets 97 ( 27.4) 13 ( 28.9) 22 ( 36.1) 5 ( 38.5) 0.415 31–60 Tablets 131 ( 37.0) 16 ( 35.6) 15 ( 24.6) 2 ( 15.4) =>90 Tablets 126 ( 35.6) 16 ( 35.6) 24 ( 39.3) 6 ( 46.2) The educational level of the visitors was mostly elementary and middle school, with 226 (47.7%) individuals. The number of illiterate individuals and university students was the same, with 51 (10.7%) individuals. The number of elementary and middle school students in males was 171 (54.5%), while in females, it was much lower, with 55 (34.6%). In contrast, the number of female university students was higher than males, with 21 (13.2%) compared to 30 (9.6%) (P < 0.001). In terms of frequency of monthly Ritalin tablet consumption, a total of 137 individuals (28.9%) consumed one tablet daily, while 164 individuals (34.6%) consumed two tablets daily and the remaining 172 individuals consumed three or more tablets per day. This consumption distribution was similar between genders (P = 0.06). Age and educational level were found to be important factors related to the reason for Ritalin consumption. Those who were referred for ADHD & ADD were mostly under 20 years of age, with 282 (79.7%) individuals falling in this age group. Of those who used Ritalin to control stress, 22 (36.1%) were under 20 years of age. On the other hand, most individuals who used Ritalin to control depression were over 30 years of age, with 41 (91.1%) individuals (p 30 Years P. value N 305 65 103 Education (%) Illiterate 47 (15.4) 0 ( 0.0) 4 ( 3.9) < 0.001 School Student 225 (73.8) 0 ( 0.0) 1 ( 1.0) University Student 1 ( 0.3) 42 (64.6) 8 ( 7.8) National Entrance Exam 28 ( 9.2) 2 ( 3.1) 0 ( 0.0) Unknown 4 ( 1.3) 21 (32.3) 90 (87.4) Monthly Use (%) 30 Tablets 84 (27.5) 24 (36.9) 29 (28.2) 0.061 31–60 Tablets 119 (39.0) 17 (26.2) 28 (27.2) =>90 Tablets 102 (33.4) 24 (36.9) 46 (44.7) Table 3 Ordinal logistic regression for the effect of sex, and age on the monthly use of Ritalin Monthly Consumption Odds Ratio SE t-value P-value 95% CI Sig sex : base Female 1 Male 1.544 0.287 2.33 0.02 1.072 2.223 ** 0–20 years 1 21–30 years >30 years 0.971 1.446 0.254 0.317 -0.11 1.68 0.912 0.093 .582 .941 1.622 2.221 * cut1 cut2 -0.545 0.931 0.179 0.183 .b .b .b .b − .895 .573 − .194 1.289 Akaike crit. (AIC) 1037.307 Bayesian crit. (BIC) 1058.102 *** P < .01, ** P < .05, * P < .1 The ordinal logistic regression model results indicated a rank order of influential factors on the monthly consumption level of Ritalin tablets. The gender and age of individuals were found to be significant factors in daily Ritalin consumption. After controlling for age, males were 1.5 times more likely than females to be in a higher consumption level. Furthermore, by controlling for gender, individuals over 30 years of age had a 1.4 times greater chance than those under 20 years of age to be in a higher consumption level. These findings suggest that gender and age should be taken into account in prescribing and monitoring Ritalin consumption (Table 3 ). Discussion The findings of this research offer valuable insights into the previously unknown of Ritalin use in Urmia City, contributing significantly to the existing literature on substance abuse and public health in the region. Over six months (December 2021 -May 2022), the Food and Drug Administration at Urmia university of medical sciences received 473 referrals for Ritalin, with males accounting for the majority and most of them being under 20 years of age. Consumers aged 0–20 stated that ADHD was the main reason for their consumption. In the age group of 21–30 years, most of them were students (64%), and the main reason for consumption was focusing on studying (49.2%). There were no search results found that specifically addressed the trend of the use of Ritalin prevalence in European and Asian countries. However, the study in Germany shows that there has been a notable increase in the use of ADHD medication over the 2009–2016 (28–41%) prescriptions issued by pediatric psychiatrists aged between 5 and 14 years [ 2 ]. Another study discusses the reasons behind the low prevalence of Ritalin use in France and notes that restrictive conditions of prescription in France are restricted to a hospital-only prescription for the initial treatment and yearly consultations [ 26 ]. Moreover, prevalence of any ADHD medication use were evaluated in two studies, previous study in 64 countries and regions from 2015 to 2019 shows Current ADHD prevalence estimates and rates of ADHD medication consumption in most middle-income countries are lower than the global epidemiological prevalence [ 27 ]. Previous study using adults and children between 2001 and 2015, Among adults aged 19 years or older, the prevalence of any ADHD medication use in 2010 varied between 0.003% and 1.48% (0.05% in Asia) [ 28 ]. Our finding similarly shows diagnosed Ritalin consumption had lower than reported global prevalence. In another systematic review /meta-analysis (until July 31, 2019) in Iran the pooled lifetime and 12-month prevalence of ATS use was 5.4% (95% CI: 4.9%-6.0%) and 2.4% (95% CI: 1.9%-2.9%), respectively. The pooled lifetime prevalence of non-prescribed methylphenidate (Ritalin) use is 16.4% (95% CI: 11.6%-21.2%) in the Iranian general population [ 20 ]. According to the world health organization, by 2020, depression ranked as the second most prevalent cause of disease burden following ischemic heart disease [ 29 ]Among the elderly population in Iran, the prevalence of depression was found to be 53.7%, with a significantly higher prevalence in women compared to men (56.1% vs. 43.2%) [ 30 ]. It is noteworthy that depressive disorders and symptoms are more frequently observed in women than in men [ 31 ]. In the present study, an additional rationale for the utilization of Ritalin was to manage depression, which is notably more prevalent in women over 30 years of age compared to men at a rate of more than double. Furthermore, the predominant usage of Ritalin to alleviate stress was observed among women, outnumbering men by more than threefold. These findings indicate a potential disparity in stress levels between men and women in our society. Regarding Ritalin consumption patterns, women constituted a larger proportion of low consumption (1 unit per day), whereas men were the primary consumers in the high consumption category (more than 3 units). It seems that restricting access to third-party consumers, especially students and academics, do not have much effect on access to this drug. This is because, in addition to pharmacies, which are the legal distributors of this drug, it is also sold in the open market at a much higher cost. The use of ATS is a major health concern after cannabis worldwide [ 20 ]. Ritalin is predominantly prescribed for the treatment of ADHD and narcolepsy. Current evidence shows the utilization of stimulants like modafinil or methylphenidate may enhance cognitive functions in cancer patients experiencing cognitive impairment due to chemotherapy [ 32 ]. Additionally, Methylphenidate has the potential to mitigate cognitive decline, specifically targeting functions closely associated with the preservation of executive functioning [ 33 ]. Nonetheless, there are documented instances of non-medical usage of Ritalin, particularly