March 25, 2011 by martin | 6 comments

Claire Murray (14 March 1985 – 1 April 2010)

April 1 2011 is the first anniversary of the death of Claire Murray, a casualty of Perth’s Generation deX. In 1998 her parents, Mick and Val Murray, took Claire aged twelve to a paediatrician. She was diagnosed with ADHD and put on 40 milligrams of dexamphetamine a day. Tragically, although hardly surprisingly, Claire went on to develop an addiction to amphetamines. She then moved onto heroin, and caught hepatitis B through needle sharing. Her liver failed and she received a transplant in 2009.

Within months of receiving the transplant Claire returned to abusing heroin and her donated liver failed. In March 2010 Claire’s aunt Caroline courageously volunteered a partial liver donation for transplant and Claire and her aunt were operated on in Singapore. Sadly, Claire’s second transplant failed due to complications, and she died aged twenty-five in Singapore on 1 April 2010, surrounded by Mick, Val and other family members, but away from her daughter Chloe (4) and son Taj (2).

Mick and Val Murray attributed Claire’s addiction to her introduction to dexamphetamine.  A letter written by Mick and read out in the Western Australian Parliament six weeks before Claire’s death stated — ‘My daughter, Claire Rita Murray … is a heroin addict with three to six months to live. Claire was an A grade student at Ursula Frayne Catholic College until she was twelve years of age. At this time Claire was diagnosed with ADHD and introduced to her first drug dexamphetamine. Claire was prescribed 10mg of this drug four times a day for a period of eighteen months; and from that day on my daughter Claire and her family’s problems began.’

Val and Mick have told me Claire’s paediatrician never informed them of the potential side effects and addictive properties of dexamphetamine. They found out the hard way when Claire had headed down the pathway of drug abuse. They told me they did not realise that the ‘medication’ Claire was taking was in fact amphetamines. They acknowledged the name ‘dexamphetamine’ would imply that, but they said Claire’s paediatrician advised them that it was safe and effective.

It was not until February 2010 when I gave Val and Mick a copy of GlaxoSmithKline’s prescribing information that they ever saw any warning like the following warning for dexamphetamine….

AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY. MISUSE OF AMPHETAMINES MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.[i]

Dexamphetamine like all ADHD stimulants and other drugs with a high potential for addiction and abuse is a schedule 8 drug (the equivalent of a schedule II drug in the US). The prescription and dispensing of schedule 8 drugs are supposed to be tightly controlled by government health authorities so as to limit the potential for abuse and protect vulnerable consumers from reckless prescribers.

In 1998 the mechanism that was supposed to safeguard Claire and other children from reckless prescribers was the (WA Health Department) Stimulants Committee. The Stimulants Committee was charged with oversighting the responsible prescription of dexamphetamine and Ritalin. However, the Stimulants Committee frequently granted ‘block authorisation’ to very frequent prescribers who were considered to be familiar with the manufacturers prescribing guidelines. Heavy prescribers should have been the most accountable but because of ‘block authorisation’ were the least accountable.

Claire’s paediatrician had bloc authorisation. In fact Claire’s paediatrician was on the Stimulants Committee and was therefore charged with making sure that responsible prescribing occurred.

Bloc authorisation was granted for prescribing within guidelines dosages. GlaxoSmithKline the manufacturer of Dexidrine recommends that ‘In pediatric patients 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day.’[ii] Claire’s paediatrician’s decision to prescribe 40 milligrams a day was against the manufacturer’s advice but just within the range that did not require him to apply for individual ‘off label’ authorisation. Obviously starting Claire, a tiny 12 year old, on such a high dose increased the risk of her becoming addicted.

When he was a member of the Stimulants Committee Claire’s paediatrician sought to further weaken the already flimsy protection offered by the committee by arguing that ‘block authorisation’ should be extended to enable unrestricted ‘off label’ prescribing (outside manufacturers guidelines). Fortunately he was unsuccessful and after WA prescribing controls were significantly tightened in 2003 retired from ‘treating ADHD’ which had previously constituted much of his practice. These reforms came too late for Claire and others in Perth’s Generation deX, however mercifully far fewer (but still too many) WA children are now prescribed ADHD amphetamines. (refer Rise and Fall of Child ADHD in Western Australia )

In March 2010 Claire’s situation became highly publicised when the Western Australian government provided a $240,000 interest-free loan to her family so that she could undergo a live liver transplant in Singapore. Despite the fact that it was only a loan and the live donor was Claire’s Aunty there were many ignorant and ugly comments expressing the view that Claire as a drug abuser was responsible for her fate and did not deserve a second chance.

