Trends in methylphenidate dispensing and regional inequalities among children and adolescents in France around the 2021 prescription reform: a repeated cross-sectional ecological analysis of national data (2014–2024)

BACKGROUND: In 2021, France broadened methylphenidate prescribing conditions by allowing treatment initiation outside hospital-based specialist settings in children and adolescents. This regulatory change occurred during the COVID-19 period and alongside broader changes in attention-deficit/hyperactivity disorder (ADHD) recognition and care organization, making its specific effect difficult to disentangle from concurrent contextual factors. We therefore examined national trends in methylphenidate dispensing and regional inequalities in France over 2014-2024, interpreting the reform and pandemic period as contextual factors rather than isolated causal exposures. METHODS: We conducted a repeated cross-sectional ecological study using annual region-level aggregated data from OPENMEDIC and INSEE for individuals aged 0-19 years in France from 2014 to 2024. OPENMEDIC records dispensed boxes rather than treatment initiations or treated individuals. Pre- and post-periods were defined as 2014-2019 and 2022-2024; 2020-2021 were treated as transition years. The primary outcome was annual methylphenidate dispensations per 1,000 inhabitants. Secondary outcomes included methylphenidate as a proportion of all psychotropic dispensations and regional inequality indices. All analyses were interpreted descriptively. RESULTS: Methylphenidate dispensations per 1,000 inhabitants aged 0-19 years increased across all 13 French regions in 2022-2024 compared with 2014-2019. Nationally, dispensations rose from 0.058 per 1,000 in 2014 to 0.189 per 1,000 in 2024, corresponding to a 3.3-fold increase. In descriptive national and panel analyses, post-2022 slopes were steeper than pre-period slopes, whereas immediate level-change estimates were imprecise. The national proportion of methylphenidate among all psychotropic dispensations increased from 6.30% in 2014-2019 to 9.09% in 2022-2024. Regional inequality metrics showed no clear convergence. CONCLUSIONS: In this nationwide ecological study based on annually aggregated data, methylphenidate dispensing more than tripled in France between 2014 and 2024, with steeper post-2022 trends, while regional disparities remained observable and showed no clear convergence. Because the 2021 prescription reform coincided with the COVID-19 period and other changes in ADHD care, these findings should be interpreted as descriptive population-level trends rather than evidence of a specific reform effect.