Monday, December 16th, 2013
The rising number of diagnoses with attention deficit hyperactivity disorder (ADHD), particularly among kids, has been paired, logically, with a sharp rise in the number of prescription drugs distributed to treat the condition. But some medical experts, even longtime advocates for better diagnostic tools and more aggressive treatment, are questioning whether drug companies have played fair with their marketing tactics. More from NBC News:
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.
Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.
But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.
Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.
A 2002 ad for Adderall showed a mother playing with her son and saying, “Thanks for taking out the garbage.”
The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.
Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often that discredit growing concerns about overdiagnosis.
Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction. Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.
Image: Prescription pills, via Shutterstock
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Friday, May 31st, 2013
Stimulant medications that are prescribed for attention deficit hyperactivity disorder (ADHD) are not predictors of later drug abuse by children, a new report based on more than 20 years of previous research has found. The news will come as a relief to parents who might have concerns about their pediatricians’ ADHD treatment plan. The New York Times has more:
The paper, written by three researchers at the University of California, Los Angeles, examined data from 15 previous studies on the subject and determined that, on average, medications like Adderall and Ritalin had no effect one way or the other on whether children abused alcohol, marijuana, nicotine or cocaine later in life.
A 2003 study in the journal Pediatrics had concluded that the introduction of stimulant medication to children with A.D.H.D. reduced the risk of such abuse later in life, a finding that has been repeated by doctors and pharmaceutical companies not only to assuage parents’ fears of medication but also to suggest that the pills would protect their children from later harm.
“I always doubted the whole ‘protection’ argument, and I wasn’t the only one, but that message was really out there,” said Liz Jorgensen, an adolescent addiction specialist at Insight Counseling in Ridgefield, Conn. “Hopefully, this message will be heard loud and clear.”
The study comes amid growing concern about the persistent rise in A.D.H.D. diagnoses and prescriptions for medication among children. A recent New York Times analysis of data collected by the Centers for Disease Control and Prevention found that 11 percent of all children ages 4 through 17 — 6.4 million over all — had received a diagnosis of A.D.H.D. from a medical professional. The diagnosis rate rose to 19 percent for boys of high school age.
Stimulant medication is by far the most prevalent treatment for childhood A.D.H.D., with the vast majority of children at least trying medication and about 60 percent of them staying on it long term. Stimulants can drastically improve the lives of children with severe A.D.H.D. but are also increasingly abused by high school and college students for their jolts of focus toward schoolwork.
Side effects can include appetite and growth suppression, sleep disturbance and occasionally psychosis, especially when the stimulants are abused.
The paper released Wednesday in the journal JAMA Psychiatry analyzed data from studies conducted from 1980 to 2012, and included more than 2,500 children with A.D.H.D. from the United States, Canada and Germany. They were followed from an average age of 8 into young adulthood.
Image: Prescription medications, via Shutterstock
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Wednesday, May 22nd, 2013
A boy who is diagnosed during childhood with attention deficit hyperactivity disorder (ADHD) has a greater risk of developing obesity as an adult, twice the risk of a child without ADHD, according to a new study published in the journal Pediatrics. The findings are, at first glance, counter-intuitive because children with ADHD are known for being active–overly so. But the study identifies a number of factors that contribute to the elevated obesity risk. More from NBC News:
These findings, published in Pediatrics, may be surprising to parents because drugs such as Ritalin or Adderall used to treat ADHD can suppress appetite, said Dr. F. Xavier Castellanos, the study co-author and a professor of child and adolescent psychiatry at New York University.
“It’s not uncommon for kids treated with ADHD medications to be fairly thin,” Castellanos said. Because parents often worry that thinner boys won’t grow as tall, “sometimes [they] will encourage their boys to eat more.”
Instead, to help avert weight problems down the road, parents should be alert to poor eating habits. “If anything, you have to pay attention to how many times they’re having fast food, how many times they’re having fried food, whether they’re getting meals supersized,” Castellanos said.
The study comes at a time when ADHD rates are rising. A new report from the Centers for Disease Control and Prevention found that ADHD is the most common mental health issue in children ages 3-17, with nearly 7 percent of kids receiving a diagnosis.
The NYU researchers followed 222 boys — 111 with ADHD and 111 without, for an average of 33 years — hoping to better understand the disorder’s effects on the brain. The boys with ADHD, all from middle-class, white families, were diagnosed between the ages of 6 and 12.
