It is difficult to ignore a new report released Wednesday by a St. Louis based prescription drug manager, Express Scripts. The data highlights a glaring reality: a near doubling in attention deficit hyperactivity disorder (ADHD) prescriptions from 2008 to 2012. The drug manager analyzed a sample of 400,000 individuals, ages 4 to 64, who filled at least one prescription for an ADHD medication during 2008-2012. The results indicate that the number of American adults receiving prescriptions for ADHD drugs (such as Adderall and Concerta) had risen 53 percent, to an estimated 2.6 million in 2012 from 1.7 million in 2008. Furthermore, within the 26-34 age group, medication use increased almost two fold, from 340,000 to 640,000 during just those four years. Dr. Brooke Molina, associate professor of psychiatry at the University of Pittsburgh School of Medicine, says, It s hard to dismiss the data in this report. There are limitations with every study, but it s hard to do anything here but conclude that we have a continually forward-marching increase.
The results from Express Scripts analysis corroborate a report released by the Center for Disease Control and Prevention last year. Based on a nationwide telephone survey of 76,000 parents, the CDC determined a similar increase in medication use. However, the CDC data was met with skepticism, and regarded as lacking scientific vigor. It is hard to discredit the CDC report if prescriptions fillings support their claims.
The issue at hand, however, goes beyond speculation about over diagnosis and over medication. Lead ADHD epidemiologist at the CDC, Dr. Susan Visser, says these numbers are a warning that it is imperative to better understand the disorder and consider possible alternative treatments. She says, It s difficult to respond to the patterns that we see if the patterns in diagnosis and medication are not taken seriously. We need to look at these patterns as a whole public health need in order to appropriately respond, and not snipe over the prevalence estimates.
She recommends that attention should be directed in particular to the recent rise in abuse and misuse of stimulants, especially among young adults. A federal agency, the Substance Abuse and Mental Health Administration, reported last year that non-medical use of stimulants rose to 22,000 from 2005 to 2010, representing a three-fold increase. In addition, improper prescription of stimulants has impacted high school and college students, who are supposedly exploiting their use to enhance academic performance.
In agreement with Dr. Visser, Dr. Lenard Adler, director of the adult ADHD program at NYU Langone Medical Center, also advocates for careful attention to these clear signs. He suggests, As we move forward, we want to make sure that people who have the disorder get the prescription. And that people who don t have the disorder don t.
ACSH s Dr. Josh Bloom has a somewhat more cynical take on this matter. He says, While it would be easy to pin all of this on drug companies, it is not that simple. Adult ADHD has become a cottage industry. Having it included in the DSM gives it a medical code, so doctors and psychopharmacologists can now be reimbursed by Medicare and insurance companies. And others have simply learned how to game the system. Your 19-year old kid, who may be having some trouble in school can get an ADHD diagnosis from a doctor, and all sorts of things start to happen, like getting extra time on exams. This is not to deny that there are adults who are genuinely affected, but there is no way the number of cases actually doubled in four years.