A fatality in a teenager from the recreational intranasal abuse of methylphenidate (Ritalin) is reported. The prescribed use of methylphenidate (Ritalin) in the treatment of attention deficit and/or hyperactivity disorder is widespread. The intranasal abuse of methylphenidate (Ritalin) among teenagers is becoming increasingly more recognized. Previous deaths from the parenteral abuse of methylphenidate (Ritalin) have been reported. This fatality is the first reported from its intranasal abuse.