ADHD Drugs Subject to Misuse
SAN FRANCISCO (UPI) — There’s little doubt some of the medicines used to treat attention-deficit/hyperactivity disorder are addictive. The question under debate is who is susceptible to the threat.
In a 30-year study of 492 youngsters, University of California, Berkeley, psychology professor Nadine Lambert found those taking the popular stimulant Ritalin faced a multi-fold greater risk of developing a tobacco or cocaine habit than their unmedicated peers.
However, the study has been generally discounted as an anomaly whose findings lack reliable replication.
Most in the medical mainstream dismiss the notion ADHD pharmaceutical treatments could lead to later drug abuse and, in fact, subscribe to the opposite view.
“There appears to be a lowered risk for substance abuse when Ritalin is given therapeutically,” said Stephen Hinshaw, professor and chair of psychology at UC Berkeley, who deems his colleague Lambert’s survey “an outlier.”
He finds more convincing a stimulant study review conducted by researchers at Massachusetts General Hospital and Harvard Medical School. That survey found adolescents with ADHD who took their medicine during their teens were less likely to engage in substance use or abuse later on than were their counterparts who were not treated with pharmaceuticals.
Nevertheless, research suggests tolerance to the drugs can build up, requiring progressively higher doses and increasing the difficulty of getting off the medicine.
Experts also acknowledge there is a high risk of addiction and other adverse effects from using the drugs without a prescription — be it to pull an all-nighter before a big exam or sharpen focus during one, or to suppress appetite in an effort to shed excess pounds.
Various surveys indicate up to 7 percent of ninth graders and as many as 11 percent of female and 17 percent of male college students have resorted at least once to such ill-advised — and illegal — tactics.
The numbers are so disturbing that government, law enforcement and health officials urge medicated minors be monitored to ensure they don’t share their medicines with their siblings or friends, a practice that appears to be growing in popularity.
“The explosion in the prescription of addictive opioids, depressants and stimulants has, for many children, made the medicine cabinet a greater temptation and threat than the illegal street drug dealer, as some parents have become unwitting and passive pushers,” cautioned former Health, Education and Welfare Secretary Joseph Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University in New York.
In the first comprehensive analysis of controlled prescription-drug abuse, the center found an astounding 212-percent leap in the number of 12- to 17-year-olds abusing stimulants and other doctor-ordered medications between 1992 and 2003.
The authors of another study, published this month in the journal Drug and Alcohol Dependence, also see the misapplication of stimulants prescribed for ADHD, narcolepsy, obesity and other conditions as a significant problem in the United States.
Analyzing the results of a national survey on drug use in 2002, they found 7.3 million Americans have abused prescribed pharmaceuticals, with a substantial number of adolescents and young adults getting hooked on the drugs.
The problem appears particularly prevalent among the 12-to-25 set, a demographic 10 times more likely than the general population to have abused the drugs, reported the investigators from the non-profit research-and-development group RTI International in Research Triangle Park, N.C.
Overall, they estimated some 1 million young people had misused prescription stimulants during a 12-month period, and 75,000 showed signs of addiction to the chemicals.
“America is in a perfect storm of abuse of mind-altering prescription drugs, including … CNS stimulants like Ritalin, Adderall and Dexedrine that boost attention and energy,” Califano warned.
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When to just say no to ADHD drugs
SAN FRANCISCO (UPI) — It takes skill, experience and a certain amount of luck to know when to fold them and when to hold them in the high-stakes gamble of treating attention-deficit/hyperactivity with drugs.
Virtually everyone agrees not every child diagnosed with the disorder needs to be medicated, but how to pick out the exception has been a matter of fierce debate.
The treatment criteria call for moderate to severe symptoms that both parents and teachers agree disrupt home life and impair school performance. Yet, medication may not suit even a youngster who fits the description to a “T.”
“We have lots of options,” noted Donna Palumbo, associate professor of neurology and pediatrics, director of the Strong Neurology ADHD Program and head of pediatric neuropsychology training at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.
“Some work beautifully for some children but not for others,” said Palumbo, who is leading a four-year, federally funded study of the viability and appropriateness of ADHD diagnosis and treatment in preschoolers. “We don’t know what works for what child ahead of time. There are lots of things to try, including non-medication treatment.”
