Purpose: The aim of this study was to describe the extent of methylphenidate (MPH) abuse and characterize its patterns by following several cases involving intravenous administration of crushed MPH tablets. Methods: First, a drug reimbursement database (covering 4 million inhabitants) was explored to assess the magnitude of MPH abuse among the general population, and second, a specific study based on individuals with drug dependence was performed to describe abusers' characteristics (n = 64), patterns of abuse and clinical implications. Results: From 2005 to 2011, the number of patients who were dispensed MPH at least once increased by 166%. The patients with ‘deviant' patterns of MPH consumption were mainly male adults with opiate maintenance treatment reimbursements. MPH abusers had precarious living conditions. Half of them consumed MPH daily by intravenous route and reported amphetamine-like effects (cardiovascular events, weight loss, psychiatric adverse events). Conclusion: Given the increase of MPH use, it is important to warn the scientific community about possible MPH abuse, especially in individuals with drug dependence. This study has facilitated public health intervention and dissemination of information related to MPH abuse among health care professionals at local and national levels.

Kaye S, Darke S: The diversion and misuse of pharmaceutical stimulants: what do we know and why should we care? Addiction 2012;107:467-477.
Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F: Trends in the prescribing of psychotropic medications to preschoolers. JAMA 2000;283:1025-1030.
Swanson JM, Volkow ND: Psychopharmacology: concepts and opinions about the use of stimulant medications. J Child Psychol Psychiatry 2009;50:180-193.
Berbatis CG, Sunderland VB, Bulsara M: Licit psychostimulant consumption in Australia, 1984-2000: international and jurisdictional comparison. Med J Aust 2002;177:539-543.
Miller AR, Lalonde CE, McGrail KM, Armstrong RW: Prescription of methylphenidate to children and youth, 1990-1996. CMAJ 2001;165:1489-1494.
Geirs DP, Pottegård A, Halldórsson M, Zoëga H: A nationwide study of attention-deficit/hyperactivity disorder drug use among adults in Iceland 2003-2012. Basic Clin Pharmacol Toxicol 2014;115:417-422.
Pottegård A, Bjerregaard BK, Glintborg D, Kortegaard LS, Hallas J, Moreno SI: The use of medication against attention deficit/hyperactivity disorder in Denmark: a drug use study from a patient perspective. Eur J Clin Pharmacol 2013;69:589-598.
Gahr M, Freudenmann RW, Hiemke C, Kölle MA, Schönfeldt-Lecuona C: Abuse of methylphenidate in Germany: data from spontaneous reports of adverse drug reactions. Psychiatry Res 2014;215:252-254.
Zetterqvist J, Asherson P, Halldner L, Långström N, Larsson H: Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006-2009. Acta Psychiatr Scand 2013;128:70-77.
Trip AM, Visser ST, Kalverdijk LJ, de Jong-van den Berg LT: Large increase of the use of psycho-stimulants among youth in the Netherlands between 1996 and 2006. Br J Clin Pharmacol 2009;67:466-468.
Treceño C, Martín Arias LH, Sáinz M, Salado I, García Ortega P, Velasco V, Jimeno N, Escudero A, Velasco A, Carvajal A: Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y León (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate. Pharmacoepidemiol Drug Saf 2012;21:435-441.
Frauger E, Pauly V, Natali F, Pradel V, Reggio P, Coudert H, et al: 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. CNS Drugs 2011;25:415-424.
Knellwolf AL, Deligne J, Chiarotti F, Auleley GR, Palmieri S, Boisgard CB, Panei P, Autret-Leca E: Prevalence and patterns of methylphenidate use in French children and adolescents. Eur J Clin Pharmacol 2008;64:311-317.
Gerada C, Ashworth M: ABC of mental health. Addiction and dependence-I: illicit drugs. BMJ 1997;315:297-300.
Lapeyre-Mestre M, Gony M, Carvajal A, Macias D, Conforti A, D'Incau P, Heerdink R, Van der Stichele R, Bergman U: A European community pharmacy-based survey to investigate patterns of prescription fraud through identification of falsified prescriptions. Eur Addict Res 2014;20:174-182.
Hernandez SH, Nelson LS: Prescription drug abuse: insight into the epidemic. Clin Pharmacol Ther 2010;88:307-317.
Casati A, Sedefov R, et al: Misuse of medicines in the European union: a systematic review of the literature. Eur Addict Res 2012;18:228-245.
McCabe SE, Teter CJ, Boyd CJ: The use, misuse and diversion of prescription stimulants among middle and high school students. Subst Use Misuse 2004;39:1095-1116.
Greely H, Sahakian B, Harris J, Kessler RC, Gazzaniga M, Campbell P, et al: Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 2008;456:702-705.
