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Guerra C, Soeiro T, Lacroix C, Jouve E, Micallef J, Frauger E. [Increasing methylphenidate abuse: Tracking and profiles during 13-years]. Therapie 2022; 77:713-721. [PMID: 35599193 DOI: 10.1016/j.therap.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Methylphenidate is indicated for attention deficit hyperactivity disorder (ADHD). Several studies have evaluated its abuse in specific populations (students, drug users) and few in the general population. This work describes the extent of its abuse in a region of more than 5 million inhabitants. METHOD Based on regional health insurance data from 2005 to 2017, the clustering method identifies different methylphenidate use profiles according to several characteristics (number of different prescribers and pharmacies, number of dispensations, number of defined daily dose dispensed). The groups characterised by high values of these variables will be qualified as "deviant". RESULTS In 13 years, the number of patients with at least one dispensation in the first quarter has been multiplied by 5.8 times. The proportion of adults has increased (20% in 2017) and their number has been multiplied by 10. Five groups are identified, three of them are characterised by "deviant" behaviour. Group 5 (n=11, 0.04%) has higher values than 4 (n=112, 0.4%) and 3 (n=407, 1.6%). These patients are older and more frequently use benzodiazepines and opiate substitution drugs. Groups 1 (n=13,132, 51%) and 2 (n=11,941, 46.7%) are more likely to be taken up by young subjects. The number of subjects with "deviant" behaviour increased until 2011 and after a decrease, the highest number of subjects concerned has been observed since 2015. CONCLUSION In view of the increase of subjects with "deviant" behaviour, it is necessary to make the medical community and patients aware on the risk of abuse of methylphenidate. The recent extension of the indication for ADHD in adults and the broadening of the conditions of prescription require increased vigilance.
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Affiliation(s)
- Clémence Guerra
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Thomas Soeiro
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Clémence Lacroix
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Jouve
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Joelle Micallef
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Frauger
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France.
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Carton L, Cabé N, Ménard O, Deheul S, Caous AS, Devos D, Cottencin O, Bordet R. Pharmaceutical cognitive doping in students: A chimeric way to get-a-head? Therapie 2018; 73:331-339. [PMID: 29625706 DOI: 10.1016/j.therap.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit/risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.
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Affiliation(s)
- Louise Carton
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France.
| | - Nicolas Cabé
- Inserm, U1077, Unicaen, EPHE, neuropsychologie et imagerie de la mémoire humaine, PSL research university, CHU de Caen, Normandie université, 14000 Caen, France; Service universitaire d'addictologie, CHU de Caen, 14000 Caen, France
| | - Olivier Ménard
- Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Sylvie Deheul
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - Anne-Sylvie Caous
- CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - David Devos
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; Licend Coen Center Lille, 59045 Lille, France
| | - Olivier Cottencin
- CNRS UMR 9193 SCALab PsyCHIC Team, université de Lille, 59045 Lille, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Régis Bordet
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
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Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Patterns and profiles of methylphenidate use both in children and adults. Br J Clin Pharmacol 2018; 84:1215-1227. [PMID: 29512177 DOI: 10.1111/bcp.13544] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3-year period. METHODS Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18-24, 25-49 and ≥50 years of age for adults and <6, 6-11 and 12-17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow-up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs. RESULTS We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long-term use of MPH with few comedications. The group of 25-49-year-old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50 year-old group was more often coprescribed antidepressants and antiparkinsonian drugs. CONCLUSIONS Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25-49-year-old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.
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Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Magalie Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
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Carton L, Cabé N, Ménard O, Deheul S, Caous AS, Devos D, Cottencin O, Bordet R. [Pharmaceutical cognitive doping in students: a chimeric way to get-a-head?]. Therapie 2017; 73:319-329. [PMID: 29224920 DOI: 10.1016/j.therap.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/04/2017] [Accepted: 10/24/2017] [Indexed: 11/27/2022]
Abstract
For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit / risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.
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Affiliation(s)
- Louise Carton
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France.
| | - Nicolas Cabé
- Inserm, U1077, Unicaen, EPHE, neuropsychologie et imagerie de la mémoire humaine, PSL research university, Normandie université, CHU de Caen, 14000 Caen, France; Service universitaire d'addictologie, CHU de Caen, 14000 Caen, France
| | - Olivier Ménard
- Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Sylvie Deheul
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - Anne-Sylvie Caous
- CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - David Devos
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; Licend Coen Center Lille, 59045 Lille, France
| | - Olivier Cottencin
- CNRS UMR 9193 SCALab PsyCHIC Team, université de Lille, 59045 Lille, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Régis Bordet
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
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Ehrhardt C, Boucherie Q, Pauly V, Braunstein D, Ronflé E, Thirion X, Frauger E, Micallef J. Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period. Therapie 2017; 72:635-641. [DOI: 10.1016/j.therap.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/11/2023]
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