Posted on 03/31/2006 7:07:06 PM PST by blam
Prescribing of hyperactivity drugs is out of control
31 March 2006
NewScientist.com news service
Peter Aldhous
Rise in ADHA?THE figures are mind-boggling. Nearly 4 million Americans, most of them children and young adults, are being prescribed amphetamine-like stimulants to treat attention deficit hyperactivity disorder (ADHD). Up to a million more may be taking the drugs illegally.
Now, amid reports of rare but serious side effects, leading researchers and doctors are calling for a review of the way ADHD is dealt with. Many prescriptions are being written by family doctors with little expertise in diagnosing ADHD, raising doubts about how many people on these stimulants really need them. Just as worrying, large numbers of children who do have ADHD are going undiagnosed.
Both trends could lead to problems with drug dependency, argue specialists in addiction. "There has to be a re-evaluation and reassessment of the extent to which there is proper prescription," says Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland.
Last week, the debate intensified, following two meetings of advisers to the US Food and Drug Administration (FDA). First, the agency's Pediatric Advisory Committee suggested that parents and doctors should be warned about the risk of ADHD drugs triggering hallucinations. This followed a review of evidence of the drugs' psychiatric side effects, including disturbing hallucinations often involving worms, snakes or insects, experienced by up to 5 per cent of children taking the drugs. In February, a separate FDA panel recommended that they should carry the most prominent type of safety warning, following 25 reports of sudden deaths from heart problems (New Scientist, 18 February, p 7).
Another FDA committee last week voted to delay an application for a drug previously used to treat sleep disorders to be marketed for ADHD. The drug, modafinil, has less potential for abuse and addiction, but the FDA's Psychopharmacologic Drugs Advisory Committee wants to see more evidence proving its safety before backing the application (see "Alternative treatments for ADHD").
Stimulants such as methylphenidate, marketed by Novartis as Ritalin, have been used to treat ADHD for decades. As well as increasing arousal and heart rate, the drugs allow people who have difficulty concentrating to focus on tasks more effectively. Their use has exploded in recent years, especially in the US, where prescription rates are several times higher than across most of the developed world - in part because US doctors tend to use a broader definition of the condition.
Psychiatrists stress that side effects are rare, and say that the drugs have helped millions of people who would otherwise have had huge problems focusing at school and work. "These are some of the most effective treatments that we have in psychiatry," says Chris Kratochvil of the University of Nebraska Medical Center in Omaha.
To diagnose ADHD reliably, a psychiatrist would ideally observe a child for several hours, checking their behaviour against a list of symptoms relating to activity and ability to concentrate. But in many cases, family doctors are prescribing the drugs after just a few minutes of consultation, based largely on evidence of boisterousness.
Doctors are under growing pressure from children and their parents to prescribe the drugs, as many believe that stimulants will help them get better school grades. "I have a colleague whose son was mobbed by friends wanting prescriptions," says Scott Kollins, a child psychologist at Duke University in Durham, North Carolina.
“Doctors are under growing pressure to prescribe the drugs, as many believe they will help deliver better school grades”This demand is also fuelling an illegal trade. Findings published last month indicate that in 2002 more than 750,000 Americans aged 12 and over were taking the stimulants without medical supervision (Drug and Alcohol Dependence, DOI: 10.1016/j.drugalcdep.2005.12.011). Some may have been using the drugs for a traditional "high", or to keep going during all-night parties. But Larry Kroutil of RTI International in Research Triangle Park, North Carolina, who led the study, suspects that much of the illegal use is by children and young adults taking the drugs as study aids. In some cases, they are being bought by parents from illicit websites that do not ask for evidence of a prescription. "We need to look more at how people are getting these drugs, and why," Kroutil says.
Members of the FDA's Drug Safety and Risk Management Advisory Committee, which recommended the prominent safety warning on heart risks, say that they were motivated in part by concerns that many people who do not have ADHD are taking the stimulants. "It has been clear that the drugs are overused," says Peter Gross of Hackensack University Medical Center in New Jersey, who chairs the committee.
The American Psychiatric Association argues that the picture is more complex. "Yes, there is overprescribing," says Jason Young, the association's communications manager. "But there is also underprescribing." Among poorer sections of the US population, and particularly in minority groups such as African Americans and Hispanics, ADHD is believed to be widely underdiagnosed.
Volkow is worried that underprescription of stimulants could lead to problems with drug abuse. Children with ADHD who are not given stimulant drugs are more likely to develop problems with drug abuse and dependency than those who are, perhaps because they have to turn to illegal stimulants on which they can become hooked to get relief from their symptoms. So improving diagnosis and treatment among people with poor access to mental health services is important, Volkow argues.
Meanwhile, the long-term effects of giving prescription stimulants to healthy people remain largely unknown. Kroutil's team asked illicit users whether the drugs were interfering with various aspects of their lives. On this basis, the researchers estimated that about 10 per cent were having problems with dependency.
Volkow fears that problems with dependency may be more widespread. There are also hints that taking stimulants may lead to abuse of other drugs. Some studies suggest that exposing juvenile animals to stimulants makes them less likely to self-administer drugs such as cocaine when they are offered the drugs as adults, but other studies indicate the opposite. What is needed, says Volkow, are long-term follow-up studies on people who do not have ADHD and who have taken stimulants such as methylphenidate. In the meantime, she wants medical associations to take a stronger lead in educating doctors about the proper diagnosis and treatment of ADHD.
William Carlezon of Harvard Medical School agrees. He has studied the drugs' effects in animals and believes that they do have some lasting effect on the brain, even if its exact nature is not yet known. "Stimulant drugs leave molecular signatures on the brain, and we have to be very careful," he says. "Diagnosis needs to be taken less lightly."
