In the Journals

Methylphenidate may be misused, abused among adults in France

Researchers observed differing patterns of methylphenidate use across age groups in France, including long-term use in children, use for medical conditions other than ADHD and narcolepsy in adults and drug abuse/misuse behaviors.

“Despite a large amount of literature on the topic, the overview of [methylphenidate] use patterns is sparse due to a scattering of populations analyzed from one study to another,” Joelle Micallef, MD, PhD, Aix-Marseille Université, France, and colleagues wrote in The Journal of Clinical Pharmacology. “Some studies focus only on children, others only on adults, and others focus on only ADHD-diagnosed patients. Nevertheless, the concerns are convergent and address persistence, duration, coprescription of other treatments including psychotropic medications and drug abuse.”

Researchers examined and characterized patterns of methylphenidate use in children and adults over a 3-year period. They examined a cohort of incident methylphenidate users between July 2010 and June 2013 using the French General Health Insurance database. Micallef and colleagues assessed participants by age groups — splitting adults into those aged 18 to 24 years, 25 to 49 years and 50 years and older, and children into those aged younger than 6 years, 6 to 11 years and 12 to 17 years — to describe differences at methylphenidate initiation and during follow-up according to treatment duration, quantities dispensed and coprescription with central nervous system drugs.

The study included 3,534 incident methylphenidate users. The estimated annual rate of incident users increased 7% from 2011 to 2013, from 27 per 100,000 people to 29 per 100,000. Children accounted for the majority of new users (66%) and were characterized by long-term use of methylphenidate.

Among the incident patients, 75% reported at least two dispensings of methylphenidate, but these proportions decreased with age from 74% for the youngest children to 45% for the oldest adults. There were different patterns of methylphenidate use according to age. The immediate-release formulation of methylphenidate was dispensed first mainly for children aged 1 to 5 years and adults aged 50 years and older. Duration of follow-up, median of drug survival and retention rates decreased with age, while in contrast, mean and median dosage increased with age.

Children on methylphenidate had few co-medications. Adults aged 25 to 49 years were dispensed methylphenidate more frequently, had the highest mean dosage and most often took other central nervous system drugs: 67% were coprescribed benzodiazepines, 40% antidepressants, 39% opioid analgesics, 35% antipsychotics and 32% opiate maintenance treatments. Adults aged 50 years and older presented the highest concomitant use of antidepressants (58%) and antiparkinsonian drugs (26%).

“We have demonstrated different patterns of use across age groups highlighting long-term use for children, associated medical conditions other than ADHD for adults and possible drug abuse/misuse behaviors in particular for 25- to 49-year-old patients,” the researchers wrote. “These different patterns imply that different strategies are called for so as to minimize risks of adverse events, in particular concerning older people and risks of abuse.” – by Savannah Demko

Disclosures: Healio Psychiatry was unable to confirm any relevant financial disclosures.

Researchers observed differing patterns of methylphenidate use across age groups in France, including long-term use in children, use for medical conditions other than ADHD and narcolepsy in adults and drug abuse/misuse behaviors.

“Despite a large amount of literature on the topic, the overview of [methylphenidate] use patterns is sparse due to a scattering of populations analyzed from one study to another,” Joelle Micallef, MD, PhD, Aix-Marseille Université, France, and colleagues wrote in The Journal of Clinical Pharmacology. “Some studies focus only on children, others only on adults, and others focus on only ADHD-diagnosed patients. Nevertheless, the concerns are convergent and address persistence, duration, coprescription of other treatments including psychotropic medications and drug abuse.”

Researchers examined and characterized patterns of methylphenidate use in children and adults over a 3-year period. They examined a cohort of incident methylphenidate users between July 2010 and June 2013 using the French General Health Insurance database. Micallef and colleagues assessed participants by age groups — splitting adults into those aged 18 to 24 years, 25 to 49 years and 50 years and older, and children into those aged younger than 6 years, 6 to 11 years and 12 to 17 years — to describe differences at methylphenidate initiation and during follow-up according to treatment duration, quantities dispensed and coprescription with central nervous system drugs.

The study included 3,534 incident methylphenidate users. The estimated annual rate of incident users increased 7% from 2011 to 2013, from 27 per 100,000 people to 29 per 100,000. Children accounted for the majority of new users (66%) and were characterized by long-term use of methylphenidate.

Among the incident patients, 75% reported at least two dispensings of methylphenidate, but these proportions decreased with age from 74% for the youngest children to 45% for the oldest adults. There were different patterns of methylphenidate use according to age. The immediate-release formulation of methylphenidate was dispensed first mainly for children aged 1 to 5 years and adults aged 50 years and older. Duration of follow-up, median of drug survival and retention rates decreased with age, while in contrast, mean and median dosage increased with age.

Children on methylphenidate had few co-medications. Adults aged 25 to 49 years were dispensed methylphenidate more frequently, had the highest mean dosage and most often took other central nervous system drugs: 67% were coprescribed benzodiazepines, 40% antidepressants, 39% opioid analgesics, 35% antipsychotics and 32% opiate maintenance treatments. Adults aged 50 years and older presented the highest concomitant use of antidepressants (58%) and antiparkinsonian drugs (26%).

“We have demonstrated different patterns of use across age groups highlighting long-term use for children, associated medical conditions other than ADHD for adults and possible drug abuse/misuse behaviors in particular for 25- to 49-year-old patients,” the researchers wrote. “These different patterns imply that different strategies are called for so as to minimize risks of adverse events, in particular concerning older people and risks of abuse.” – by Savannah Demko

Disclosures: Healio Psychiatry was unable to confirm any relevant financial disclosures.