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EBM analysis
Mental health
Methylphenidate denied access to the WHO List of Essential Medicines for the second time
  1. Johanne Pereira Ribeiro1,
  2. Charlotte Lunde2,
  3. Christian Gluud3,4,
  4. Erik Simonsen1,5,
  5. Ole Jakob Storebø1,6,7
  1. 1 Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
  2. 2 Centre for Medical Ethics, University of Oslo, Oslo, Norway
  3. 3 The Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
  4. 4 Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  6. 6 Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
  7. 7 Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
  1. Correspondence to Dr Ole Jakob Storebø, Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse 4200, Denmark; ojst{at}regionsjaelland.dk

https://doi.org/10.1136/bmjebm-2021-111862

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    Introduction

    Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder with estimated prevalence between 3% and 5% in children and about 2.5% in adults.1 The prevalence varies across countries and even regions within the same country.2 The psychostimulant methylphenidate is used as the first-line treatment for ADHD in children, adolescents and adults in many countries.3

    Essential medicines are those that satisfy the priority healthcare needs of the majority of the population and, as such, should be available in a functioning healthcare system at all times. This concerns the availability of appropriate dosages, amounts and quality. The costs of an essential medicine should be set at a level, which is affordable to the individual in a given community. To ensure low costs, sufficient supply and rational use of essential medicines, the World Health Organization (WHO) created the first Model List of Essential Drugs in 1977 (now Model List of Essential Medicines). The list has since then been updated 22 times, most recently in September 2021.4 The selection of a medication as an essential medicine should be based on its relevancy to disease patterns, the quality and cost-effectiveness of the medicine, its pharmacokinetics and acceptability, notwithstanding the evidence of its performance in a variety of settings as well as evidence of its efficacy and safety.5

    For the 21st update of the WHO Model List in 2018, an application was submitted by researchers from Mount Sinai Graduate Programme in Public Health to include methylphenidate on the list as an essential medicine for children, adolescents and adults with ADHD. The 2018 application had several deficiencies, which has been covered elsewhere.6 The application was rejected by the WHO Expert Committee due to concerns regarding the quality and interpretation of the evidence for benefits and harms. The same research team …

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    Footnotes

    • Contributors OJS developed the idea for the manuscript. JMPR and OJS drafted the first version of the manuscript. CL and CG added sections. All authors critically reviewed and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests OJS, ES and CG: coauthors of Storebø et al. 2015 and 2018, which are mentioned in the application and in the review process.

    • Provenance and peer review Not commissioned; externally peer reviewed.