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May 14, 2014
Prescribers Often Detect Efforts Among Teens to Get ADHD Drugs for Diversion
Vancouver, BC—Diversion of medication for attention-deficit/hyperactivity disorder (ADHD) is a common practice, but are prescribers doing anything to prevent the practice among their teenage patients? That is the question addressed by investigators from Cohen Children’s Medical Center of New York. Their research, based on a survey, was presented recently at the Pediatric Academic Societies meeting in Vancouver. “Diversion of stimulation medications for ADHD by high school and college students is widespread, as those with ADHD are often sharing pills with their peers who don't have the condition to try to improve their academic performance,” said senior investigator Andrew Adesman, MD, chief of developmental behavioral pediatrics at the medical center. “Many pediatric colleagues don’t feel adequate in counseling their ADHD patients about diverting stimulant medications or are unfamiliar with some of the legal and health consequences of non-ADHD patients taking an unprescribed controlled substance." Almost half of all physicians surveyed said they believe diversion is common among teens with ADHD, yet a third of physicians responded that they rarely counsel teens about the health and legal consequences of diverting stimulating medication, partly because they don’t feel qualified to do so. Researchers point out that the majority never received training on the topic. The survey analyzed responses from 815 physicians who specialize in ADHD—child neurologists, child psychiatrists, and developmental pediatricians. Results indicate that, within the past 12 months, 59% of respondents suspected some of their teenage ADHD patients were diverting medications, and 54% said they thought some patients were exaggerating symptoms to obtain stimulation medications to divert. When evaluating teens for an initial diagnosis of ADHD, 66% of the doctors said they had reason to believe that some patients were trying to obtain stimulant medication to improve academic performance. Respondents listed other reasons they thought teens were seeking the drugs outside of their approved therapeutic use, including to lose weight (40%), get high (38%), or divert their stimulant medication to others (39%). Asked if they had received training on preventing prescription drug diversion, 73% of the medical professionals said they had received no instruction in medical school, 57% in residency, and 51% in fellowship. Questioned about the difference in the legal consequence of selling versus giving away stimulant medication, 19% of the physicians responding chose the wrong answer and 36% were unsure. Adesman pointed out “in the eyes of the law, there is no difference between someone giving away a pill or selling one; they are both prosecuted as unlawful distribution of a controlled substance.” As far as health risks, he added, “A patient taking an ADHD medication has been titrated up to a certain dose over time. If someone else takes another person’s dose it can be risky because there is no health history and medication naiveté can lead to potential risks, especially if there is an underlying heart condition. “While many prevention strategies can be used to prevent diversion of stimulant medication-informational brochures, a medication contract, pill counts, limiting pill quantities, counseling and other methods, our research showed that while doctors are encouraged to use many of these strategies, most MDs don’t believe the strategies to be effective.”
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