In state parliament I argued that Claire ‘did not go out and abuse recreational drugs, as many of us did through choice when we got a bit bored on a Saturday night at 18, 19 or 20 years of age… She did not make that choice; that choice was made for her when she was 12 years of age. That is why Claire deserves a first chance.’

Tragically whilst the operation initially appeared to have been successful complications resulted in Claire passing away on 1 April 2010. Val and Mick have lost a daughter and Chloe (now 5) and Taj (3) have lost their mother. As well as dealing with the grief and helping raise Chloe and Taj, the Murray family is tens of thousands of dollars out of pocket and saddled with an unpaid $240,000 debt to the WA State Government.

In the meantime the ADHD industry continues to profit by promoting the drugging with amphetamines of inattentive and/or impulsive but perfectly healthy children.

[i] GlaxoSmithKline, Prescribing Information – Dexedrine (dextroamphetamine sulphate). Available here (accessed 28 July 2009).

[ii] GlaxoSmithKline LLC, ‘Dexedrine Dosage’, Drug.com: Drug Information Online, February 2010 <http://www.drugs.com/dosage/dexedrine.html> (18 March 2011)

6 comments

  1. Tom Stephens on March 26, 2011 at 5:27 pm

    Martin

    1 Are you saying that ADHD does not ever exist?
    2 Are you saying that there is never a case for prescribing medication to respond to severe ADHD symptoms?
    3 In the case of Claire Murray, is there anything known about why she was first taken to a paediatrician at age 12 while she was an A grade student?
    4 If it was behavioural issues at home, what pathway would you suggest to a parent to take if they are very concerned by chronic impulsive, inattentive behaviours at home and in the absence of an academic problem at school?
    5 People with impulse control problems (who turn up in the diagnosed/ADHD category?) will turn in the category of recreational drug users; it does not mean that it is necessarily their diagnosis or medication prescribed that will lead to them turning to recreational drug use, but rather their underlying problem with impulse control.
    6 Do you argue against the involvement of psychologists in tackling ADHD-type symptoms? And if so, why?
    7 How are people who present with “ADHD type symptoms” to get access to professional responses around “behavioural therapy” if they are discouraged from going near ANY psychologist because SOME psychologists are open to (lean towards) a medication model?
    8 Do you acknowledge that there are many (a majority) of psychologists who go from a diagnosis of behavioural problems to behavioural therapy strategies ?
    9 Do you see a role of psychologists in dealing with the behavioural issues that present?

    Cheers

    Tom

    1. martin on March 26, 2011 at 7:34 pm

      Thanks Tom. My answers are;

      1 Are you saying that ADHD does not ever exist?
      There are no objective, scientific, diagnostic tests for ADHD. The diagnosis of ADHD is entirely based on observations of a child’s behaviour, as ‘there are no laboratory tests, neurobiological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention Deficit/Hyperactivity Disorder’. In reality clinicians can diagnose children with ADHD by relying entirely on third party (usually parent and teacher) reports of children exhibiting childish behaviours including; failing to pay close attention, not finishing school work and chores, disliking homework, running about or climbing excessively, playing loudly and being impatient.
      That doesn’t mean that some children don’t have real problems that need addressing; they do. However, ADHD is a dumbed down label that over-simplifies their often complex individual circumstances. Children need individualised responses to their individual circumstances.

      2 Are you saying that there is never a case for prescribing medication to respond to severe ADHD symptoms?
      What do you mean by severe symptoms of ADHD? The symptoms (i.e. diagnostic criteria) are not in themselves severe. They are normal childhood behaviours like avoiding homework, fidgeting, climbing, butting in, so we must reject the language that legitimizes the label. Having said that, there are some children that are diagnosed ADHD that show extreme and disturbed behaviors that can’t be ignored. I acknowledge there can be a role for the cautious temporary use of drugs to modify extreme and dangerous behaviours by children.
      We should also be careful about the use of the term ‘medications’. The drugs most commonly used to treat ‘ADHD’ are amphetamines or near amphetamines like Ritalin. They do alter behavior in the short term masking ‘symptoms’ but the available evidence is that in the long term they do significant harm.

