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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.
Thanks for relating your child's journey. Sounds like he had a pretty tough time. I share your happiness that he made it through. Good for him. And good for you. I appreciate your comments.
Thanks for the candid comments. I appreciate you relating the process utilized for evaluations in your area. It sounds like there is a lot more due process in these situations than I was led to believe earlier. I appreciate being set straight on this.
So glad my son never went on any drug. We have used Medical Orgone Therapy. Described in a rather long article here http://www.orgonomy.org/article_094.html and my son is miles ahead of the other kids we've known since he was 4 who are/were given Ritalin.
This is a very common symtom of stimulent abuse. The hallucination is more ofter tactile than visual. The abusers say they feel bugs or snakes crawling on or under their skin. This is so common among cocaine abusers that it is referred to as "coke bugs"
A generic run-of-the-mill school employee cannot prescribe any medication. A physician or psychiatrist hired by the school system can. But even in the case of a school hired physician, the parents still msut consent to evaluation and treatment or run afoul of violating the IDEA.
I do agree that based on anecdotal statements that doctors do prescribe these meds too willy-nilly. My daughter has had over 11 different combinations of meds over her school career (she is a HS senior) because her psychiatrist and I are very in-tune with any signs of the meds being ineffective. I've had several parents tell me that if the 20 mg of Ritalin doesn't' seem to work, the doc ups it to 25, etc. That might not be the best way to go.
She is a sweet kid, but like your nephew, she is just an average student with average grades. Nothing wrong with that.
Thanks for your correction. There have been a number of them on this thread. That's appropriate. Take care.
D1
Fight drugs for the children ... unless it threatens the profits of big campaign contributors.
I can only tell you that when our daughter was diagnosed with ADHD it was through extensive medical testing and ONLY her doctor could prescribe the medication. She took it at home and not at school. The school never even hinted that she should be tested; it was our decision. She took it for three years and then all concerned made the decision she could stop. I still think it was an important aid for her during those years.
I would agree that the medications are overprescribed and overused, but I don't think the school can just order up a batch and started medicating.
Thanks for the feedback and interest. My case was '90-91 school year. It is true the drugs must be prescribed by an MD, but in my experience, the school had a "pet" MD who took the ARD recommendation from a team of teacher, counselor, vice-principal, reviewed the file, then spent a whole half-hour with step-son before approving the drug regime. By the way, I hear schools are more aggressivly enlisting CPA's to use the "child abuse" pressure now than when we fought our battle. Today, we may have ended up in court.
DoughtyOne, the DEA has so aggressively hunted down pain management MD's that real people live and die in unnecessary agony, but DEA has no interest in federal doctors. A major source of black market pain pills is VA patients with long term presriptions for opioids, most commonly hydrocodone, who sell any above personal need for desperately needed cash, usually to people in real need of relief from medically legitimate pain who cannot find civilian doctors willing to risk their license. DEA has no interest in chasing kids on schedule II drugs when those drugs come out of a federal program.
Final point; there is a huge incentive to the schools to have ever more children officially defined as ADD, ADHD, whatever. This kicks them into, lets call it "Special Ed" for lack of a better term. More kids, more money, more employees, basic bureaucratic Empire Building 101. I do not believe America is suddenly giving birth to genetically deficient children in record numbers. We are supposed to believe we have five times the rate of ADHD as the rest of the world, let alone America of thirty years ago.
Show me a blood test, a brain scan, a measurable increase/decrease in serotonin or some other synaptic brain chemical, then we are talking legitimate medicine. ADHD in America today is a follow-the-money problem more often than it is medical.
For a non-drug treatment of ADD and ADHD see
http://www.drakeinstitute.com/
You can't make an omelette without breaking eggs. </sarcasm>
Thanks for the comments. A number of others chimed in as well to make it known the process that seemed to be rather similar for each of them. I'm glad it worked well for your daughter.
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Children with ADHD who are not given stimulant drugs are more likely to develop problems with drug abuse and dependency than those who are
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Well, from personal experience I can tell you it is very, very true. :)
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.
It happens all the time. I know of one instance where a student began having shaking and dizzy spells at school. Turns out the kid was hypoglycemic. The school refused to accept it. The guidance counselor insisted the kid's problem was psychological and said they worked with some doctors and could get a prescription for Ritalin, et al, for the kid. All the parents had to do was sign a release form. Obviously the parents stayed as far away from those doctors as possible. The school was really pissed.
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