ADHD medication may be overprescribed in the U.S.

Nearly 5 million privately insured Americans used a medication to treat attention deficit hyperactivity disorder (ADHD) in 2012, a 35% increase from 2008, according to an analysis from Express Scripts released this month. ADHD diagnoses and drug treatment are at “questionable levels” in the U.S., the authors suggested, further noting that the disease may have become a “go-to diagnosis” that masks other problems, like mood or anxiety disorders.

Spending on ADHD medications rose 14.2% in 2012, which the report says is the greatest increase seen among any traditional drug category. Although children remain the primary users of ADHD medications, the authors were surprised to see that the number of adults using ADHD drugs also had increased dramatically, from rising 18.9% in 2008 to a 53.4% jump in 2012. Approximately two-thirds of adults were prescribed ADHD medications by a primary-care physician, rather than a specialist.

“That was a bit of an eye-opener,” said study co-author, Dr. David J. Muzina, vice president of specialist practice at Express Scripts. For patients with ADHD, getting the right medication at the right time is a life changer, he says, but these latest results suggest more than merely improvements in recognizing the condition.

“Given the trajectory of these numbers and the promotion of these medications, it's hard to imagine there is not some element of overdiagnosis,” he said.

Study findings also pointed out gender differences in the drugs' use. Male teens between ages 12 and 18 were the most prevalent users of ADHD medications, with 9.3% taking a prescription for one of the medications. However, the number of ADHD prescriptions decreased for males after age 18, and that's when the rates started to increase for females. The prevalence of women ages 26 to 34 taking an ADHD drug rose 85.1% between 2008 and 2012, surpassing the number of women under 18.

Boys often display the more impulsive and aggressive symptoms of the condition and are therefore treated earlier in their lives, Muzina suggests, while symptoms may become more apparent in women as they age.

The findings were drawn from an analysis of pharmacy claims of more than 400,000 individuals ages 4 to 60, who had at least one prescription for an ADHD medication filled during the five-year study period.

Many existing guidelines recommend behavioral therapies as the first step in dealing with ADHD, especially in younger children, using interventions to help them learn to manage, cope and function better. For example, the American Academy of Pediatrics recommends “evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment” in its ADHD guidelines, and the Seattle-based non-profit GroupHealth recommends that medication be considered as only one component of a comprehensive treatment program that also addresses other behavioral or psychological needs in adults.

However, the new report says medication therapy is often the first chosen treatment.

“If there is a pill that can provide a quick fix, one might be easily convinced that is what they need to do,” Muzina said. The “try and see” approach, in which a physician will prescribe an ADHD drug to see if there are any improvements, is not a good litmus test for ADHD, he says. These stimulant drugs often produce heightened energy, euphoria or other short-term boosts, but there are long term-side effects associated with use of the medications.

“If you believe a patient may have ADHD, then the proper next step is to either dive deeper and do a diagnostic assessment yourself,” he recommends, “or refer that person to a specialist.”

Follow Sabriya Rice on Twitter: @MHSrice