among students, aimed at enhancing academic performance. In the academic context, the primary motivations for the use of Ritalin encompass augmenting concentration, improving memory, and heightening alertness [ 34 ]. One research revealed that the non-medical use of methylphenidate among medical students is principally oriented towards enhancing academic performance [ 16 ]. The influence of living arrangements, particularly residing in independent accommodations, appears to be a significant factor in the non-medical use of methylphenidate. Furthermore, individuals in training and assistant positions exhibit a higher incidence of non-medical methylphenidate use compared to those in other educational strata. Importantly, the period preceding internship and assistantship examinations emerges as a critical phase for initial acquaintance and the commencement of non-medical methylphenidate utilization. The participants in the current study provided data on their monthly frequency of Ritalin tablet consumption. Notably, 28.9% of the individuals reported using one tablet per day, while 34.6% reported consuming two tablets daily. A majority of the participants (65.3%) indicated a daily consumption of three or more tablets. Conversely, a separate study focusing on Iranian medical students found that the majority (54.3%) used the lowest dosage [ 35 ]. In the present study, we observed a higher proportion of male students attending elementary and middle school (54.5% vs. 34.6%), while a greater percentage of female students were found in university settings (13.2% vs. 9.6%). Although limited information is available in the search results regarding Ritalin consumption, a study conducted in Iran revealed a notable prevalence (11.2%) of nonmedical Ritalin use across different educational stages and marital statuses. Additionally, a separate study at Zahedan (in South-eastern Iran) University of Medical Sciences documented that 13.9% of medical students had used Ritalin at least once, with the primary reason for consumption being the enhancement of academic performance. Furthermore, this research indicated a higher prevalence of non-medical Ritalin use among female students compared to their male counterparts [ 16 ]. A Systematic Review carried out in Iran revealed a substantial prevalence of Ritalin misuse among students, ranging from 5–43%. The high prevalence of Methylphenidate misuse is of concern due to its associated side effects, signifying a potential alarm for young individuals in Iran [ 36 ] Moreover, a study involving British medical students indicated that 18% of those who had utilized neuro-enhancing drugs had specifically used Ritalin to augment their academic performance [ 37 ]. In this study, gender and age were identified as significant factors influencing the degree of Ritalin consumption. When adjusting for age, it was found that males were 1.5 times more likely than females to consume higher quantities of Ritalin. Furthermore, individuals over the age of 30 exhibited a 1.4-fold increased likelihood of consuming higher amounts compared to those under 20, after adjusting for gender. Additionally, the findings indicated that ADHD diagnosis predominantly impacts boys over girls. A French retrospective cohort study utilizing a general health insurance scheme revealed increasing trends in ADHD diagnoses among children and adolescents, with a noticeable gender discrepancy wherein ADHD affects more boys than girls [ 38 ]. One study revealed a Ritalin consumption frequency of 17.3% among medical students, with no reported significant variations between male and female students. However, an Iranian systematic review indicated that the combined lifetime prevalence of non-prescribed methylphenidate (Ritalin) use was 18.7% among men and 4.6% among women [ 16 ]. These findings underscore the significance of taking into account male gender and individuals over 30 years of age when prescribing and overseeing Ritalin consumption within the general population. Several studies have documented cases of oral methylphenidate misuse disorder (MPHUD) associated with significant mood disturbances during abstinence. Moreover, it has been observed that as the abstinence period extends, the symptoms of depression and anxiety tend to diminish. Time-dependent affective disturbances during abstinence have been reported among various substance abusers, encompassing individuals using methamphetamine, alcohol, nicotine, and heroin [ 10 ]. Considering the abstinence-related mood disturbances, it is imperative to consider targeted management of individuals experiencing MPHUD. [ 6 ] The development of psychosis has also been reported [ 39 ]. Disruption of mesolimbic dopamine transmission, neurotropic factor decreases, and altered opioid receptor signaling were implicated in the altered affective processing in the abstinence period, including other psychostimulant abusers (e.g., methamphetamine) [ 8 – 10 ]. Indeed, withdrawal from MPH exposure increases midbrain neural activity and alters the stress sensitivity of the brain [ 11 ]. Other clinical cases have reported depression, fatigue, loss of appetite, and even movement disorders (e.g., dystonia) in MPH abstinence [ 12 , 13 ]. The findings revealed a positive association between negative emotion, social pressure and the daily dosage of Ritalin in the subjects studied [ 2 ]. Among the studied population, 10.7% were college students and 47.7% were school students, with 55.7% of these students using Ritalin for studying purposes. It’s important to note the high prevalence of Methylphenidate (Ritalin) misuse among students in Iran raises concerns, due to its associated side effects. There is a critical need to enhance awareness regarding the use of Methylphenidate to address this issue effectively in Iran [ 36 ] . Conclusion In Iran, the prevalence of Ritalin abuse was reported to be negligible in general population, similar many other middle income countries. However, the prevalence of stimulant use disorders, including Ritalin, in Iran was found to be lower compared to other middle-income countries. Additionally, studies on university students have shown that Ritalin is the most common type of stimulant used among students, indicating a certain level of prevalence within this specific demographic group. In order to obtain a more precise estimation of the prevalence, it is curtail to conduct comprehensive survey among population. Valuable sampling methods for estimating the sizes of hidden populations provides a flexible and potentially more accurate means of estimating the prevalence of Ritalin use in populations, contributing to improved public health interventions and policy decisions. Abbreviations ADD Attention Deficit Disorder ATS Amphetamine-type stimulants ADHD Attention Deficit Hyperactivity Disorder CHMP Committee for Medicinal Products for Human Use MMT Methadone Maintenance Treatment METH Methamphetamine MPH Methylphenidate MPHUD Methylphenidate misuse disorder Declarations Acknowledgements The authors would like to express their gratitude to the Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Iran. Authors’ contributions Conception and design: Elham Moharamzade, Mohammad Heidari Administrative support: Mohammad Heidari Collection and assembly of data: Elham Moharamzade Data analysis and interpretation: Mohammad Heidari Manuscript writing: Sima Oshnouei, Elham Moharamzade Final approval of manuscript: All authors Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials All data generated or analyzed during this study are included in this published article .The datasets used and/or analyzed during the study are available from the corresponding author on reasonable request. Ethics approval and Consent to Participate The study was approved by the Ethics Committee of Urmia University of Medical Sciences with the code: IR.UMSU.REC.1402.045. 