Decades later, when some of the men returned for brain scans, many of the now 40-something adults who had ADHD as children had gained so much weight they barely fit into the fMRI machine, Castellanos said.
Image: Boy eating, via Shutterstock
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Thursday, May 31st, 2012
The U.S. Food & Drug Administration has announced that counterfeit versions of the 30 milligram dose of the drug Adderall, which is commonly used to treat attention deficit hyperactivity disorder (ADHD) in children, are in circulation. The counterfeit medications might be tempting to some because of a months-old shortage of Adderall and other drugs. But the counterfeit drugs, which are being sold on the Internet, are incorrectly made and could be dangerous to children. The Boston Globe reports:
According to the FDA, the counterfeit version being sold on the Internet contains the wrong active ingredients — containing tramadol, a narcotic-like painkiller, and acetaminophen (Tylenol). Tramadol isn’t a controlled substance and may be easier to obtain for fraudulent purposes than the active ingredients in Adderall, which are all forms of amphetamine stimulants.
“Consumers should be extra cautious when buying their medicines from online sources,” said the FDA in a media statement. “Rogue websites and distributors may especially target medicines in short supply for counterfeiting.”
Counterfeit Adderall tablets, which are white, look strikingly different from the real version, which is orange/peach in color and manufactured by Teva Pharmaceuticals. Real Adderall, in a 30-milligram dose, is imprinted with a “dp” on one side and “30” on the other side of the tablet.
Photos of the counterfeit version and the real drug can be found posted by the FDA on flickr. The agency added that the Adderall 30-mg. product may be counterfeit if:
– The product comes in a blister package.
– There are misspellings on the package such as “NDS” instead of “NDC”; “Aspartrte” instead of “Aspartate”; Singel” instead of “Single”
– The tablets are white in color, round in shape, and are smooth.
– The tablets have no markings on them.
Consumers who suspect they’ve purchased the fraudulent Adderall should file a report online at the FDA’s MedWatch site or call 1-800-332-1088 to request a reporting form.
Image: Prescription bottle, via Shutterstock.
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Tuesday, January 10th, 2012
Medications commonly used to treat attention deficit hyperactivity disorder are in short supply because tight regulations by the US Drug Enforcement Agency are limiting the manufacture of the drugs, The Boston Globe reports. Parents whose children are on medications including Ritalin, Adderall, and their generic equivalents are more and more often having to jump through logistical hoops to get their kids’ prescriptions filled.
From the Globe:
Often, parents must come back to his office after an appointment to request a new prescription for a different dose pill, replacing a 30 milligram pill, for example, with three 10 milligram pills to be taken in the morning, since pharmacies aren’t allowed to make these replacements on their own to handle shortages.
The drug that seems to be in the shortest supply? Adderall XR (extended release), said [Children's Hospital Boston's psychopharmacology director Dr. Joseph] Gonzalez-Heydrich, which is made by Shire and lost its patent two years ago. (The drug appears on this FDA list of drug shortages.)
Shire has instead been promoting and steadily producing its newer and more expensive drug Vyvanse — which is in plentiful supply and works similarly to Adderall XR; the DEA allows manufacturers to decide how they will divvy up their restricted production among expensive brand names and lower-priced generics.
“I’ve switched a lot of my patients to Vyvanse since it’s more in stock and has a similar action,” said Gonzalez-Heydrich. But many are forced to pay more for the prescription as a result.
Gonzalez-Heydrich offered advice to parents who are struggling with this issue:
Those expecting to get a new prescription for their recently diagnosed child should be aware of the shortage and ask the doctor to call their local pharmacy to see what’s in stock before walking out with a script.
Those bringing their child in for a prescription refill should call their pharmacy before their child’s appointment — even in the doctor’s waiting room — to find out whether the store has their child’s prescription in stock and, if so, in what dosage.
“If they have the drug in stock, ask if the pharmacy can set aside some pills for a prescription that’s about to be filled,” if their stock is running low, advised Gonzalez-Heydrich. Doctors can’t call in prescriptions, so pharmacies can sometimes run out during the time it takes to bring the script in to be filled.
Parents may also want to call around to other pharmacies to see what they have in stock, also before the doctor’s appointment. That way, said Gonzalez-Heydrich, doctors can tailor the dose and number of pills based on what’s in stock.
Image: Prescription medication, via Shutterstock.
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