      3 In the case of Claire Murray, is there anything known about why she was first taken to a paediatrician at age 12 while she was an A grade student?
      I am not going to break confidences or pretend I know all the circumstances of 13 years ago. Many bright and bored children, particularly kids experiencing the difficulties of early adolescents and making the transition to high school get diagnosed with ADHD.
      4 If it was behavioural issues at home, what pathway would you suggest to a parent to take if they are very concerned by chronic impulsive, inattentive behaviours at home and in the absence of an academic problem at school?
      As I wrote at 1, some children have real problems that need addressing but ADHD is a dumbed down label that over-simplifies their often complex individual circumstances. Children need individualised responses to their individual circumstances. Without understanding a child’s individual circumstances how can anybody legitimately begin to advise what is an appropriate response?
      5 People with impulse control problems (who turn up in the diagnosed/ADHD category?) will turn in the category of recreational drug users; it does not mean that it is necessarily their diagnosis or medication prescribed that will lead to them turning to recreational drug use, but rather their underlying problem with impulse control.
      Fair point but if you put 12 year old girl’s on 40 milligrams of amphetamine a day every day what chance do they have?
      6 Do you argue against the involvement of psychologists in tackling ADHD-type symptoms? And if so, why?
      No.
      7 How are people who present with “ADHD type symptoms” to get access to professional responses around “behavioural therapy” if they are discouraged from going near ANY psychologist because SOME psychologists are open to (lean towards) a medication model?
      I certainly don’t discourage anybody from going near psychologists or peadiatricians or psychiatrists. There are good and bad practitioners in every discipline (politics included).
      8 Do you acknowledge that there are many (a majority) of psychologists who go from a diagnosis of behavioural problems to behavioural therapy strategies?
      Yes and that is good thing.
      9 Do you see a role of psychologists in dealing with the behavioural issues that present?
      Yes.

  2. Tom Stephens on March 27, 2011 at 4:52 pm

    thanks Martin – much appreciated – another thought:

    Use of the term “ADHD” as a label – i guess that is a problem with labels, that they do generalise; and run the risk of being an oversimplification that can lead to causing other problems; I guess the medical diagnosis “has cancer” covers a lot of conditions; a whole spectrum of problems; I guess it is a “dumbing down” to say that someone “has cancer”; but using a term for a condition that features a spectrum of issues has some sort of natural inevitability about it; it is convenient to have a label; it is perhaps even necessary short-hand for normal discourse, and professional discourse; and sometimes systems (i.e. government support programs) require labels for the purpose of allocating resources…. the problem is not so much having a label, but misusing labels; pretending that a label is a precise diagnosis of a precise condition.

  3. Martin on March 27, 2011 at 6:15 pm

    Hi Tom

    Cancers are many and varied and everybody understands that there are many subtypes. All cancers involve demonstrable changes to cell biology with real adverse consequences. The term Cancer doesn’t dumb down government policy resposes or medical treatment resposes.

    The same can not be said for ADHD. Legitimising the label invites dumbed and harmful responses from both the medical profession and government. If all it ever was regarded as was a loose description of a set of behaviours perhaps it would be harmless. However, it has been so agressively marketed as a medical condition (often equated with real disease like insulin dependent diabetes). The label ADHD has done too much damage to be rehabilitated it must be rejected and abandoned.

  4. Mum of a child with ADHD on March 30, 2011 at 2:09 pm

    I have a child who’s been diagnosed with ADHD. He is incredibly bright and capable and a lovely child. He also requires a lot more work from my husband and myself. We have been through the OT, speech, physio and nutritionist for help. We have daily homework from a range of therapists to help him.

    He has an addictive personality. When he enjoys something he hyperfocuses to the extent of obsessiveness. He can be so focussed on somethings but can’t concentrate on others without a lot of help.

    We prefer not to medicate and with the school’s help and the help of his paediatrician and various specialists we are managing his ADHD without medication but with a lot of training on how to be organised, how to respond to social cues, how to speed up/slow down/switch focus, etc.

    He has an addictive personality and even if we don’t medicate him in the future, he is at greater risk of becoming addicted. We are already trying to counteract this by informing him of the negative implications of drugs and by directing his interests and finding friends from ‘good’ families to try and limit the risk of heading that way when he reaches his teens.

    Being a parent to a child with ADHD is not easy. It is made harder by the media who make ‘medication’ out to be evil and ADHD to be about bad parents and not a medical condition.

  5. Martin on April 3, 2011 at 6:48 am

    It seems to Me that ‘Mum of a child with ADHD’ has a good handle on her sons individual circumstances and responds appropriately. However, the obvious question is does the label ADHD add anything to understanding and supporting him?
    As for him being obsessive with things that interest him and disinterested in things that don’t, I am exactly the same. At risk of stating the obvious, I think it is perfectly natural to find interesting things interesting, and boring things boring.
    If as ‘Mum of a child with ADHD’ says her son has an addictive personality then it is doubly important that he is not on ADHD ‘medications’. As these ‘medications’ are in most cases highly addictive amphetamines (dexamphetamine) or near amphetamines (Ritalin , Concerta etc) which are certainly not good for people with addictive personalities.

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