Physicians' perceptions and knowledge of diversion of stimulant medications for Attention Deficit Hyperactivity Disorder (ADHD) as well as practices physicians use to prevent diversion among their patients prescribed these medications were examined in two recent studies by investigators at the Cohen Children's Medical Center of New York.
The results showed that while almost half of all physicians surveyed believe diversion is common among teens with ADHD, the majority never received training on the topic. Furthermore, about one-third of physicians rarely counsel teens about the health and legal consequences of diverting stimulating medication and don't feel qualified to do so.
"Diversion of stimulation medications for ADHD by high school and college students is widespread as those with ADHD are often sharing pills with their peers, who don't have the condition, to try to improve their academic performance," said Andrew Adesman, MD, senior investigator and chief of developmental behavioral pediatrics at Cohen Children's Medical Center of New York. "Many pediatric colleagues don't feel adequate in counseling their ADHD patients about diverting stimulant medications or are unfamiliar with some of the legal and health consequences of non-ADHD patients taking an unprescribed controlled substance."
The survey analyzed responses from 815 physicians who specialize in ADHD - child neurologists, child psychiatrists and developmental pediatricians. In the past 12 months, 59 percent of physicians suspected some of their teen ADHD patients were diverting their medications and 54 percent believed some patients were exaggerating symptoms to obtain stimulation medications to divert. When evaluating teens for an initial diagnosis of ADHD, 66 percent of doctors suspected that some patients were trying to obtain stimulant medication to improve academic performance. Surveyed doctors also believed patients wanted the medication to either lose weight (40 percent), get high (38 percent) or divert their stimulant medication to others (39 percent). The study also showed that the majority of physicians received no training on prevention of prescription drug diversion in medical school (73 percent), residency (57 percent) or fellowship (51 percent).
When physicians were asked if there is a difference in the legal consequence of selling vs. giving away stimulant medication, 19 percent chose the wrong answer and 36 percent were unsure. Dr. Adesman said that "in the eyes of the law, there is no difference between someone giving away a pill or selling one; they are both prosecuted as unlawful distribution of a controlled substance." As far as health risks, he also noted that, "A patient taking an ADHD medication has been titrated up to a certain dose over time. If someone else takes another person's dose it can be risky because there is no health history and medication naiveté can lead to potential risks, especially if there is an underlying heart condition. "While many prevention strategies can be used to prevent diversion of stimulant medication- informational brochures, a medication contract, pill counts, limiting pill quantities, counseling and other methods, our research showed that while doctors are encouraged to use many of these strategies, most MDs don't believe the strategies to be effective," Dr. Adesman said. "It is important that physicians treating patients with ADHD are continually educated about stimulant diversion problems and become active in mitigating this from happening."