Trends in Office-Based Treatment of Adults With Stimulants in the United States
New York State Psychiatric Institute. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY . The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
01/2013; 74(1):43-50. DOI: 10.4088/JCP.12m07975
The authors investigated trends and patterns in stimulant treatment of adults visiting office-based medical practices in the United States.
A time series analysis of data from the 1994 to 2009 National Ambulatory Medical Care Surveys (no. of visits = 372,702) was performed, focusing on adult (aged ≥ 18 years) visits in which stimulant medications (amphetamine salts, methylphenidate, or pemoline) were prescribed. The authors computed trends in the percentage of visits in which a stimulant was prescribed stratified by background and clinical patient characteristics. Results are reported as odds ratios (ORs) over the 1994 to 2009 period. The authors also compare visits to psychiatrists and nonpsychiatrist physicians that yielded a stimulant prescription to an adult.
The percentage of visits in which stimulants were prescribed increased from 0.11% (1994-1997) to 0.70% (2006-2009) (OR = 13.72, 95% confidence interval [CI], 9.40-20.03). Among adults aged 18 to 29 years, the corresponding increase in stimulant visits was from 0.17% to 1.83% (OR = 30.14, 95% CI, 15.84-57.36). Stimulant prescriptions increased significantly more rapidly among visits without a clinical ADHD diagnosis (OR = 11.86, 95% CI, 7.49-18.80) than among visits with such a diagnosis (OR = 5.45, 95% CI, 2.96-10.04) (interaction P = .04) and among visits to nonpsychiatrist physicians (OR = 21.54, 95% CI, 12.84-36.12) than psychiatrists (OR = 10.64, 95% CI, 6.72-16.86) (interaction P = .03). By 2006-2009, nonpsychiatrist physicians provided most (57.7%) of the stimulant prescriptions linked to adult office-based visits. As compared with psychiatrists, nonpsychiatrist physicians diagnosed ADHD in a significantly smaller proportion of their adult visits in which stimulants were prescribed (62.5% vs 34.4%, P < .0001).
Between 1994 and 2009, there was a substantial increase in stimulant prescriptions during adult outpatient visits, especially during visits of younger adults. The increase in stimulant treatment occurred significantly more rapidly in the practices of nonpsychiatrist physicians than in those of psychiatrists.
Available from: Sherry Ferguson
- "A recent drug utilization analysis indicated that ADHD drug treatments increased more than 85% in women 26–34 years of age (Express Scripts Holding Company, 2014). Further evidence confirms an increase in stimulant prescriptions for young adults, and treatment rates have increased more rapidly for women than for men, raising concerns that females of reproductive age may be exposed during pregnancy (Van Brunt et al., 2006; Castle et al., 2007; Olfson et al., 2013; Zetterqvist et al., 2013). Indeed, a Danish register-based study indicated a substantial increase in the number of pregnancies that were exposed to ADHD medications between 2003 and 2010 (Haervig et al., 2014). "
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ABSTRACT: Methylphenidate (MPH) is a common treatment for adult Attention Deficit Hyperactivity Disorder (ADHD). However, little information exists regarding its safety during pregnancy and thus, women with ADHD face difficult decisions regarding continued use during pregnancy. Thus, Sprague-Dawley rats were orally treated 3x/day with 0 (control), 6 (low), 18 (mid), or 42 (high) mg MPH/kg/day (i.e., 0, 2, 6, or 14 mg/kg at each treatment time) on gestational days 6-21. All offspring/litter were orally treated with the same dose their dam had received on postnatal days (PNDs) 1-21. After weaning, offspring were assessed for adolescent play behavior, locomotor activity, motor coordination, Barnes maze performance, acoustic startle response, novel object recognition, residential running wheel activity, flavored solution intake, home cage behavior, water maze performance, elevated plus maze behavior, locomotor response to an MPH challenge, and passive avoidance. At euthanasia, whole brain and striatal weights as well as serum hormone levels were measured. Body weights of the high MPH group were reduced in both sexes. Males of the high MPH group were less active than control males in open field assessments on PNDs 40-42. Latency to maximum acoustic startle was significantly altered in females of the medium and high MPH groups and residential running wheel activity of females of the low and medium MPH groups was lower than control females. Open arm entries in the elevated plus maze were increased in subjects of the medium MPH group. Females of the low MPH group were less sensitive to the locomotor-increasing effects of an acute 5 mg/kg MPH challenge. Serum hormone levels and whole brain and striatal weights were not altered by prior MPH treatment. These results indicate that MPH treatment during development has sporadic effects on postweaning behaviors and those effects were generally exhibited by females.
Published by Elsevier Inc.
Available from: Chelsea Jin
- "Prescription drugs such as opioid analgesics, sedatives, tranquilizers and stimulants are essential medications for the treatment of pain, insomnia, anxiety, attention-deficit hyperactivity disorder (ADHD), and other psychiatric disorders (Olfson et al., 2013a,b; Resnik and Rehm, 2001). However, management of these medications is complicated by their liability to lead to abuse or dependence (Blanco et al., 2007; Compton and Volkow, 2006; Martins et al., 2012). "
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ABSTRACT: Despite growing concerns about non-medical prescription drug use and prescription drug use disorders, whether vulnerability for these conditions is drug-specific or occurs through a shared liability and common risk factors is unknown.
Exploratory and confirmatory factor analysis of Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the latent structure of non-medical prescription drug use and prescription drug use disorders. Multiple Indicators Multiple Causes (MIMIC) analysis was used to examine whether the effect of sociodemographic and psychiatric covariates occurred through the latent factor, directly on each drug class or both.
A one-factor model described well the structure of both non-medical prescription drug use and prescription drug use disorders. Younger age, being White, having more intense pain or one of several psychiatric disorders increased the risk of non-medical prescription drug use through the latent factor. The same covariates, except for anxiety disorders also significantly increased the risk of prescription drug use disorders through the latent factor. Older age directly increased the risk of non-medical use of sedatives, and alcohol use disorders decreased the risk of non-medical tranquilizer use. No covariates had direct effects on the risk of any prescription drug use disorders beyond their effect through the latent factor.
The risk for non-medical prescription drug use and prescription drug use disorders occurs through a shared liability. Treatment, prevention and policy approaches directed at these drugs as a group maybe more effective than those focused on individual classes of drugs.
Available from: PubMed Central
- "Nearly 14 million monthly prescriptions for ADHD were written for Americans ages 20–39 in 2011, two and a half times the 5.6 million just 4 years before (Schwarz, 2013). In fact, between 1994 and 2009, a substantial increase in stimulant prescriptions occurred even without a clinical diagnosis of ADHD, or any other disorder (Olfson et al., 2013). Numerous surveys of college populations have reported an increase in stimulant prescriptions and a corresponding escalation of illicit use (Wilens et al., 2008; Advokat, 2010; Advokat and Vinci, 2012; Varga, 2012), with lifetime rates of diversion ranging from 5–29% (Wilens et al., 2008; Smith and Farah, 2011), although accurate data are difficult to obtain (Ragan et al., 2013). "
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ABSTRACT: Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as "cognitive enhancers."Such concern appears misplaced in the face of substantial evidence that stimulant drugs do not improve the academic performance of ADHD-diagnosed students. Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve "attention," produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote "risky behavior" and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the "real world," despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.
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