From issue 2545 of New Scientist magazine, 31 March 2006, page 8 Alternative treatments for ADHD Despite concerns about the possible side effects of stimulant drugs such as methylphenidate, the alternative treatment options are limited.
A non-stimulant called atomoxetine was approved in the US for ADHD in November 2002. Although it belongs to a different class of drugs from the more widely used stimulants, atomoxetine was implicated in some of the cases of hallucinations considered by the FDA's Pediatric Advisory Committee last week.
ADHD specialists had hoped that atomoxetine would be joined by modafinil later this year. This drug is currently used to treat excessive sleepiness, and seems to improve focus and alertness (New Scientist, 18 February, p 34). But an application to approve modafinil for treating ADHD suffered a setback on 23 March when the FDA's Psychopharmacologic Drugs Advisory Committee recommended that the drug's manufacturer, Cephalon, conduct a further study in 3000 children. Committee members were worried about a single case of a potentially fatal skin condition among the 933 patients in Cephalon's trials so far.
Though slightly less effective than methylphenidate in treating ADHD, both modafinil and atomoxetine are less likely to lead to addiction problems. That may make them particularly useful in treating patients whose social environment makes them vulnerable to drug abuse.
It's like the horrific use of antibiotics once they were discovered!
Little boys at the mercy of our ilustrious education system. I've got a great idea, let's double the budget again, wheeeeeeeeeeeeee...
I would like to see where this little unchallenged factoid came from.
Me too. I'm sure that conclusion is speculative at best.
Why don't they prescribe some intensive physical education? When I run 7-10 miles a week I feel less jittery, it strengthens my posture muscles so I sleep better, and I feel like I'm getting more oxygen to my brain.
And it works for my pup as well. If I don't walk her every day, she's a lot harder to deal with.
Been there, done that. Went to war with a school system when they wanted to medicate step-son. Did some serious research on a (to me) new topic. The diagnosis is purely subjective. There is no physical test, so the set of questions are such as; Does the student fidget too much? Does the students attention wander more than others? Is the student involved in more than normal disciplinary problems?
Obvious that the upper 50% on any one question are by comparison "more" whatever than the class. I finally fell out cackling when I read one defender of ADHD meds who assured me that the Scedule 2 narcotics they wanted to prescribe for the boy absolutely were not addictive, he knew this because he had been taking them daily for 26 years!
Told the school to pound sand and was threatened with a charge of "child abuse" for withholding essential medication. Instead of tugging my forelock, I invited the SOBs to court and never heard any more about it.
Good for you! How long ago was this?
What is absolutely incredible to me, is that it doesn't even require a physician to make the call. As I understand it, school staff members essentially prescribe and dispense. If this isn't against every DEA rule known to man, I don't know what is. As you stated, it's a Class II medication.
If the DEA was worth it's salt, it would be breaking down doors across this nation and prosecuting these people and placing them in prison where I think they belong.
I am glad this worked out well for you. I can't imagine how many people get intimidated and give in.
Kudos to you.
Nicely done! I am glad you were able to avoid the profound waste of everything that court appearances represent.
As you can see from my screen name, I solved this problem long ago, now I'm trying to go the other way!
Just kidding. Congrats!
Her doc prescribed 5mg Ritalin, twice a day, to give her an "energizing spark", so to speak.
I quizzed the pharmacist, and he totally concurred....strange, because the higher doses used to drug kids into compliance, have the exact 90 degree different effect.
"What is absolutely incredible to me, is that it doesn't even require a physician to make the call. As I understand it, school staff members essentially prescribe and dispense."
Umm, where did this come from? Never heard of such a thing. School staff members can't just prescribe a medication unless they're doctors.
I have read reports that led me to believe what I said was true. If you know otherwise I'll stand corrected. I'm not trying to decieve anyone, but I'm not convinced that physicians are always in the loop on school administration of Ritalin in particular.
It would take a physician to get the meds on campus, but from then on out as along as records were kept... do you know?
#1. Your mother would have done better with venlafaxine.
#2. Children with ADD/ADHD have "sleepy" brains. Scans of these kid's brains look like a normal person who is sleepy/fatigued. You know how kids act when they are VERY tired and fighting sleep - they go nuts. When ADD/ADHD kids are given a stimulant, their brains more closely resemble a brain that is not sleepy.
There are reasons for paradoxical reactions. ADD/ADHD kids are normalized by proper doses of stimulants. Kids with a discipline problem, treated by stimulants, turn into zombies.
Well, 5% of 4 million is 200,000 - a year.
Add to that the fact that these drugs were never tested for safety with children - and the fact that almost to a case, the school shootings were done by kids on these drugs!
It's not the guns or the pipe bombs - it's the cult of legal drug pushing on our most venerable.
The brightest boys, who are bored in the dumbed down schools, often clown around and are a prime target to get quieted down for the teacher's benefit - rather than upping the level of teaching. And if the parent complains and fights the drugging they can be charged with child abuse.
It's time for this horror to be stopped. Child abuse, pure and simple.
THIS is exactly what is needed.
The lack of natural exercise and fresh oxygen is also a big part of the growing (no pun) obesity with our children.
The solution is to only let child psychiatrists evaluate and prescribe these medications. Unfortunately, there is a shortage of child psychiatrists in this country.
So what is happening? Some Dr Feelgood is writing prescriptions for the school nurse and she just gives them to whomever she thinks needs them? Truly, that is just insane. I can't get my wheezing son an inhaler into school without a ton of documentation for it. But, of course, the school administrators are EVIL and want to DRUG CHILDREN!!!
My son's teacher suggested that my son be looked at for ADD. I consulted my pediatrician who suggested testing with a psychologist. The tests were done. My son has problems with short term memory and a visual processing disorder. I would recommend the testing to anyone who has a child with attention problems.
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