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Methylphenidate improves executive functions in patients with traumatic brain injuries: a feasibility trial via the idiographic approach. BMC Neurol. 2020;20(1):1–4. Korn L, Hassan K, Fainshtein N, Yusov N, Davidovitch N. Non-Medical Use of Prescription Stimulants for Treatment of Attention Disorders by University Students: Characteristics and Associations. Med Sci Monit. 2019;25:3778–87. Bimorgh MS, Akbarzadeh F, Afin AA, Talaei A, Jafarian T, Teimouri MM, et al. Prevalence of nonmedical use of Ritalin among medical students of Mashhad University of Medical Sciences. J Fundamentals Mental Health. 2023;25(1):27. Amirzade-Iranaq MH, Masoumi SM. 99: PREVALENCE OF METHYLPHENIDATE (RITALIN) MISUSE AMONG STUDENTS OF IRAN: A SYSTEMATIC REVIEW. BMJ Open. 2017;7(Suppl 1):bmjopen–2016. Ridgway A, Haq I, Memon A. Prevalence and pattern of performance-enhancing drugs use in a sample of British medical students: Anjum Memon.The European. J Public Health. 2015;1(25suppl3):ckv172–085. Ponnou S, Thomé B. ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010–2019. Front Psychiatry. 2022;13:957242. Louw WAN, Davids RA. Prevalence of methylphenidate use by Master of Medicine students at a South African university. Postgrad Med J. 2022;98(1166):925–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4555815","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317167113,"identity":"58e5616d-8861-4225-9f66-bdfcfb7ee8ad","order_by":0,"name":"Elham Moharamzade","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"","lastName":"Moharamzade","suffix":""},{"id":317167114,"identity":"9ca8897d-b84c-402f-8936-4728be2c7936","order_by":1,"name":"Sima Oshnouei","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sima","middleName":"","lastName":"Oshnouei","suffix":""},{"id":317167115,"identity":"bdfe4618-3ff6-4e95-89e3-0033bca8541a","order_by":2,"name":"Mohammad Heidari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACAwbGBgkGBiBib4CJMTbgVo+ihecA0VrA6kFkApEOM2dvbrzxc48Fg+7MN6Ybf7YxyPM3MLd9wKfFsudgs2XPMwkGs9s5Zrd52xgMZxxgbJ6B12E3EtskeA5AtTC2MTBuYGBsxu+X+w/bJP+AtNw8Y3YT6DB7wlpuMLZJg225wWN2A+iwRMJaziQ2W8sckOAxO5NWdpvnnETyjMOEtBw//vDmmwN1cmbHD2+7+aPMxra/vf0xXi0wwAOlgXHETJSGUTAKRsEoGAX4AAB7f0emMASUGAAAAABJRU5ErkJggg==","orcid":"","institution":"Assistant professor of Epidemiology, Urmia University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Heidari","suffix":""}],"badges":[],"createdAt":"2024-06-10 05:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4555815/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4555815/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59966050,"identity":"9f5c4f14-dfd3-485a-ad59-3e935e93b77e","added_by":"auto","created_at":"2024-07-10 02:04:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28742,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence rate of legal Ritalin use per 100,000 in Urmia 2022 foe male and female\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4555815/v1/a70d202cefa5ec4928bd6651.png"},{"id":59966051,"identity":"66c0a851-c008-4f82-aa66-9c77bef5c5d2","added_by":"auto","created_at":"2024-07-10 02:04:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67438,"visible":true,"origin":"","legend":"\u003cp\u003ethe age and sex distribution of the cases of Ritalin use in Urmia in 2022\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4555815/v1/7a767db6cc5e5d8c611c802f.png"},{"id":60446114,"identity":"4b860436-6b23-40e3-9e82-176b5019564b","added_by":"auto","created_at":"2024-07-16 21:39:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":577379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4555815/v1/741df176-902e-497f-9c76-4438944eb0b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring Patterns of Methylphenidate (Ritalin) Consumption: An Epidemiological Study in Northwestern Iran (Urmia City, 2022)\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe youth is the main population at risk for substance abuse in each country [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Between 162 and 324\u0026nbsp;million individuals globally have used illicit substances like heroin, cannabis, cocaine, and amphetamine-type stimulants within the past year. Notably, methamphetamine (METH) is a highly addictive psycho-stimulant and poses a significant health concern in Iran [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is a global epidemic among young people and can have negative effects on their education and professional lives [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of substance abuse is estimated to be between 2% and 3% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], this prevalence is not a fixed number and changes each year, requiring annual studies in this field. The prevalence of METH dependence is less than 1% in the general population of Iran. Various reports have revealed that the prevalence of METH use in Iran has increased among methadone maintenance treatment (MMT) patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe reported rate of drug-related deaths in Iran is approximately 38.2 per million population [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The most significant contributing factors are anxiety, stress, occupational challenges, academic pressure, and sleep disorders [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Amphetamine-type stimulants (ATS) are a major health concern after cannabis worldwide [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The use of methylphenidate (MPH) is globally increasing [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] while MPH is considered safe when taken as prescribed, it has the potential for abuse due to its focus-enhancing, appetite-reducing, and euphoric effects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. MPH is commonly preferred and well-tolerated in the treatment of children and adolescents. However, certain side effects may occur during treatment, including nausea, lack of appetite, weight loss, and sleep disturbances [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to these common side effects, MPH has also been reported to cause rare side effects such as skin eruptions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], inappropriate sexual behavior [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], obsessive-compulsive symptoms[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e],hallucinations, pain[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], full muscle cramps[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and excessive and frequent menstrual