Seasonal trends in methylphenidate use: A mirror of misuse or compliance?

Background: A steady growth in the use of medication for the treatment of attention-deficit hyperactivity disorder (ADHD) has been evident over the past few decades. While growth attests to increased awareness of ADHD and improved access to diagnosis and treatment, concerns have been raised about poor adherence to treatment and diversion of medication. Aim: This current study explored the seasonal and/or temporal use of methylphenidate (MPH) in South Africa. Setting: The study was conducted in South Africa. Methods: A retrospective database analysis was conducted to examine unit sales of MPH over a 9-year period. The unit sales of MPH were compared to those of atomoxetine for the same period. Results: Unit sales for MPH peaked in May and October, which coincided with the academic high-pressure periods for school learners and university students. This was most evident for MPH immediate release 10 mg. There was a noticeable decrease in unit sales for MPH during December. Atomoxetine demonstrated much less seasonal variation. Conclusion: The seasonal and/or temporal use of MPH fluctuates following the academic calendar. These changes are driven by both temporary interruptions of treatment, such as 'drug holidays', and the misuse and diversion of MPH for non-medical use. This holds significant implications for interventions to improve ADHD outcomes. It is crucial to balance accessibility to treatment with the prevention of misuse of MPH. Contribution: Our findings highlight the need to reconsider current policies and regulations regarding the appropriate diagnosis and management of ADHD and the scripting, dispensing and monitoring of MPH.