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Patterns of Methylphenidate Use and Assessment of its Abuse and Diversion in Two French Administrative Areas Using a Proxy of Deviant Behaviour Determined from a Reimbursement Database

Main Trends from 2005 to 2008

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Abstract

Background: Methylphenidate is a psychostimulant drug indicated for the treatment of attention-deficit hyperactivity disorder (ADHD). Its abuse and diversion have been previously described in specific populations, such as students; however, few studies investigating abuse and diversion among the overall population are available.

Objectives: The aim of this study was to describe patterns of methylphenidate use and to explore the magnitude of its abuse and diversion in two French administrative areas using data from a reimbursement database. A proxy of ‘deviant behaviour’ was used for the abuse and diversion of methylphenidate, defined using the following parameters: total number of defined daily doses (DDDs) of methylphenidate dispensed; number of different pharmacies seen for dispensing of methylphenidate; number of prescribers consulted for a prescription of methylphenidate; and number of dispensings of methylphenidate. Data from the reimbursement database were analysed by clustering methods. These data were assessed from 2005 to 2008.

Method: The French General Health Insurance System (GHIS) database was used to obtain data on methylphenidate use in two French administrative areas. Individuals affiliated to the GHIS who had a prescription for methylphenidate reimbursed between 1 January and 31 March of 4 selected years (2005, 2006, 2007 and 2008) were included. After the first dispensing of methylphenidate for these individuals, all their dispensings (including methylphenidate and other psychoactive drugs) were monitored over a 9-month period. Following a descriptive analysis, a clustering method was used to identify different subgroups of subjects according to the methylphenidate consumer profile characteristics.

Results: With regard to the number of patients who had a dispensing for methylphenidate during the first quarter of the year, an 84% increase was observed between 2005 (n = 640) and 2008 (n= 1175). The clustering method identified two subgroups. One of them was characterized by a higher number of dispensings, different prescribers and pharmacies and a greater total dispensed quantity, suggesting a deviant behaviour and, thus, possible abuse and diversion of methylphenidate. These subjects were older (aged 35.4 ± 11.3 years) and were more frequently patients receiving benzodiazepines, antidepressants, antipsychotics and maintenance opioid treatment. The proportion of subjects with a deviant behaviour increased from 0.5% in 2005 to 2% in 2007 and then decreased to 1.2% in 2008.

Conclusion: This method was able to assess the magnitude of methylphenidate abuse liability and to follow its evolution. The decrease in methylphenidate abuse and diversion seen between 2007 and 2008 can be explained by the enactment in April 2008 of specific regulations for prescription drugs (such as methylphenidate) that are deemed by the French government to have the potential for misuse; these regulations require the establishment of a ‘contract of care’ between the GHIS, prescriber and patient.

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Acknowledgements

We thank Christophe Moracchini for critical reading of the manuscript. None of the authors has any conflict of interest to declare in relation to this work. There was no specific funding for the study and the preparation of the manuscript. The CEIP receives funds annually from the Afssaps (the French Medicine Agency) to collect data and to perform studies about abuse of and dependence on any psychoactive drug.

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Authors and Affiliations

  1. Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, CEIP-A, Pharmacologie Clinique, CHU Timone, Marseille, France

    Elisabeth Frauger, Vincent Pradel &  Joëlle Micallef

  2. Institut des Neurosciences Cognitives de la Méditerranée, Faculté de médecine, UMR 6193 Université de la Méditerranée-CNRS, Marseille, France

    Elisabeth Frauger

  3. Centre d’Evaluation et d’information sur la Pharmacodépendance-Addictovigilance, CEIP-A Centre Associé, Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Marseille, France

    Vanessa Pauly, Vincent Pradel & Xavier Thirion

  4. Direction Régionale du Service Médical de l’Assurance Maladie des régions Provence-Alpes-Côte d’Azur et Corse (CNAMTS), Marseille, France

    François Natali, Patrick Reggio & Hervé Coudert

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  1. Elisabeth Frauger
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Correspondence to Joëlle Micallef.

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Frauger, E., Pauly, V., Natali, F. et al. Patterns of Methylphenidate Use and Assessment of its Abuse and Diversion in Two French Administrative Areas Using a Proxy of Deviant Behaviour Determined from a Reimbursement Database. CNS Drugs 25, 415–424 (2011). https://doi.org/10.2165/11587640-000000000-00000

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