Intravenous Use of Prescription Psychostimulants; A Comparison of the Pattern and Subjective Experience between Different Methylphenidate Preparations, Amphetamine and Cocaine

Abstract

Background/Aims: Methylphenidate (MPH) has been the most commonly used intravenous (i.v.) substance in Iceland in recent years. In Iceland, MPH is available in 3 forms: immediate-release (IR) tablets (MPH IR, short-acting), sustainable-release (SR) capsules (MPH SR, long-acting) and osmotic-release (OROS) tablets (MPH OROS, long-acting). The aims of the study were to compare the pattern and subjective effects of i.v. MPH use to other i.v. psychostimulants and examine whether the pattern of use differs among MPH preparations. Methods: This is a nationwide descriptive study. Information was collected from 95 i.v. substance users undergoing inpatient detoxification and reporting i.v. MPH use in the last 30 days using a semi-structured interview. Results: MPH SR was both the most commonly used (96%) and preferred i.v. psychostimulant (57%). The intensity and duration of ‘euphoria' did not differ between cocaine and MPH SR. No participant reported MPH OROS as their preferred substance even though a third had used it in the past month. Conclusions: The pattern of i.v. MPH use is similar to other psychostimulants among treatment seeking patients. MPH OROS was the least preferred i.v. psychostimulant, despite having the largest market share in Iceland. The results indicate that MPH OROS has less abuse potential than other MPH preparations.

Reply to ‘Overuse or underuse of methylphenidate in adults in France: commentary on Pauly et al. 2018’ by Weibel et al.

“…substance among treatment seeking i.v. substance users . In Denmark, which faced an important increase of methylphenidate use among adults, raising questions about deviant patterns of its use allowed to identify linked factors like those suspected in our study like age 25–49 years, general practitioners or hospital doctors as initial prescriber, prior use of drugs .…”

Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France

“…In addition, formulations with higher ratio of immediate‐release/extended‐release methylphenidate, such as methylphenidate IR and methylphenidate SODAS, were more used, while the formulation with OROS technology was less used, compared with subjects with no doctor‐shopping behavior. Given that use of intravenous route is frequent in France [14,44], this pattern suggests that a part of methylphenidate obtained by doctor shopping may be used by intravenous route, because methylphenidate OROS is the least preferred substance for intravenous route in drug‐abusing subjects [13]. Interestingly, OROS technology increases the time for preparing and the viscosity of the preparation, which may be the reason for this preference [45].…”

“…In the USA, misuse of methylphenidate is frequently reported in students, for improving cognitive performances or euphoric effects [9,10]. In Iceland, where methylphenidate has one of the highest prescription rates per capita [11], methylphenidate is the preferred substance for intravenous route in drug‐abusing subjects [12,13]. In France, evidence of doctor shopping for methylphenidate was identified as early as 2005 [14], while other complementary analysis conducted by the French Addictovigilance Network identified patterns of use suggesting abuse in adults, and use by intravenous route [15–17].…”

Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network

“…Patients with doctor shopping behavior preferred formulations with a higher ratio of immediate-release/extendedrelease methylphenidate (e.g., methylphenidate with Spheroidal Oral Drug Absorption System and methylphenidate immediaterelease) over methylphenidate with Osmotic-Controlled Release Oral Delivery System (OROS) (45) (Figure 3). Given that the use of intravenous route for methylphenidate is frequent in France (79)(80)(81), this pattern also suggests that a part of methylphenidate obtained by doctor shopping may be used by intravenous route, because methylphenidate OROS is the least preferred drug for intravenous route in drug-abusing patients (82). Interestingly, OROS increases the time for preparing due to the viscosity of the preparation, which may be the reason for this preference (83).…”