bleeding. Gynecomastia is a rare side effect during MPH therapy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudents using methylphenidate can experience numerous side effects, such as hallucinations, anxiety, dry mouth, and visual disturbances [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Withdrawal symptoms can include fatigue, disturbed sleeping patterns, and depression, while the use of high doses can result in cardiovascular failure or lethal seizures [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2009, after reviewing the available research evidence, the Committee for Medicinal Products for Human Use (CHMP) concluded that the ratio of benefit-to-risk for MPH when used for authorized indications, such as Attention deficit hyperactivity disorder (ADHD), was favorable (European Medicines Agency, 2007). However, they also noted that more data were needed on long-term effects in children and young adults, including neurological and psychiatric effects. In particular, the CHMP noted a range of psychiatric adverse events, including aggression, psychosis, mania, irritability, and suicidality, and suggested that methylphenidate may play a causative role in the development of serious psychiatric disorders [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudents are taking methylphenidate for academic purposes, calling it a 'smart drug' or 'study drug\u0026rsquo;. A previous systematic review of 21 studies showed that 5%-9% of grade school and high school-age children, as well as 5%-35% of college-age students, misused stimulants such as methylphenidate and amphetamines. In addition, children and adolescents take methylphenidate to stay up for parties and experience euphoria [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the potential for misuse of methylphenidate, numerous countries classify and regulate the drug legally [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While it is true that certain college students may require psychiatric medications, it is important to acknowledge that some individuals may engage in the unauthorized use of these medications. It has been suggested that certain individuals perceive psychiatric medications as performance-enhancing substances that could potentially address severe psychiatric symptoms and enhance productivity, efficiency, and relaxation. According to the national survey reports on drug use and health in 2006, almost one-third of individuals aged 18 to 25 have engaged in the illicit use of prescription drugs [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, it is worth noting that some individuals who do not suffer from ADHD may illicitly utilize methylphenidate for weight control, alleviating sleeplessness, boosting energy levels, enhancing concentration, and improving educational, occupational, or athletic performance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study is the first to explore the use of ritalin in Urmia city, a location in northwestern Iran. The goal is to increase knowledge about the prevalence of Ritalin use in this region, which has not been studied before.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present study employed a cross-sectional design to gather data from patients between December 2021 and May 2022 who visited the Food and Drug Administration of Urmia University of Medical Sciences.\u003c/p\u003e \u003cp\u003eThe study variables included age, gender, educational level, reason for drug use, and daily consumption of Ritalin, which were obtained from official documents. The frequency of drug use was expressed as a percentage, and the statistical significance of its relationship with other variables was assessed using the Chi-square (Fisher's exact) tests. An ordinal logistic regression model was employed to investigate the moderating effects of age and gender on drug consumption levels. A significance level of less than 0.05 was considered statistically significant, and all analyses were conducted using the STATA version 15 statistical software.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring six months, 473 individuals were referred to the Food and Drug Administration of Urmia University of Medical Sciences to obtain Ritalin, of which 314 (66.3%) were male. The prevalence rate of legal ritalin use in Urmia in six months of 2022 was 85.3 per 100,000 people which the rate in men was more than double that women (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMost of the individuals were under 20 years of age with 305 (64.4%) falling in this age group, while the lowest number of individuals was in the age group of 21\u0026ndash;30 years, with 65 (13.7%). There was a significant difference in the age distribution of male and female visitors (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 224 (71.3%) males and 81 (50.9%) females under 20 years of age. In the 21\u0026ndash;30 age group, 35 (11.1%) males and 30 (18.9%) females were referred (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe most common reason for referral was ADHD \u0026amp; ADD, with 354 individuals (74.8%) referred for this reason, followed by 61 individuals (12.9%) for concentration in studying. The least common reason was depression, with 45 individuals (9.5%). Although ADHD \u0026amp; ADD were the most common reasons for referral in both genders, but the referral for depression was more than twice as high in females than males, with 24 (15.1%) compared to 21 (6.7%) in males (P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ethe distribution of age, education and monthly use of Ritalin by the courses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eADHD \u0026amp; ADD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepression Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTo Focus On Studying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTo Reduce The Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP.value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;20 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282 ( 79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 ( 36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 ( 8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 ( 6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 ( 49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 ( 23.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 ( 12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 ( 91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 ( 14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 ( 76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 ( 13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 ( 8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool Student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 ( 63.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 ( 3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity Student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 ( 4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 ( 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 ( 55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 ( 7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNational Entrance Exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 ( 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 ( 34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 ( 16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 ( 86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 ( 6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 ( 92.