All ADHD stimulants are addictive and carry warnings for abuse similar to that below which appears on the prescribing information Dexedrine, a brand of dexamphetamine.[1]
Even the inventors of ADHD, the American Psychiatric Association recognise that amphetamines (including dexamphetamine and methamphetamine), methylphenidate (Ritalin) and cocaine are ‘neuropharmacologically alike’.[2]
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders categorises the abuse and addiction of these drugs in a common class of ‘Amphetamine or Amphetamine-Like – Related Disorders’. It states: ‘Prescribed stimulants have sometimes been diverted into the illegal market…Most of the effects of amphetamines and amphetamine-like drugs are similar to those of cocaine.’[3]
Furthermore, the diagnostic criteria for ‘Amphetamine Intoxication’ include ‘recent use of amphetamine or a related substance (e.g. methylphenidate)’ and many of their potential side effects such as ‘impaired social or occupational functioning, tachycardia, elevated blood pressure, nausea or vomiting, weight loss dyskinesia and dystonia’.[4]
Despite the clear warnings for addiction and abuse, one of the most aggressively marketed claims about ADHD is that its ‘under-recognition’ is a cause of illicit drug abuse. It is argued by the ADHD industry that early identification of ADHD and subsequent medication prevents undiagnosed individuals using illicit drugs to self-medicate.[5]
Perth Western Australia – A natural experiment in the relationship between ADHD and illicit drug use
In the 1990s and early 2000s Western Australia, particularly Perth, had Australia’s highest ADHD amphetamine prescription rate for both adults and children and in 2000 Western Australia’s per capita exceeded the US national average. If the above claims about drug abuse were correct, it would be expected that WA rates of drug abuse would have been among the lowest in Australia. The evidence suggests the opposite.
ADULTS – Since the mid 1990’s Western Australia has had the highest adult prescribing rates in Australia. In 2002 WA adults were prescribed government subsidised ADHD medications at 7.1 times the national rate (excluding WA). By 2011 there had been a closing of the gap but WA’s rate was still 3.3 times the national rate.
The 2001,2004,2007,2010 and 2013 Australian National Drug Strategy Household Survey all showed Western Australia had higher rates of ‘illicit use of drugs’ than all Australian states. In addition Western Australian adult rates of amphetamine misuse have been much higher than other Australian states since at least 2000.[6]
CHILDREN – Throughout the 1990s and early 2000s Western Australian child prescribing rates were much higher than other Australian states. In 2002 WA’s child per capita prescribing rate of dexamphetamine (at the time the only government subsidised ADHD drug) was approximately 2.8 times the rate of other Australian states. [7]
Between 2002 and 2008 there was a 48% decline in Western Australian child prescribing rates. Over the same period there was a 51 per cent reduction (for people aged twelve to seventeen years of age) in self reported rates of amphetamines misuse.[8]
Even though abuse rates began to drop by 2005, a survey of Western Australian secondary school students (the Australian School Students Alcohol and Drug Survey or ASSAD) found that 84 per cent of those who had abused amphetamines in the last year had abused prescription amphetamines.[9] The same survey found that 27 per cent of twelve to seventeen-year-olds who had been prescribed stimulant medication either gave it away or sold it.[10]
Far from validating the assertion that medicating for ADHD prevents illicit drug abuse by self-medicating untreated ADHD sufferers, the West Australian experience makes a mockery of the ADHD industry claims. WA’s experience provides unequivocal evidence supporting the commonsense proposition that prescribing amphetamines facilitates their abuse.
Also refer to Perth’s Dexamphetamine Hangover.
[2] American Psychiatric Association, Treatments of Psychiatric Disorders: a task force report of the American Psychiatric Association 1st ed., 1989, quoted in ibid., p. 71.
[3] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington DC, 2000, p. 223.
[4] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington DC, 2000, p. 225
[5] For instance, see Dave Coghill, ‘Attention-deficit hyperactivity disorder: should we believe the mass media or peer-reviewed literature?’, The Psychiatrist, 29, 2005, pp. 228-91; Dr Ken Whiting, Fact Sheet: Attention Deficit/Hyperactivity Disorder 2003 Update,Learning and Attentional Disorders Society of WA, Perth, 2003.
[6] Australian Institute of Health and Welfare (2014), National Drug Strategy Household Survey detailed report: 2013. Drug statistics, series no. 28. Cat. no. PHE 183. Canberra: AIHW http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848Conversely when Perth’s prescribing rates for children plummeted so did amphetamine abuse rates.
[7] Australian Department of Health and Ageing, Letter to Martin Whitely dated 21 April 2012.
[8] The 2008 Australian Secondary Students’ Alcohol and Drug Survey (ASSAD) data indicated a reduction in ‘last 12 month amphetamine abuse’ by school children 12-17 years old from 10.3 per cent in 2002, 6.5 per cent in 2005, and 5.1 per cent in 2008. P. Griffiths, R. Kalic, & A. Gunnell, Australian School Student Survey 2008: Western Australian Results (excluding tobacco), Brief Communication no. 2, Drug and Alcohol Office, Perth, 2009.
[9] Drug and Alcohol Office WA, ASSAD Drug Report 2005, Mt Lawley, March 2007, pp. 30-32.
[10] Drug and Alcohol Office WA, ASSAD Drug Report 2005, Mt Lawley, March 2007, p. 33.