Canada’s growing adult ADHD epidemic
Psychiatrist says growing numbers of healthy people taking ‘prescription speed’
A fast-rising number of Canadian adults are being diagnosed with ADHD, and being prescribed speed-like stimulants, but experts suggest many are taking the drugs for a mental edge, not because they have a true brain disorder.
Adults now account for more than a third of all ADHD-medication prescriptions, and their share of the $408-million Canadian market is increasing quickly, according to Shire, maker of the ADHD drug Vyvanse.
In an article published this month in the Canadian Journal of Psychiatry, McGill University psychiatrist Dr. Joel Paris says the diagnostic criteria for adult ADHD are so broad they could easily describe anyone who has trouble focusing.
He and others worry the drugs are being used by growing numbers of healthy people as pharmacological brain “enhancers” in today’s hyper-competitive corporate culture.
“Society increasingly demands a high level of performance on tasks that require sustained attention and multi-tasking,” Paris and his co-authors write.
Those social forces can motivate people to seek stimulant prescriptions, he said. And a prescription requires a diagnosis of ADHD.
“A rapidly increasing frequency of a once-rare condition may reflect increased recognition,” Paris writes, “but may also constitute a diagnostic epidemic.”
Dr. Allen Frances, a professor emeritus at Duke University, said the upswing in stimulant prescriptions for adults is a result of aggressive marketing to doctors and the public.
“Pharma has already created a wild and dangerous epidemic of prescription narcotics,” Frances said. “Next on its agenda is pushing the sale of prescription speed.”
“If we want to allow people to take speed for performance enhancement, or make it legal for recreational purposes, there should be a discussion of that,” said Frances, author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma and the Medicalization of Ordinary Life.
“We shouldn’t be sneaking in the legalization of speed for a fake diagnosis of ADHD in adults. It’s medicalizing what should be a societal debate about the role of these medicines in society.”
Paris is more worried people are being misdiagnosed with ADHD when other issues, such as anxiety, depression or substance abuse may be at play.
“It’s what I call a psychiatric fad, in which you have a medication which is known to work for certain people and you say, ‘let’s try it here, let’s try it there,’” Paris said in an interview.
“And some of these patients do have a little bit more focus after you give them stimulants, because everybody is somewhat better focused if they get a stimulant.
“But when people report this back to their doctor, this is seen as, ‘I knew it was ADHD, and I’m right.’”
Children still surpass adults as the main users of ADHD drugs (64 per cent versus 36 per cent), according to Shire. In 2014, the adult ADHD market grew by 17 per cent, versus 10 per cent for children. In all, more than 4.5 million prescriptions were filled by Canadian drugstores in 2014, according to market research firm IMS Brogan.
Paris said ADHD is a neurodevelopmental disorder rooted in childhood. According to the official diagnostic criteria, an adult can’t have ADHD if he or she did not have it as a child.
“I do a lot of consultations for family doctors, a couple of hundred a year,” he said. “And some patients are coming in having received this diagnosis and stimulants without sufficient data to support it.
“They complain of various things — I can’t focus or I can’t multi-task, I can’t get things done, I’m disorganized,” he said. But they have no history of ever having been in trouble at school, or being sent to the principal’s office or pulled out of class.
High doses of stimulants can cause high blood pressure and arrhythmias, or erratic heartbeat in people with underlying structural changes in their heart. Health Canada recently strengthened warnings that an array of ADHD drugs can increase the risk of suicidal thoughts.
Stimulants can also make mental disorders worse.
“You don’t want to take speed — and this is essentially speed — if you’re schizophrenic or have bipolar disorder, anxiety disorder, sleep problems or a whole host of other psychiatric conditions,” said Frances, who chaired the task force that produced the fourth version of the Diagnostic and Statistical Manual of Mental Disorders used the world over to diagnose mental illness.
An expert in ADHD, Dr. Anthony Rostain, professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, said stimulants are clearly being misused.
“There is no question that there are forces at work to push people to increase productivity,” Rostain said. “Sometimes it’s very conscious-like: ‘I’m just going to go in (to see a doctor) and say I have it when I don’t.’ That would be a form of malingering; it’s feigning ADHD.”
But Rostain said there is no evidence of an “epidemic” of over-diagnosis, and the rate of adult ADHD is increasing largely because it’s a relatively recently recognized phenomenon.
ADHD looks different in adults, Rostain said. “Fidgety and squirmy may be things we notice in children, but in adults it may be more restlessness and an inability to get things done and constantly being late or disorganized.”
Some adults were never treated for ADHD in childhood. Rostain said that, as books like Driven to Distraction were published and as more parents were getting their children diagnosed, “the doctor would say, ‘ Do you have any of these symptoms, did you have them as a child?’ And the parents would say, ‘ Oh my god, yes I did. In fact, I was just like my son.’ And a certain number of them would say, ‘ By the way, I still am.’”
“Pharma has already created a wild andd angerous epidemic of prescription narcotics. Next on its agenda is pushing the sale of prescription speed.
DR. ALLEN FRANCES PROFESSOR EMERITUS AT DUKE UNIVERSITY