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly Use (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 Tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 ( 27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 ( 28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 ( 36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 ( 38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;60 Tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131 ( 37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 ( 35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 ( 24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 ( 15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u0026gt;90 Tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 ( 35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 ( 35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 ( 39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 ( 46.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe educational level of the visitors was mostly elementary and middle school, with 226 (47.7%) individuals. The number of illiterate individuals and university students was the same, with 51 (10.7%) individuals. The number of elementary and middle school students in males was 171 (54.5%), while in females, it was much lower, with 55 (34.6%). In contrast, the number of female university students was higher than males, with 21 (13.2%) compared to 30 (9.6%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn terms of frequency of monthly Ritalin tablet consumption, a total of 137 individuals (28.9%) consumed one tablet daily, while 164 individuals (34.6%) consumed two tablets daily and the remaining 172 individuals consumed three or more tablets per day. This consumption distribution was similar between genders (P\u0026thinsp;=\u0026thinsp;0.06).\u003c/p\u003e \u003cp\u003eAge and educational level were found to be important factors related to the reason for Ritalin consumption. Those who were referred for ADHD \u0026amp; ADD were mostly under 20 years of age, with 282 (79.7%) individuals falling in this age group. Of those who used Ritalin to control stress, 22 (36.1%) were under 20 years of age. On the other hand, most individuals who used Ritalin to control depression were over 30 years of age, with 41 (91.1%) individuals (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ethe distribution of education and monthly use of Ritalin by age groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;20 Years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e21\u0026ndash;30 Years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;30 Years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP. value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIlliterate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 ( 3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c7\" namest=\"c6\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSchool Student\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225 (73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 ( 1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUniversity Student\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 ( 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 ( 7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNational Entrance Exam\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 ( 9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 ( 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 ( 0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnknown\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 ( 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90 (87.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly Use (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e30 Tablets\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c7\" namest=\"c6\" rowspan=\"3\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e31\u0026ndash;60 Tablets\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (27.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e=\u0026gt;90 Tablets\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (44.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOrdinal logistic regression for the effect of sex, and age on the monthly use of Ritalin\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly Consumption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003esex : base Female\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c11\" namest=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;20 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c11\" namest=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21\u0026ndash;30 years\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026gt;30 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003cp\u003e1.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.582\u003c/p\u003e \u003cp\u003e.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.622\u003c/p\u003e \u003cp\u003e2.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ecut1\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ecut2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e-0.545\u003c/p\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.b\u003c/p\u003e \u003cp\u003e.b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.b\u003c/p\u003e \u003cp\u003e.b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.895\u003c/p\u003e \u003cp\u003e.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.194\u003c/p\u003e \u003cp\u003e1.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAkaike crit. (AIC)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1037.307\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eBayesian crit. (BIC)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1058.102\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*** P\u0026thinsp;\u0026lt;\u0026thinsp;.01, ** P\u0026thinsp;\u0026lt;\u0026thinsp;.05, * P\u0026thinsp;\u0026lt;\u0026thinsp;.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe ordinal logistic regression model results indicated a rank order of influential factors on the monthly consumption level of Ritalin tablets. The gender and age of individuals were found to be significant factors in daily Ritalin consumption. After controlling for age, males were 1.5 times more likely than females to be in a higher consumption level. Furthermore, by controlling for gender, individuals over 30 years of age had a 1.4 times greater chance than those under 20 years of age to be in a higher consumption level. These findings suggest that gender and age should be taken into account in prescribing and monitoring Ritalin consumption (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this research offer valuable insights into the previously unknown of Ritalin use in Urmia City, contributing significantly to the existing literature on substance abuse and public health in the region. Over six months (December 2021 -May 2022), the Food and Drug Administration at Urmia university of medical sciences received 473 referrals for Ritalin, with males accounting for the majority and most of them being under 20 years of age. Consumers aged 0\u0026ndash;20 stated that ADHD was the main reason for their consumption. In the age group of 21\u0026ndash;30 years, most of them were students (64%), and the main reason for consumption was focusing on studying (49.2%).