Western Australia (WA) is the world’s only ADHD hot spot to have experienced a significant and sustained downturn in child ADHD prescribing rates. The explosion in prescribing rates from 1989 to 2003 was created by a handful of Perth paediatricians who were very enthusiastic at marketing, diagnosing and prescribing for ADHD. The introduction of tighter prescribing accountability measures in 2003 and an intense local debate around the validity of the diagnosis and the safety of the drugs, lead to a massive downturn in Western Australia’s child drugging rates.
From 1989-2003 in WA there was a massive increase in the prescription of dexamphetamine and to a lesser extent methylphenidate (Ritalin) for ADHD. By 2002 WA prescription rates were amongst the highest in the world, exceeding the US national average.[1] WA prescribing rates continued to grow until August 2003 when tighter ADHD amphetamine prescribing accountability measures – most notably the abolition of Block Authorisation – were introduced via the Stimulants Regulatory Scheme.
Block Authorisation had granted an exemption from normal accountability requirements to frequently prescribing clinicians considered to be ‘familiar with the prescribing guidelines’.[2] In effect Block Authorisation meant that frequent prescribers were the least accountable. In contrast, a clinician who prescribed infrequently as a last resort was accountable for every individual script. Presumably the rationale for the policy of ‘Block Authorisation’ was the assumption that those who prescribe frequently were familiar with, and therefore competent in, the prescription of dexamphetamine and methylphenidate. The abolition of Block Authorisation and the introduction of the scheme with annual reporting was followed by a large and sustained fall in Western Australian child patient numbers.
The 2011 Annual Report (the eighth annual report) was released on 17 October 2012. The report confirmed between 2004 (the first year for which figures are available) and 2010 per-capita ADHD child prescribing rates fell from 2.25 % to 1.3%.[3] Federal Government figures[4] indicate the number of children on ADHD medications in WA peaked in 2002 at 2.6%, indicating a 50% fall from the peak. Over a similar timeframe (2002 to 2008) amphetamine abuse rates by West Australian teenagers fell approximately 51% supporting the contention that if you stop giving teenagers amphetamines they stop abusing them.[5]
Although WA still has the highest (and rising) adult prescribing rates in Australia, since 2003, WA prescriptions to children have plummeted while they have skyrocketed elsewhere. Perth has fortunately forfeited its claim to be the ADHD child prescribing capital of Australia. Sydney, Brisbane and Hobart now vie for that dubious honour.
[1] Berbatis CG, Sunderland VB, Bulsara, M. Licit Psychostimulant consumption in Australia, (2002) 1984-2000: international and jurisdictional comparison, Medical Journal of Australia, 177 (10) pp.539-543. © Copyright 2002. The Medical Journal of Australia.
[2] The Report of the Technical Working Party on Attention Deficit Disorder to the Cabinet Sub-Committee (1997); Parliament House Western Australia: p20
[3] Note: The stimulants regulatory scheme only reports child ADHD prescribing rate for stimulants (1.25% in 2010). Strattera (the brand name for atomoxetine hydrochloride) is a rarely prescribed non-stimulant ADHD medication. When Commonwealth Department of Health and Ageing data on Strattera Pharmaceutical Benefits Scheme prescriptions is included the rate in 2010 is 1.3% of 4 to 17 year olds. WA Stimulants Regulatory Scheme 2011 Annual Report http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf and Department of Health and Ageing Pharmaceutical Benefits Scheme figures prescribing of ADHD medications provided to Martin Whitely on request.]
[4] Department of Health and Ageing Pharmaceutical Benefits Scheme figures prescribing of ADHD medications provided to Martin Whitely on request.]
[5] 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.]