While the nation’s attention has been focused on the role of prescription painkillers in our current, tragic opioid epidemic, another class of overprescribed drugs — those used to treat attention deficit hyperactivity disorder (ADHD) in adults — is also causing “a trail of misuse, addiction and death,” according to a new investigative report published jointly Saturday in the Milwaukee Journal Sentinel and MedPage Today.
As reporters John Fauber, Matthew Wynn and Kristina Fiore point out, ADHD was rarely diagnosed in adults two decades ago. Today, however, it is part of mainstream medicine, “fueled by relaxed standards for diagnosis and a push from drug companies, one of which helped fund a study that claimed 1 in 23 adult Americans are affected by it. That represents about 10 million people.”
And as the number of people diagnosed with the condition has risen, so have reports of medical complications from the drugs — mostly stimulants like Adderall, Ritalin and Vyvanse — used to treat it.
More than 19,000 incidents of ADHD-drug-related complications have been reported to the Food and Drug Administration (FDA) since 2013, but the actual number is probably much higher, due to limitations in how such events get reported, say Fauber, Wynn and Fiore.
They also point out that although two-thirds of those reported complications involved children, adults accounted for half of the hospitalizations and 85 percent of the deaths.
Indeed, hospital emergency departments saw a quadrupling of cases related to ADHD drugs in just seven years, from 2008 to 2014.
“And at morgues in Florida, a bellwether state for drug abuse problems, overdose deaths involving amphetamines increased more than 450% between 2008 and 2014,” Fauber and his colleagues write.
Here are examples of the reports that have been received by the FDA:
A 41-year-old woman was hospitalized with kidney failure after abusing methylphenidate, better known as the stimulant in the ADHD drug Ritalin.
A man on heart medications also was on two ADHD drugs, which can increase heart problems. He had a fatal heart attack at age 41.
A 33-year-old man on the ADHD drug Vyvanse was hospitalized after suffering a panic attack, an increased heart rate, chest pain and dizziness.
A familiar path
The number of recreational users of Adderall, an amphetamine, jumped fourfold in less than a decade, from 345,000 people in 2006 to 1.4 million in 2014 (the year with the latest available federal data), Fauber, Wynn and Fiore report.
College students — particularly those at private and “elite” schools — often take it (and other stimulant drugs) to help them concentrate and study, for example.
Yet ADHD drugs can become addictive, a factor of huge concern to health officials, as it can cause patients to seek out illicit drugs to meet their increased need for the “up” feeling provided by the stimulants.
“While opioids are more lethal than prescription stimulants, some experts see parallels between the opioid epidemic and the increase of problems tied to stimulants,” write Fauber, Wynn and Fiore. “In the opioid epidemic, users switched from prescription narcotics to heroin and illicit fentanyl. With the ADHD drugs, patients … have switched from legally prescribed stimulants to illicit ones, such as methamphetamine and cocaine.”
People with an addiction can “doctor shop” for ADHD drugs, just as others do for prescription painkillers. As Fauber and his colleagues point out, it’s easy to persuade a doctor that you have ADHD because the symptoms — such as an inability to focus on tasks, fidgeting or interrupting others — are so vague.
A 2011 study led by Paul Marshall, a clinical neuropsychologist based in Minneapolis, found that almost 1 in 4 adults with ADHD are exaggerating their symptoms.
Not all those people, however, are faking their symptoms to get access to stimulant drugs, as Marshall told a reporter for MSNBC News when the study was published.
“A lot of people think they have [ADHD] because they are struggling, but it’s not because of ADHD,” he said. “Often times, it’s simply depression, anxiety or lack of sleep.”
A controversial definition
In 2013, the American Psychiatric Association relaxed the definition of adult ADHD, an action that greatly expanded the number of people who could be diagnosed with the condition.
“Under the new definition, adults need to have five of a possible nine symptoms from either of two categories, down from six of a possible nine, and the symptoms must have been present before age 12, instead of the previous age 7,” write Fauber and his colleagues.
That new definition — and how it came about — has been highly controversial.
“Of the experts on the panel that approved the changes, 78% had financial ties to drug companies, according to a 2012 analysis by the journal PLoS Medicine,” Fauber and his colleagues point out.
The APA has minimized those conflicts of interest. A spokesperson told the Journal Sentinel/MedPage Today reporters that the conflicts were insignificant because none of the panel members received more than $10,000 annually from drug companies. He also insisted that the new, broader definition of adult ADHD describes a real condition, one that affects many people.
But, as Fauber and his colleagues point out, “that belief was undermined last year, when researchers published the results of a long-term study that began in the early 1970s and followed more than 1,000 New Zealand children until age 38. The study found little overlap between those who had ADHD as children and those who were diagnosed as adults.”
FMI: There’s many more disturbing details in the article (including the finding from a 2013 study that the presence of amphetamines collected from wastewater samples near college dormitories in Tacoma, Washington, was “eight times higher during final exams week than the first week of classes”). You can read the article at both the Journal Sentinel and the MedPage Today websites.