\u003c/p\u003e \u003cp\u003eThere were no search results found that specifically addressed the trend of the use of Ritalin prevalence in European and Asian countries. However, the study in Germany shows that there has been a notable increase in the use of ADHD medication over the 2009\u0026ndash;2016 (28\u0026ndash;41%) prescriptions issued by pediatric psychiatrists aged between 5 and 14 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Another study discusses the reasons behind the low prevalence of Ritalin use in France and notes that restrictive conditions of prescription in France are restricted to a hospital-only prescription for the initial treatment and yearly consultations [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, prevalence of any ADHD medication use were evaluated in two studies, previous study in 64 countries and regions from 2015 to 2019 shows Current ADHD prevalence estimates and rates of ADHD medication consumption in most middle-income countries are lower than the global epidemiological prevalence [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Previous study using adults and children between 2001 and 2015, Among adults aged 19 years or older, the prevalence of any ADHD medication use in 2010 varied between 0.003% and 1.48% (0.05% in Asia) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our finding similarly shows diagnosed Ritalin consumption had lower than reported global prevalence.\u003c/p\u003e \u003cp\u003eIn another systematic review /meta-analysis (until July 31, 2019) in Iran the pooled lifetime and 12-month prevalence of ATS use was 5.4% (95% CI: 4.9%-6.0%) and 2.4% (95% CI: 1.9%-2.9%), respectively. The pooled lifetime prevalence of non-prescribed methylphenidate (Ritalin) use is 16.4% (95% CI: 11.6%-21.2%) in the Iranian general population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the world health organization, by 2020, depression ranked as the second most prevalent cause of disease burden following ischemic heart disease [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]Among the elderly population in Iran, the prevalence of depression was found to be 53.7%, with a significantly higher prevalence in women compared to men (56.1% vs. 43.2%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It is noteworthy that depressive disorders and symptoms are more frequently observed in women than in men [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In the present study, an additional rationale for the utilization of Ritalin was to manage depression, which is notably more prevalent in women over 30 years of age compared to men at a rate of more than double. Furthermore, the predominant usage of Ritalin to alleviate stress was observed among women, outnumbering men by more than threefold. These findings indicate a potential disparity in stress levels between men and women in our society. Regarding Ritalin consumption patterns, women constituted a larger proportion of low consumption (1 unit per day), whereas men were the primary consumers in the high consumption category (more than 3 units). It seems that restricting access to third-party consumers, especially students and academics, do not have much effect on access to this drug. This is because, in addition to pharmacies, which are the legal distributors of this drug, it is also sold in the open market at a much higher cost. The use of ATS is a major health concern after cannabis worldwide [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRitalin is predominantly prescribed for the treatment of ADHD and narcolepsy. Current evidence shows the utilization of stimulants like modafinil or methylphenidate may enhance cognitive functions in cancer patients experiencing cognitive impairment due to chemotherapy [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Additionally, Methylphenidate has the potential to mitigate cognitive decline, specifically targeting functions closely associated with the preservation of executive functioning [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNonetheless, there are documented instances of non-medical usage of Ritalin, particularly among students, aimed at enhancing academic performance. In the academic context, the primary motivations for the use of Ritalin encompass augmenting concentration, improving memory, and heightening alertness [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne research revealed that the non-medical use of methylphenidate among medical students is principally oriented towards enhancing academic performance [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The influence of living arrangements, particularly residing in independent accommodations, appears to be a significant factor in the non-medical use of methylphenidate. Furthermore, individuals in training and assistant positions exhibit a higher incidence of non-medical methylphenidate use compared to those in other educational strata. Importantly, the period preceding internship and assistantship examinations emerges as a critical phase for initial acquaintance and the commencement of non-medical methylphenidate utilization.\u003c/p\u003e \u003cp\u003eThe participants in the current study provided data on their monthly frequency of Ritalin tablet consumption. Notably, 28.9% of the individuals reported using one tablet per day, while 34.6% reported consuming two tablets daily. A majority of the participants (65.3%) indicated a daily consumption of three or more tablets. Conversely, a separate study focusing on Iranian medical students found that the majority (54.3%) used the lowest dosage [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, we observed a higher proportion of male students attending elementary and middle school (54.5% vs. 34.6%), while a greater percentage of female students were found in university settings (13.2% vs. 9.6%). Although limited information is available in the search results regarding Ritalin consumption, a study conducted in Iran revealed a notable prevalence (11.2%) of nonmedical Ritalin use across different educational stages and marital statuses. Additionally, a separate study at Zahedan (in South-eastern Iran) University of Medical Sciences documented that 13.9% of medical students had used Ritalin at least once, with the primary reason for consumption being the enhancement of academic performance. Furthermore, this research indicated a higher prevalence of non-medical Ritalin use among female students compared to their male counterparts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA Systematic Review carried out in Iran revealed a substantial prevalence of Ritalin misuse among students, ranging from 5\u0026ndash;43%. The high prevalence of Methylphenidate misuse is of concern due to its associated side