An advocate who once pushed for greater awareness about the problems associated with attention deficit hyperactivity disorder (ADHD) now says that drug companies have gone too far in promoting their products, resulting in far too many children being diagnosed with the disorder and prescribed powerful, sometimes harmful medications.
Dr. Keith Conners, a psychologist and professor emeritus at Duke University, suggested in a recent New York Times and NBC News article that 15% of all high school-age children in the United States have been diagnosed with ADHD. He called the situation preposterous, indicating that it was a creation of the drug industry that has led to the overuse and even abuse of drugs like Adderal, Ritalin, Daytana and others.
Experts estimate that the actual number of children with ADHD is probably about 5%. However, Conner and others say that the inflated diagnoses and prescriptions come after a 20 year effort by the pharmaceutical industry to cash in on concerned parents who hope poor grades and typical childhood behavior can be cured by drugs.
According to the report, at some point since 2000, the FDA has cited every major ADHD drug for false and misleading advertising. While some companies have paid doctors to argue against concerns of over diagnosis, some have gone straight to children with comic books encouraging them to take medication to address ADHD.
Those efforts led to $9 billion in sales for the ADHD drug industry in 2012, and 3.5 million children using ADHD medications.
Some say it has also led to problems with abuse. An August report by the Drug Abuse Warning Network (DAWN) indicated that the number of emergency room visits involving patients ages 18 to 34 taking ADHD drugs known as central nervous system (CNS) stimulants rose from 5,605 in 2005 to nearly 23,000 in 2011. Adults who were not diagnosed with ADHD as children but are now being diagnosed as adults is another fast growing segment of the ADHD drug market, according to the article.
Nearly 30% of the emergency room visits involved both stimulants and alcohol. More than half of the stimulant drugs were received without a prescription, at no charge from a friend or relative and 17% were bought from friends and family.
Non-medical use of stimulants has been linked to blood vessel problems, drug abuse and drug dependence. CNS stimulants often hide the effects of being drunk, when paired with alcohol, increasing the risk of alcohol poisoning or other alcohol-related injuries.
The demand for such drugs is so high that in May 2012 the FDA warned that counterfeit Adderall pills were being sold on the internet, as Teva Pharmaceuticals struggled to meet demand for the pills.
ADHD Drug Side Effects
The concerns come among increasing evidence that overuse of ADHD drugs may have negative consequences and that some of the side effects of ADHD drugs are not fully known.
On December 17, the FDA warned that the active ingredient methylphenidate could cause long-lasting and painful erections; a condition known as priaprism. The drug is the active ingredient in Ritalin and the Daytrana patch.
A 2009 report revealed Ritalin and other ADHD medications may be linked to fatal heart problems in children. The study found ADHD drugs increased a child’s risk of sudden death due to heart problems, such as sudden cardiac events. The FDA warned parents of the possible side effects of these medications, but still cautioned them not to stop taking the drugs.
A more recent study published in the journal Pediatrics in 2011 took an in depth look at the effects of many ADHD drugs. The researchers found there was no heightened risk of sudden death in children. A followup study funded by the FDA concurred with the findings of the 2011 study, showing children taking ADHD drugs did not suffer heart attacks, strokes or sudden death at higher rates than children not taking the drugs.
In a report released at the beginning of 2013, the Institute for Safe Medication Practices (ISMP) warned that more than 1,000 cases of problems with the Daytrana patch were reported in just the second quarter of 2012. The patch is used to treat ADHD symptoms, and while it only accounts for 3% of ADHD sales, it received 99% of the complaints during that time. Complaints included children suffering erythema, irritation, rashes, pruritus, burns, erosions, swelling vesicles, urticaria, and involuntary muscle movements. At least one case resulted in severe injury and hospitalization.
The cases of involuntary movements were of particular concern, as in clinical trials there was at least one case where the child’s involuntary movements never resolved. The involuntary movements, often referred to as tardive dyskinesia, are a common complaint among some stimulants, but the ISMP report notes that health experts at the FDA are concerned that Daytrana tardive dyskinesia symptoms seem to appear more often than with other ADHD drugs.
ISMP recommended the FDA issue a Daytrana recall, but that has not occurred.