Ethylphenidate: availability, patterns of use, and acute effects of this novel psychoactive substance.

PURPOSE: Ethylphenidate is a novel psychoactive substance that is an analogue of methylphenidate. This paper describes its availability, patterns of use, and acute effects. METHODS: Searches of the scientific and grey literature (publicly accessible Internet resources) were undertaken, using the keywords "Ethylphenidate", "Ethyl phenidate", "Ethyl phenyl(piperidin-2-yl)acetate", and "Nopaine", to identify information on the prevalence and patterns of use, desired effects, and toxicity of ethylphenidate. An Internet snapshot survey was performed on 10 February 2015 to provide information on availability and cost of ethylphenidate. RESULTS: The literature search identified 1 case series of acute recreational ethylphenidate toxicity, 1 case report of ethylphenidate dependence, 1 qualitative analysis of user reports on Internet drug forums, 2 conference abstracts for surveillance studies, 1 report of two cases of ethylphenidate detected in post-mortem analyses, and 198 user reports on Internet discussion forums and social media sites. The Internet snapshot survey found 83 websites selling ethylphenidate, with purchase prices ranging from £28.20 ± 0.63 (€37.71 ± 0.85) per gram for a 500-mg amount to £2.64 ± 0.57 (€3.53 ± 0.77) per gram for 1 kg. The published cases and Internet user reports suggest the acute effects of ethylphenidate are similar to other stimulant drugs; the most common route of use was by nasal insufflation. The most common desired effects were euphoria, stimulation, and increased concentration, sociability, and energy levels; the most common unwanted effects included anxiety, palpitations, insomnia, and paranoia. CONCLUSION: This review of the scientific and grey literature has demonstrated that the acute harms associated with its use are stimulant in nature and that ethylphenidate is widely available to users over the Internet, with significant discounts for bulk purchases.

The discrepancy in attention deficit hyperactivity disorder (ADHD) medications diffusion: 1994-2003--a global pharmaceutical data analysis.

OBJECTIVE: The purpose of this paper was to examine the patterns of spending, price, and the utilization of ADHD medications during the 10-year period, from 1994 to 2003 among 4 different per capita GDP group countries. METHODS: This study used the IMS Health database and included both branded and generic ADHD medications. We examined the changes in quantity and price as well as the mixed effects of these changes in the U.S.A. and 3 other groups of countries classified according to their level of per capita GDP. RESULTS: During this study (1994-2003), the U.S. expenditures for ADHD medications increased 594%; sales volume rose by 80%; and price increased by 285%. In other high GDP countries, expenditures increased 493%, sales volume 328%, and price increased by 39%. In the middle GDP countries, expenditures increased 164%, sales volume 141%, and price increased by 9%. In the countries with a lower per capita GDP, expenditures increased 149%, sales volume 464%, however price decreased by 37%. CONCLUSIONS: The launch of long-acting ADHD medications has dramatically increased the total medication expenditure in the U.S. as well as in other high GDP markets. In the other countries quantity was the most important growth factor.

[The use of methylphenidate in children: analysis of prescription usage based in routine data of the statutory health insurance bodies concerning drug prescriptions]. / Der Einsatz von Methylphenidat im Kindesalter: Analyse des Verordnungsverhaltens auf der Basis von Routinedaten der gesetzlichen Krankenkassen zu Arzneimittelverordungen.

UNLABELLED: In Germany only few data is available on the use of stimulants in the treatment of Attention Deficit/Hyperactivity Disorder. For the first time a full survey of health insurance data was carried out on methylphenidate prescriptions from 2000 to 2001 in an East German District. 783 patients of the total cohort received at least one prescription for methylphenidate. In our sample, the treatment prevalence more than doubled in the observation period from 0.6 % to 1.4 % in children aged between 5 and 15 years, this age group representing the largest treatment group. Younger children, adolescents and adults were only rarely treated. The treatment was undertaken predominantly by paediatricians, general practitioners and neurologists/psychiatrists/child psychiatrists. Prescriptions were issued by one, or by not more than two doctors. CONCLUSION: In Mecklenburg-Vorpommern the prevalence of stimulant treatment has clearly increased. Since diagnosis-related data is not available it is not possible to assess the indications for treatment. Further studies should serve to evaluate the correspondence between diagnosis and therapy in relation to stimulant medication.