In a consensus statement, the National Institutes of Health, the nation’s medical research behemoth, noted, “Experts disagree on the best approaches to treating ADHD — medication, behavioral therapy or a combination.”
All sides concur no single treatment is the answer for every child, and much thought, reflection, observation and careful consideration of personal needs and family history should precede a prescription for a course of action.
“You should be skeptical if a doctor or therapist diagnoses ADHD at the first visit and immediately prescribes a drug,” the advocacy group Consumers Union warned in a comprehensive analysis of ADHD drug treatments.
With insurance-coverage restrictions and managed-care limits tightening the constraints on a doctor’s time and reimbursed treasure, critics contend too often it may be too tempting for physicians to reach for that prescription pad prematurely — or exclusively.
Popular fears of an over-reliance on drugs notwithstanding, the medical mainstream stands by its mainstay of pharmaceutical solutions.
Respected professional journals are devoid of evidence that would convict doctors of the massive overmedicating charged by skeptics, these specialists assert. If anything, they see a criminal neglect of youngsters who struggle needlessly when quick and easy help awaits in a capsule.
They say the power of stimulants to produce often dramatic results was established by 1997 when scientists at McMaster University in Canada concluded from an analysis of 92 studies the drugs could change behavior in some 70 percent of their users.
Two years later, what many regard as a watershed survey evaluated the safety and relative effectiveness of the leading ADHD treatments in 579 elementary school children ages 7 to 9 for up to 14 months.
The Multimodal Treatment Study of Children with ADHD, or MTA, funded by the National Institute of Mental Health, indicated pharmaceuticals trump non-drug options for speedily alleviating the core symptoms of hyperactivity, impulsiveness, inattention and aggression. But it acknowledged more than a pill is needed to address such overarching problems as arrested academic achievement, poor social skills or conflict at home or school.
Those challenges appeared better served with a combined approach that supplemented medication with teacher consultations, 27 group and eight individual behavioral training sessions for parents and an eight-week intensive summer program aimed at boosting the child’s social, sports and scholastic skills.
All four treatment strategies — chemicals, talk therapy, both together, and standard care — brought some relief. The difference lay in degree.
Children receiving managed medication and pharmaceuticals paired with psychotherapy made greater strides than the other two groups. Drugs proved superior for squelching standard symptoms. The combined package worked best in broader areas, including anxiety, oppositional disorder, social and parent struggles and classroom failings.
But just as in the race between the tortoise and the hare, the gap began to close during the second-year, a follow-up study found. By then, the groups that had made the greatest headway started to lose steam, and its gains began to dwindle.
With a shortage of even short-term studies comparing all treatment options and with the chronic disorder often persisting for many years, the results underscore the need for a scientifically sound assessment of how long, and how well, the cornucopia of ADHD treatments works, the authors said.
The MTA findings that strictly supervised stimulant use bested community care, which relied on methylphenidate (the main ingredient in Ritalin) in 68 percent of cases but under a less watchful eye, underscore the critical importance of proper monitoring of medicated children, the investigators said.
The authors noted despite “public concerns regarding stimulant treatment, wide variations in treatment practices, and lack of evidence to guide long-term treatments of this chronic disorder,” theirs was the first systemic comparison of options to last longer than four months.
“The MTA is considered the gold standard treatment study for ADHD,” Palumbo said.
Even so, the survey has been nearly as much criticized as cited.
Detractors like psychiatrist Dr. Peter Breggin contend the stimulant-showcasing results were skewed because, among other flaws, the study lacked a comparison group of untreated children, included participants who already had shown a successful response to the drugs, failed to measure adverse effects, which most of the subjects experienced, and lacked a “double-blind” design. Such a setup is considered a key element of rigorous research.
Rather than being kept in the dark to minimize the possibility of biased assessments, parents and teachers knew in advance whether the children they were evaluating were taking the medication that was supposed to help them.
(Editors’ Note: This series on ADHD is based on a review of hundreds of reports and a survey of more than 200 specialists.)
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