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Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data

Authors Bjerkeli PJ, Perez Vicente R, Mulinari S, Johnell K, Merlo J

Received 29 June 2018

Accepted for publication 14 September 2018

Published 9 November 2018 Volume 2018:10 Pages 1657—1665


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Vera Ehrenstein

Pernilla J Bjerkeli,1,2 Raquel Perez Vicente,2 Shai Mulinari,3 Kristina Johnell,4 Juan Merlo2,5

1Department for Biomedicine and Public Health Research, School of Health and Education, University of Skövde, Skövde, Sweden; 2Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden; 3Department of Sociology, Lund University, Lund, Sweden; 4Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; 5Center for Primary Health Care Research, Region Skåne, Malmö, Sweden

Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics.
Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6–79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose.
Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46–65 years vs 6–12 years 17.5, 95% CI 14.3–21.3), and was higher in men (OR 1.4, 95% CI 1.3–1.5) and individuals with low income (OR 1.1, 95% CI 1.0–1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3–1.6), health care visits (OR 1.3, 95% CI 1.2–1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4–2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0–2.3).
Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

Keywords: methylphenidate, prescription drug diversion, pharmacoepidemiology, attention deficit disorder with hyperactivity, prescription drug overuse

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