Physician Perceptions of ADHD Stimulant Diversion and Misuse.

Objective: The recent rise in ADHD has prompted concerns about adolescents with ADHD diverting and/or misusing stimulants. This is the first study to assess physician perceptions of the pervasiveness of these issues. Method: Questionnaires were mailed to a national sample of pediatric subspecialists. Responses were analyzed (n = 826; 18% response rate) using descriptive statistics and regression analyses. Results: In the past year, 59% of physicians suspected ≥1 patient(s) with ADHD diverted stimulants. Seventy-four percent believed ≥1 patient(s) feigned symptoms to obtain an initial ADHD diagnosis; 66% believed ≥1 patient(s) wanted stimulants to improve academic performance. Child and adolescent psychiatrists were most likely to suspect diversion and feigning symptoms. Thirty-nine percent of physicians believed diversion was at least "common." Conclusion: Although many physicians suspected stimulant diversion and misuse, a substantial number were unaware of these issues, and subspecialist perceptions varied. These findings support the potential pervasiveness of these issues and the need for increased physician awareness.

Physician Training and Qualification to Educate Patients on Attention-Deficit/Hyperactivity Disorder Stimulant Diversion and Misuse.

OBJECTIVES: The increased number of adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in recent years has raised concerns regarding diversion and misuse of prescription stimulant medications. As prescribers of these medications, physicians must be prepared to educate patients on these issues. This is the first study to evaluate physician training and qualification to educate adolescent patients on stimulant diversion and misuse. METHODS: A questionnaire was developed and mailed to a national sample of child and adolescent psychiatrists (CAPs), child neurologists (CNs), and developmental-behavioral pediatricians (DBPs) in the United States. In addition to descriptive statistics, multivariable regressions (log-binomial and ordinal logistic) were performed to identify differences between subspecialists. RESULTS: The final sample consisted of 826 physicians who currently prescribe stimulants. Only 48% of physicians reported receiving formal training on prescription drug diversion (PDD) in medical school, residency, and/or fellowship. Twenty five percent and 48% of physicians felt inadequately qualified to educate patients on the health and legal consequences, respectively, of stimulant misuse and diversion. CAPs were more likely to have received formal training and felt better qualified to educate patients than CNs and DBPs. Physicians who received formal training were 2.4 times more likely to feel adequately qualified to educate patients on these issues. Only 58% of physicians correctly answered a legal question relating to stimulant diversion. CONCLUSIONS: Most physicians have not received formal training on PDD and many feel inadequately qualified to educate patients on the health and legal consequences of stimulant misuse and diversion. Increased training is needed so physicians can effectively educate patients with ADHD.

Pharmacological cognitive enhancement in pediatrics.

PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement. RECENT FINDINGS: The current article highlights findings on the pervasiveness of stimulant misuse and diversion in youth, the motivations and effects of stimulant use, health and legal consequences associated with use, and physician perceptions and preventive practices. Ethical concerns regarding pharmacological cognitive enhancement in pediatrics are also outlined - including coercion for nonusers, inequities in access, and threats to an individual's sense of self with regard to authenticity and autonomy. SUMMARY: Pharmacological cognitive enhancement in pediatrics will become a larger, clinically relevant issue in the coming years. Physicians who care for children and adolescents must become more aware of this issue. Given the myriad health, legal, and ethical concerns, clinicians should discourage use of pharmaceuticals for enhancement purposes in the pediatric population.

Physician practices to prevent ADHD stimulant diversion and misuse.

BACKGROUND: Recent studies report that a significant number of adolescents misuse and divert prescription stimulants. As prescribers of these medications, physicians have a unique opportunity to help prevent the improper use and unlawful distribution of these medications. This study evaluates the extent to which physicians employ prevention practices with their adolescent patients with ADHD and their perceptions of the effectiveness of these practices. METHODS: A questionnaire was developed and mailed to child and adolescent psychiatrists, child neurologists, and developmental-behavioral pediatricians in the US. Descriptive statistics were performed on the final sample (n=828; response rate=18.4%), as were regressions to identify differences when physicians were grouped by subspecialty and prescribing volume. RESULTS: Many physicians "never" or "rarely" use medication contracts (85.2%) or distribute print materials (81.0%) to patients with ADHD when they suspect misuse and/or diversion. 46.2% do not "often" refer for drug counseling or substance abuse treatment when they suspect a patient of stimulant misuse and/or diversion. The leading prevention practices implemented by physician respondents at least "often" when they suspect stimulant misuse and/or diversion are prescribing long-acting instead of immediate-release stimulants (79.2%) and prescribing non-stimulants (71.9%). 71.4% of respondents believed prescribing non-stimulants is "very effective" at preventing misuse and diversion. Conversely, 53.4% and 31.5% of physicians, respectively, labeled using a medication contract and distributing print materials as "not likely effective." Child and adolescent psychiatrists were more likely to implement certain prevention practices compared to other subspecialists. Many responding physicians do not regularly implement practices that may prevent stimulant misuse, and the majority thinks most prevention practices are not very effective. CONCLUSION: Physicians should assume greater responsibility in the prevention of stimulant misuse and diversion by implementing prevention practices more often with their adolescent patients with ADHD. With respect to the generalizability of these findings, it must be noted that the sample was limited to pediatric subspecialists and may be influenced by selection bias and response bias. Further research must be performed to better understand physicians' views of the risks and benefits of stimulants and to ascertain best practices for the prevention of stimulant misuse and diversion.

Adolescent Patient Education Regarding ADHD Stimulant Diversion And Misuse.

OBJECTIVES: Recent studies report that adolescents misuse and divert ADHD stimulants. This study evaluates the extent to which physicians educate adolescents with ADHD about stimulant misuse and diversion (M/D). METHODS: Child/adolescent psychiatrists (CAP), child neurologists (CN), and developmental-behavioral pediatricians (DBP) in the US completed a questionnaire. Descriptive statistics were performed on the final sample (n=826); multivariate regressions were performed to identify education practice differences. RESULTS: Only 46% and 44% of physicians educate patients "often" or "very often" on health risks and legal consequences, respectively, of stimulant M/D. CAP are more likely to educate on health and legal consequences than CN, and more likely to educate on legal consequences than DBP. Compared to physicians who prescribe stimulants to 1-10 patients (low prescribers), medium prescribers (11-30 patients) and high prescribers (30+ patients) are more likely to educate about M/D. 60% of physicians counsel patients at least "often" about M/D in a pre-college appointment; 8% have written materials regarding M/D available. CONCLUSIONS: Many physcians currently don't educate adolescent patients with ADHD often enough about M/D. CN and DBP, and low prescribers, are less likely to educate about M/D. PRACTICE IMPLICATIONS: Physicians who prescribe stimulants must educate patients more often to prevent stimulant M/D.