BACKGROUND : The incremental off-label use of methylphenidate by students to enhance cognitive performance has been widely described in international studies. Recent local media reports have suggested a similar trend in spite of its strict prescription requirements. Although a few South African researchers have started reporting on this peculiarity, data regarding the bona fide extent of stimulant misuse among South African students remains unexplored. OBJECTIVES : To determine the incidence of methylphenidate use, methods of acquisition and perceived academic benefit among health sciences students at a South African university. METHODS : A quantitative cross sectional pilot study was conducted by administering a closed ended questionnaire to 160 students registered for various degrees in a Faculty of Health Sciences during August and September 2014. Student demographics, lifetime methylphenidate use, means and reasons of procurement, subjective assistance and experienced side effects were documented and analysed for trends and frequencies. RESULTS : Response rates varied considerably (1% - 40%) among students enrolled for different fields of study in the faculty of health sciences. Overall lifetime methylphenidate use was reported at 16.9%, with a noticeable 10% increase during examination periods. Enhancement in cognitive performance (81.5%) was the principle reason for use, although only 66.7% indicated a subjective academic benefit. The majority of respondents had a valid prescription (59.3%), of which 3.1% were justified by an attention deficit hyperactivity disorder diagnosis. Medical students accounted for 70% of methylphenidate users. Diversion of personal prescribed medication was expressed by 7.4% and the most frequently encountered side effects were anxiety (20%) and loss of appetite (17.8%). CONCLUSION : The unjustified medical use of methylphenidate in South African students correlates well with documented literature from international reports, confirming a global trend. Medical practitioners appear to prescribe this substance more frequently for off-label use, rather than for its registered indications. Methylphenidate use increases during times of high academic stress. Appropriate multidisciplinary student support and education relating to the misuse and long term adverse effects need to be implemented by the medical community and relevant university structures.
This project was presented at the annual congress of the South African Society for Basic and Clinical Pharmacology, held at the University of the Witwatersrand in September 2015. A conference abstract was published in a supplementary edition of the South African Journal of Infectious Diseases.