title: 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.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre dEvaluation et dInformation sur la Pharmacodpendance-Addictovigilance, CEIP-A, Pharmacologie Clinique, CHU Timone, Marseille, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Frauger
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pauly
authors.forename: François
authors.initials: F
authors.lastname: Natali
authors.forename: Vincent
authors.initials: V
authors.lastname: Pradel
authors.forename: Patrick
authors.initials: P
authors.lastname: Reggio
authors.forename: Hervé
authors.initials: H
authors.lastname: Coudert
authors.forename: Xavier
authors.initials: X
authors.lastname: Thirion
authors.forename: Joëlle
authors.initials: J
authors.lastname: Micallef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D010594:Pharmacies; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate