Geringe, jedoch steigende Zahl spontaner Berichte über Missbrauch von Methylphenidat in Deutschland

 

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Zusammenfassung

Gegenstand und Ziel: In den letzten Jahren lässt sich eine zunehmende Auseinandersetzung mit dem Phänomen des Pharmakologischem Neuroenhancements (PNE) beobachten, definiert als die freiwillige Einnahme von psychotropen Substanzen zur Steigerung der kognitiven Leistungsfähigkeit durch gesunde Personen. Methylphenidat (MPH) wird im Kontext des PNE am häufigsten eingesetzt. Da die Praktik des PNE eine Form von Missbrauch darstellt, ist PNE auch Thema der Pharmakovigilanz. In dieser Studie wurde untersucht, ob die zunehmende Verbreitung von PNE bzw. MPH-Missbrauch mit einer Zunahme der Zahl spontaner Meldungen über MPH-Missbrauch korrespondiert. Material und Methoden: Im Oktober 2012 erfolgte eine Abfrage der Datenbank unerwünschter Arzneimittelwirkungen des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM) im Hinblick auf MPH-Missbrauch. Ergebnisse: Es wurden 23 Fälle von MPH-Missbrauch identifiziert (mittleres % 29 Jahre; Männer 78%). Der erste Bericht stammte aus dem Jahr 1999; es zeigte sich ein deutlicher Anstieg der Meldefrequenz zwischen den Jahren 2004 und 2010. Die Häufigkeit der oralen Applikation (∼70%) war ein indirekter Hinweis auf einen möglichen Zusammenhang mit der Praktik des PNE. Schlussfolgerungen: Die beobachtete Zunahme der Meldefrequenz kann entweder als Ausdruck erhöhter Aufmerksamkeit der Meldenden gegenüber MPHMissbrauch/ PNE oder eines tatsächlichen Anstiegs des MPH-Missbrauchs eingeordnet werden. Die kontra-intuitiv niedrige Gesamtzahl an Meldungen könnte in Verbindung mit einem im Hinblick auf MPH grundsätzlich unzureichenden Meldeverhalten stehen. Klinische Relevanz: Angehörige der Heilberufe sollten (Verdachts-)Fälle von MPH-Missbrauch, insbesondere im Kontext des PNE, an die zuständigen Einrichtungen der Pharmakovigilanz melden.

Summary

Objective: In the last decade pharmacological neuroenhancement (PNE), defined as the voluntary application of psychotropic agents by healthy persons in order to improve the performance of particular cognitive domains, has gained momentum as an issue of increasing scientific interest. Here, methylphenidate (MPH) is the agent that is most frequently used for the purpose of PNE. PNE must be considered as a form of abuse and thus is a matter of pharmacovigilance. This study aims at investigating, whether the increase of MPH-abuse respective PNE is reflected by an increase of the number of spontaneous reports of MPH-abuse to a national pharmacovigilance institution. Material and methods: In October 2012, the database of adverse drug reactions of the German Federal Institute for Drugs and Medical Devices (BfArM; a Federal Institute within the portfolio of the Federal Ministry of Health) was accessed and queried for MPH abuse. Results: 23 cases of MPH abuse were detected (mean age 29 y; male 78%) with the first report dating back to 1999; an increase of the reporting frequency between the years 2004 and 2010 was observed. Predominance of oral application in the analysed cohort (∼ 70%) was an indirect reference to a possible connection with the practice of PNE. Conclusions: The observed increase of the reporting frequency may be due to an increased alertness of physicians towards PNE/MPH abuse or actually increased prevalence of PNE/ MPH abuse in Germany. The counter-intuitive low number of reported cases of MPH abuse may be associated with an insufficient reporting behaviour regarding MPH. Clinical relevance: Health professionals should report cases suspicious of MPH abuse, especially in the framework of PNE, to the responsible pharmacovigilance institutions.

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