effects, signifying a potential alarm for young individuals in Iran [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] Moreover, a study involving British medical students indicated that 18% of those who had utilized neuro-enhancing drugs had specifically used Ritalin to augment their academic performance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, gender and age were identified as significant factors influencing the degree of Ritalin consumption. When adjusting for age, it was found that males were 1.5 times more likely than females to consume higher quantities of Ritalin. Furthermore, individuals over the age of 30 exhibited a 1.4-fold increased likelihood of consuming higher amounts compared to those under 20, after adjusting for gender. Additionally, the findings indicated that ADHD diagnosis predominantly impacts boys over girls. A French retrospective cohort study utilizing a general health insurance scheme revealed increasing trends in ADHD diagnoses among children and adolescents, with a noticeable gender discrepancy wherein ADHD affects more boys than girls [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. One study revealed a Ritalin consumption frequency of 17.3% among medical students, with no reported significant variations between male and female students. However, an Iranian systematic review indicated that the combined lifetime prevalence of non-prescribed methylphenidate (Ritalin) use was 18.7% among men and 4.6% among women [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These findings underscore the significance of taking into account male gender and individuals over 30 years of age when prescribing and overseeing Ritalin consumption within the general population.\u003c/p\u003e \u003cp\u003eSeveral studies have documented cases of oral methylphenidate misuse disorder (MPHUD) associated with significant mood disturbances during abstinence. Moreover, it has been observed that as the abstinence period extends, the symptoms of depression and anxiety tend to diminish. Time-dependent affective disturbances during abstinence have been reported among various substance abusers, encompassing individuals using methamphetamine, alcohol, nicotine, and heroin [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Considering the abstinence-related mood disturbances, it is imperative to consider targeted management of individuals experiencing MPHUD. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The development of psychosis has also been reported [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Disruption of mesolimbic dopamine transmission, neurotropic factor decreases, and altered opioid receptor signaling were implicated in the altered affective processing in the abstinence period, including other psychostimulant abusers (e.g., methamphetamine) [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Indeed, withdrawal from MPH exposure increases midbrain neural activity and alters the stress sensitivity of the brain [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Other clinical cases have reported depression, fatigue, loss of appetite, and even movement disorders (e.g., dystonia) in MPH abstinence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings revealed a positive association between negative emotion, social pressure and the daily dosage of Ritalin in the subjects studied [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Among the studied population, 10.7% were college students and 47.7% were school students, with 55.7% of these students using Ritalin for studying purposes. It\u0026rsquo;s important to note the high prevalence of Methylphenidate (Ritalin) misuse among students in Iran raises concerns, due to its associated side effects. There is a critical need to enhance awareness regarding the use of Methylphenidate to address this issue effectively in Iran [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] .\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn Iran, the prevalence of Ritalin abuse was reported to be negligible in general population, similar many other middle income countries. However, the prevalence of stimulant use disorders, including Ritalin, in Iran was found to be lower compared to other middle-income countries. Additionally, studies on university students have shown that Ritalin is the most common type of stimulant used among students, indicating a certain level of prevalence within this specific demographic group. In order to obtain a more precise estimation of the prevalence, it is curtail to conduct comprehensive survey among population. Valuable sampling methods for estimating the sizes of hidden populations provides a flexible and potentially more accurate means of estimating the prevalence of Ritalin use in populations, contributing to improved public health interventions and policy decisions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADD Attention Deficit Disorder\u003c/p\u003e\n\u003cp\u003eATS Amphetamine-type stimulants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;ADHD Attention Deficit Hyperactivity Disorder\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CHMP \u0026nbsp; Committee for Medicinal Products for Human Use\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MMT Methadone Maintenance Treatment\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMETH Methamphetamine\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MPH Methylphenidate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMPHUD Methylphenidate misuse disorder\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Iran.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: Elham Moharamzade, Mohammad Heidari\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdministrative support: Mohammad Heidari\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Collection and assembly of data: Elham Moharamzade\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: Mohammad Heidari\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eManuscript writing: Sima Oshnouei, Elham Moharamzade\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinal approval of manuscript: All authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article .The datasets used and/or analyzed during the study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Urmia University of Medical Sciences with the code: IR.UMSU.REC.1402.045. The data of patients receiving Ritalin prescriptions are recorded and compiled in the Treatment deputy of Urmia University of Medical Sciences, specifically in the Legal Distribution of Ritalin department. Access to this information is granted with the approval of the university\u0026apos;s ethics committee, and the results are presented without disclosing the patients\u0026apos; identity details. Therefore, informed consent is not required in this case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHerizchi S, Dargahi Abbasabad G, Delnavaz P, Torkmandi H, Dezhampoor S, Roshanas B et al. Factors Involving in the Substance Abuse among Medical Students and its Association with medical students' general health: mixed-method study. CNM. 2020;10(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAryan N, Banafshe HR, Farnia V, Shakeri J, Alikhani M, Rahimi H, et al. 