Background and aims No effective pharmacotherapy for methamphetamine (MA) use disorder has yet been found. This study evaluated sustained‐release methylphenidate (MPH‐SR) compared with placebo (PLA) for treatment of MA use disorder in people also undergoing behavioural support and motivational incentives. Design This was a randomized, double‐blind, placebo‐controlled design with MPH‐SR or PLA provided for 10 weeks (active phase) followed by 4 weeks of single‐blind PLA. Twice‐weekly clinic visits, weekly group counseling (CBT), and motivational incentives (MI) for MA‐negative urine drug screens (UDS) were included. Setting Treatment sites were in Los Angeles, California (LA) and Honolulu, Hawaii (HH), USA. Participants 110 MA‐dependent (via DSM‐IV) participants (LA = 90; HH = 20). Measurements The primary outcome measure is self‐reported days of MA use during the last 30 days of the active phase. Included in the current analyses are drug use (UDS and self‐report), retention, craving, compliance (dosing, CBT, MI), adverse events, and treatment satisfaction. Findings No difference was found between treatment groups in self‐reported days of MA use during the last 30 days of the active phase (p=0.22). In planned secondary outcomes analyses, however, the MPH group had fewer self‐reported MA use days from baseline through the active phase compared with the PLA group (p=0.05). The MPH group also had lower craving scores and fewer marijuana‐positive UDS than the PLA group in the last 30 days of the active phase. The two groups had similar retention, other drug use, adverse events, and treatment satisfaction. Conclusions Methylphenidate may lead to a marginal reduction in concurrent methamphetamine use when provided as treatment for patients undergoing behavioural support for moderate to severe methamphetamine use disorder but this requires confirmation.