Farquhar S, Fawcett P, Fountain J: Illicit intravenous use of methylphenidate (ritalin) tablets: a review of four cases. Aust Emerg Nurs J 2002;5:25-29.
Dart RC: Monitoring risk: post marketing surveillance and signal detection. Drug Alcohol Depend 2009;105(suppl 1):S26-S32.
Pauly V, Frauger E, Pradel V, Nordmann S, Pourcel L, Natali F, et al: Monitoring of benzodiazepine diversion using a multi-indicator approach. Int Clin Psychopharmacol 2011;26:268-277.
Mounteney J, Haugland S: Earlier warning: a multi-indicator approach to monitoring trends in the illicit use of medicines. Int J Drug Policy 2009;20:161-169.
Nordmann S, Pradel V, Lapeyre-Mestre M, Frauger E, Pauly V, Thirion X, Mallaret M, Jouanjus E, Micallef J: Doctor shopping reveals geographical variations in opioid abuse. Pain Physician 2013;16:89-100.
Pradel V, Thirion X, Ronfle E, Masut A, Micallef J, Bégaud B: Assessment of doctor-shopping for high dosage buprenorphine maintenance treatment in a French region: development of a new method for prescription database. Pharmacoepidemiol Drug Saf 2004;13:473-481.
Pradel V, Frauger E, Thirion X, Ronfle E, Lapierre V, Masut A, et al: Impact of a prescription monitoring program on doctor-shopping for high dosage buprenorphine. Pharmacoepidemiol Drug Saf 2009;18:36-43.
Frauger E, Moracchini C, Le Boisselier R, Braunstein D, Thirion X, Micallef J; French CEIPA-A Network: OPPIDUM surveillance program: 20 years of information on drug abuse in France. Fundam Clin Pharmacol 2013;27:672-682.
Micallef J, Frauger E, Palmaro A, Boucherie Q, Lapeyre Mestre M: Example of an investigation of an ‘emergent' phenomenon in addiction vigilance: the case of methylphenidate. Therapie 2015;70:191-202.
Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE: Use of ADHD drugs in the Nordic countries: a population-based comparison study. Acta Psychiatr Scand 2011;123:360-367.
McDonald DC, Carlson KE: The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers (‘doctor shopping'). Pharmacoepidemiol Drug Saf 2014;23:1258-1267.
Cepeda MS, Fife D, Berwaerts J, Yuan Y, Mastrogiovanni G: Shopping behavior for ADHD drugs: results of a cohort study in a pharmacy database. Drugs R D 2014;14:205-211.
Bjarnadottir GD, Rafnar BO, Sigurdsson E, Steingrimsson S, Bragadottir H, Haraldsson M, Magnusson A: Methylphenidate use among Icelandic i.v. substance abusers. Eur Psychiatry 2013;28(suppl 1):P703.
Bruggisser M, Bodmer M, Liechti ME: Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets. Swiss Med Wkly 2011;141:w13267.
Shlomi D, Shitrit D, Bendayan D, Sahar G, Shechtman Y, Kramer MR: Successful lung transplantation for talcosis secondary to intravenous abuse of oral drug. Int J Chron Obstruct Pulmon Dis 2008;3:327-330.
Cook RC, Fradet G, English JC, Soos J, Müller NL, Connolly TP, et al: Recurrence of intravenous talc granulomatosis following single lung transplantation. Can Respir J 1998;5:511-514.
Ward S, Heyneman LE, Reittner P, Kazerooni EA, Godwin JD, Müller NL: Talcosis associated with IV abuse of oral medications: CT findings. AJR Am J Roentgenol 2000;174:789-793.
Stern EJ, Frank MS, Schmutz JF, Glenny RW, Schmidt RA, Godwin JD: Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol 1994;162:555-560.
Volkow ND, Swanson JM: Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am J Psychiatry 2003;160:1909-1918.
Rigg KK, Ibañez GE: Motivations for non-medical prescription drug use: a mixed methods analysis. J Subst Abuse Treat 2010;39:236-247.
ANSM 2013-Données d'Utilisation et de Sécurité du Méthylphenidate en France, Juillet 2013. http://ansm.sante.fr/var/ansm_site/storage/original/application/8dd1277a3867155547b4dce58fc0db00.pdf (available December 23, 2014).
Karlstad Ø, Furu K, Skurtveit S, Selmer R: Prescribing of drugs for attention-deficit hyperactivity disorder in opioid maintenance treatment patients in Norway. Eur Addict Res 2014;20:59-65.
Pérez de los Cobos J, Siñol N, Pérez V, Trujols J: Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction. Br J Clin Pharmacol 2014;77:337-356.
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