Example of an Investigation of an “Emergent” Phenomenon in Addiction Vigilance: the Case of Methylphenidate

Abstract

-Abuse of and addiction to medication are a major public health issue which is evolving fast, in particular in countries like France, one of the largest consumers of medication in Europe. As a single source of information is not generally sufficient to measure a phenomenon as difficult to apprehend as medication-related addiction, as can be seen in the case of methylphenidate, it is essential to mobilise all the tools available, here surveillance programmes developed by the French CEIP Addiction vigilance network, such as suspicious prescriptions indicating possible abuse data (OSIAP) or observatory of illegal or misused psychoactive medications (OPPIDUM), as well as the health insurance databases, and health professional sentinel networks. The latest data available on methylphenidate abuse in France suggests a stabilisation of the phenomenon, which emerged in the Provence-Alpes-Côte-d'Azur (PACA) region in southern France. It also evidences its diffusion to other regions, so that the information needs to be widely relayed, and suggests that health professionals should exercise the greatest caution in the use of this substance, and should look for early signs of its misuse.Abbreviations: see end of article.

Patterns of Methylphenidate Use and Assessment of Its Abuse among the General Population and Individuals with Drug Dependence

“…This trend has already been described by different drug utilization studies in other European countries [6,7,9,28,29] . An extensive variability was observed in the European levels between 2002 and 2010, for example, +425% in Denmark (0.8-4.2 DDD/1,000 inhabitants/day), +67% in France (0.18-0.3 DDD/1,000 inhabitants/day), +116% in Germany (1-2.16 DDD/1,000 inhabitants/day), and +122% in the Netherlands (2.04-4.53 DDD/1,000 inhabitants/day) [28] . In our study, 2,802 patients were MPH users in 2011, leading to an exposure of 0.39 DDD/1,000 inhabitants/day.…”

“…In our study, 2,802 patients were MPH users in 2011, leading to an exposure of 0.39 DDD/1,000 inhabitants/day. The fact that such a situation of MPH abuse was observed in France, even though the level of exposure in the general population is 'low' in comparison to other European countries, is an important warning in terms of public health [28,29] . Currently, there are many drug utilization studies that describe the prevalence or incidence of ADHD drugs, patient profile and data on ADHD drugs.…”

“…Information regarding MPH abuse was also included in the MPH report published in 2013 by the French Drug Agency [40] . These interventions had a positive impact because prescribers and pharmacists became aware of MPH abuse liability and MPH prescription, and dispensing conditions were actually more respected afterwards in our geographic area [28] .…”

Drug Abuse Monitoring: Which Pharmacoepidemiological Resources at the European Level?

“…[36] Using dependence-relatedness indicator on the whole database (including Europe and other countries), the authors showed that routine screening would have quantitatively highlighted a potential signal with pregabalin already in the second quarter. To the best of our knowledge, there are few examples of using VigiBase ™ for identification of safety signals related to abuse or addiction, with the exception of methylphenidate as discussed by Micallef et al [37] In Germany, pregabalin was ranked as the 12 th most sold drug in Germany in 2009, with an increase in prescriptions of approximately 22% in 2009 compared to 2008. Face to this indirect reference to a possible abuse of this drug, Gahr et al analysed all reported cases of pregabalin abuse and dependence in Germany that had been submitted to the responsible federal authority, the German Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte [BfArM]).…”

Signal Identification in Addictovigilance: the Functioning of the French System

“…One example of this could be the misuse of methylphenidate, identified in the PACA-Corsica region: [27] the question of whether to reiterate this survey in other regions can be raised in case of a generalisation of the phenomenon.…”