Attention Grabber: ADHD Prescriptions Soar

Kathleen Louden

March 14, 2014

The percentage of US adults receiving prescription medications to treat attention-deficit/hyperactivity disorder (ADHD) rose 53.4% from 2008 to 2012 during the 5-year study period, new data from a large, privately insured population shows.

Women aged 26 to 34 years accounted for the greatest surge in use — an 85% increase during the study period. Although children remain the primary users of ADHD medications, the large growth in the number of prescriptions for adults reflects a better understanding of this disorder, said David Muzina, MD, a psychiatrist and vice president of specialist practice for Express Scripts, the St. Louis, Missouri–based pharmacy benefit manager that conducted the research.

"We know now that ADHD is not just a childhood condition but can continue to impact behavior in adults," Dr. Muzina wrote in a report of the study findings, published online March 12.

"One unexpected development that has resulted from recognition of adult ADHD is that women have been receiving treatment to a greater extent than men," he added.

This trend reverses that seen in childhood, when boys outnumber girls in their use of ADHD drugs by more than 2:1.

Dr. Muzina suggested several possible reasons why women use these medications more often than men. His explanations include frequent delays in diagnosis of attention deficits until girls reach adulthood, greater compliance compared with men in continuing ADHD medications first prescribed during childhood, and more off-label or inappropriate uses of stimulants, such as to reduce appetite.

He also said that women "may turn to these medications, or experience symptoms of attention disorders, as a result of keeping up with the multiple demands on their time."

The analysis examined the deidentified pharmacy claims of more than 400,000 privately insured individuals younger than 65 years who filled at least 1 prescription for a medication indicated for treatment of ADHD during the study period. Investigators identified prevalence and trends in utilization and costs of ADHD drugs by age, sex, and geography, as well as the use of concurrent treatments.

Overdiagnosing, Overmedicating?

Joseph Austerman, DO, head of the Section of Child and Adolescent Psychiatry at Cleveland Clinic Children's Hospital, in Ohio, wrote in the report that "there is no doubt that there are adults who require ADHD medication to succeed in both their professional and private lives.

"However, the fact that there's been a substantial spike in medicating adults for ADHD does raise the same questions we've asked about appropriate use of these treatments in children: are we now over-diagnosing and overmedicating in the adult population?"

Other key study findings include the following:

  • Primary care physicians prescribe most of the ADHD medications, rather than specialists (for about 66% of adults and more than 75% of children).

  • Doctors in the South were most likely to prescribe ADHD medications, with a prevalence in use of 3.5%, whereas the western United States demonstrated the lowest use, at 2.2%.

  • Spending on ADHD drug prescriptions increased by more than 14% from 2008.

  • There is a higher rate of antipsychotic use among patients receiving ADHD medicines than those not receiving treatment of ADHD (9.9% vs 1.5%, respectively). However, among users of ADHD drugs, concomitant antipsychotic use has decreased across all age groups since 2009.

  • More than 4.8 million Americans used an ADHD medication, according to Express Scripts' extrapolation of its prevalence figures against US census data for privately insured Americans in 2012.

Dr. Muzina is an employee of Express Scripts. Dr. Austerman has no affiliation with Express Scripts and received no compensation for providing commentary for the report, according to the company.

Express Scripts, Turning Attention to ADHD. Published online March 12, 2014. Full text

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