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Prevalence of amphetamine-type stimulants use in Iran: a systematic review and meta-analysis. J Subst Use. 2021;26(6):569\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Guideline Centre (UK). Withdrawal from pharmacological treatment and drug holidays: Attention deficit hyperactivity disorder: diagnosis and management: Evidence review I. London: National Institute for Health and Care Excellence (NICE). 2018 Mar. (NICE Guideline, No. 87.) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK578102/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK578102/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, et al. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neurosci Biobehav Rev. 2019;107:945\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim MG, Kim J, Kim SC, Jeong J. Twitter Analysis of the Nonmedical Use and Side Effects of Methylphenidate: Machine Learning Study. J Med Internet Res. 2020;22(2):e16466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeter CJ, McCabe SE, Boyd CJ, Guthrie SK. Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors. Pharmacotherapy. 2003;23(5):609\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKadison R. Getting an edge use of stimulants and antidepressants in college. N Engl J Med. 2005;353(11):1089\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVall\u0026eacute;e M. The countervailing forces behind France's low Ritalin consumption. Soc Sci Med. 2019;238:112492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan AYL, Ma TT, Lau WCY, Ip P, Coghill D, Gao L, Jani YH, Hsia Y, Wei L, Taxis K, Simonoff E, Taylor D, Lum TY, Man KKC, Wong ICK. Attention-deficit/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study. EClinicalMedicine. 2023;58:101780.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaman SR, Man KKC, Bahmanyar S, Berard A, Bilder S, Boukhris T, et al. Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases. Lancet Psychiatry. 2018;5(10):824\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoskun M, Kaya I. Painful Muscle Cramps Possibly Associated with Withdrawal from Methylphenidate. J Child Adolesc Psychopharmacol. 2016;26(7):658\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarayagmurlu A, Varli AT, Coskun M, Gynecomastia. A Rare Adverse Effect of Methylphenidate in an Adolescent Boy. Clin Psychopharmacol Neurosci. 2020;18(2):337\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoskun M, Zoroglu S. Tactile and visual hallucinations in a child with methylphenidate and fluoxetine combination. J Clin Psychopharmacol. 2008;28(6):723\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis J, Ahlberg FM, Berk M, Ashley DM, Khasraw M. Emerging pharmacotherapy for cancer patients with cognitive dysfunction. BMC Neurol. 2013;13:153.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Adawi S, Al-Naamani A, Jaju S, Al-Farsi YM, Dorvlo AS, Al-Maashani A, et al. Methylphenidate improves executive functions in patients with traumatic brain injuries: a feasibility trial via the idiographic approach. BMC Neurol. 2020;20(1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorn L, Hassan K, Fainshtein N, Yusov N, Davidovitch N. Non-Medical Use of Prescription Stimulants for Treatment of Attention Disorders by University Students: Characteristics and Associations. Med Sci Monit. 2019;25:3778\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBimorgh MS, Akbarzadeh F, Afin AA, Talaei A, Jafarian T, Teimouri MM, et al. Prevalence of nonmedical use of Ritalin among medical students of Mashhad University of Medical Sciences. J Fundamentals Mental Health. 2023;25(1):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmirzade-Iranaq MH, Masoumi SM. 99: PREVALENCE OF METHYLPHENIDATE (RITALIN) MISUSE AMONG STUDENTS OF IRAN: A SYSTEMATIC REVIEW. BMJ Open. 2017;7(Suppl 1):bmjopen\u0026ndash;2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRidgway A, Haq I, Memon A. Prevalence and pattern of performance-enhancing drugs use in a sample of British medical students: Anjum Memon.The European. J Public Health. 2015;1(25suppl3):ckv172\u0026ndash;085.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonnou S, Thom\u0026eacute; B. ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010\u0026ndash;2019. Front Psychiatry. 2022;13:957242.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLouw WAN, Davids RA. Prevalence of methylphenidate use by Master of Medicine students at a South African university. Postgrad Med J. 2022;98(1166):925\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Epidemiology, Ritalin, Methylphenidate, Drug Misuse, Iran, Urmia","lastPublishedDoi":"10.21203/rs.3.rs-4555815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4555815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e The prevalence of methamphetamine consumption among youth in Iran is high, but there is a lack of information in provincial level. Therefore, this study aimed to investigate the epidemiology of methamphetamine use in city of Urmia in the Northwest of Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod \u003c/strong\u003eData of study was collected from patients referred to the Food and Drug Administration of Urmia University of Medical Sciences between December 2021 and May 2022. We calculate the prevalence of legal Ritalin use in the city and describe the characteristics of the patients. The ordinal logistic regression model was employed to explore the moderating effects of studied factors on drug consumption levels. Analysis was done in STATA 15.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eA total of 473 individuals sought Ritalin, with 314 (66.3%) being male. The prevalence of legal Ritalin use in Urmia during the first six months of 2022 was 85.3 per 100,000 people. The majority of individuals were under 20 years old 305 (64.4%). There was a significant difference in the age distribution between male and female (P\u0026lt; 0.001). The most common reason for referral was ADHD \u0026amp; ADD, with 354 individuals (74.8%), and the majority of visitors had an elementary and middle school education 226 (47.7%). University students mainly 34 (55.7) use Ritalin to focus on studding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eStudents are in high-risk groups for Ritalin misuse. Considering the cultural and social conditions of Iran, the actual prevalence of drug consumption are likely to be much higher than reported, to accurately estimate the volume of this problem, more extensive studies using more accurate methods are needed.\u003c/p\u003e","manuscriptTitle":"Exploring Patterns of Methylphenidate (Ritalin) Consumption: An Epidemiological Study in Northwestern Iran (Urmia City, 2022)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 02:04:08","doi":"10.21203/rs.3.rs-4555815/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c96ff17-b0cd-435b-a7af-2c5473ec7a58","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-16T21:30:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-10 02:04:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4555815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4555815","identity":"rs-4555815","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}