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Rising misuse of Ritalin

RISK: Dr Adrian Dunlop, area director and addiction medicine Senior Staff Specialist with Hunter New England Local Health District. Picture: Max Mason-HubersNEWCASTLE-based drug and alcohol expert Dr Adrian Dunlop has warned against the overdiagnosis of attention deficit hyperactivity disorder (ADHD) in children, and the over-prescription of psychostimulants such as Ritalin to treat it.
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In an articlein the Medical Journal of Australia, Dr Dunlop says rising rates of psychostimulant prescription highlightthe possibility of over-prescription and overdiagnosis,with the implication that disorders of children in particular are being “medicalised”.

RISKS: Dr Adrian Dunlop is among a number of experts calling for closer scrutiny of the rising prescription rates of ADHD medications, citing anecdotal reports of Ritalin being mixed with party drugs.

There are 24,000 new cases of medicated ADHD every year in Australia, an increase of about 20 per cent per yearamong children and adults, Dr Dunlop said.

Careful assessment and universal precautions are necessary, he says, to ensure other more complex problems which might be underlying behavioural and emotional difficulties were investigated and taken into account.Dr Dunlop has linked the rising rate of prescriptions with a reported three-foldrise in the number of ADHD medication-relatedpoisonings, a total of about 150 per year. “The data,from the NSW Poisons Information Centre,is very specific, but not super-sensitive, so we can’t tell if it is self-harm, or not, we don’t have enough details to really know,but themedian age of those reporting is 17, which is a real concern.”

The study cites a doubling inthe rate of themisuse of Ritalin in the ten years to December 2014, with at least 93 per cent of overdose patients requiring hospitalisation.

Some users were injecting the drugs, and others were taking them with alcohol and other drugs, increasing the risk of serious side effects, Dr Dunlop said.There were two broad categories of users, adultswho were prescribed the medication and were misusing itor giving it to somebody else; and cases where it hadbeenprescribed for a child, and misused by the parents.

“Critics of the article would say, ‘Oh,150 poisonings, that’s not that many given there are 117,000 people nationally medicated with ADHD’, but that number is increasing by about 20 per cent per year. It’sputting it out there for discussion.”

Dr Dunlop is among a number of experts calling for closer scrutinyof the rising prescription rates of ADHD medications, citing anecdotal reports of Ritalin being mixed with party drugs, and with underlying concerns that assessments for ADHD and the need for medication may not be comprehensive enough.

It was important thatalternativediagnoses such as fetal alcohol spectrum disorders were also considered, Dr Dunlop said.“The use of medication in various neurodevelopmental conditions may be quite appropriate but should not be seen as the sole treatment approach.”

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