In August 2003 in response to concerns about the high number of children prescribed dexamphetamine for ADHD in Western Australia (WA), the state government tightened prescribing controls and introduced the Stimulants Regulatory Scheme. The introduction of the scheme with annual reporting was followed by a large and sustained fall in child patient numbers but a significant increase in the number of WA adults prescribed ADHD stimulants.
The 2011 Annual Report (the eighth annual report) was released on 17 October 2012 and is available at http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf
Highlights of the WA Stimulants Regulatory Scheme 2011 Annual Report
Child Prescribing Rates- WA Stimulants Regulatory Scheme 2011 Annual Report contains both good and bad news. The good news is that the 2011 report confirms there has been a massive decline in per-capita prescribing rates for children since the Stimulant Regulatory Scheme was introduced in mid-2003. However, the bad news is that there was a spike in the number of new cases diagnosed in 2011.
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%.1 Federal Government figures2 indicate the number of children on ADHD medications in WA peaked in 2002 at 2.6%, indicating a 50% fall from the peak. However, in 2011 the rate rose marginally (to 1.34%) for the first time since the system was introduced. This was due to a significant increase in the number of first time child patients from a low of 883 in 2007, to 1628 in 2011.3 Most of these (824 or 51%) were aged 9 or less.
The bottom line is that although Perth is the world’s only ADHD child drugging hotspot to have seen a massive decline in child prescribing rates, there are signs that this hard won progress is in danger of being undone. To prevent history repeating there needs to be a crackdown on reckless prescribing now.
Adult Prescribing Rates- Adult ADHD per-capita prescribing rates continue to grow. They are generally not carryover patients from childhood, as 80% are diagnosed first as adults.4 The vast majority of adults get prescribed dexamphetamine (81.3% as opposed to 22.3% for children)5 and the majority are first diagnosed between 18 and 29.6 During 2011, 137 patients had their authority to receive psychostimulants withdrawn because they had abused prescription drugs.7 All of the facts support the contention that this is the tip of the iceberg and that many of Perth’s twenty to thirty somethings are doctor shopping for dexamphetamine. (For more info see Perth’s Dexamphetamine Hangover )
Perth’s New Rogue Prescriber- One clinician (a psychiatrist) was responsible for prescribing to 1473 patients (1346 adults and 127 children) in 2011.8 The obvious question is how long is this doctor spending with each patient before prescribing them amphetamines? They can’t be doing much more than meeting each patient for a brief consultation and issuing a script!
There is a precedent for this type of prescribing. When the stimulants monitoring system was first introduced it revealed that a single paediatrician prescribed to 2077 children in 17 months from August 2003 to December 2004.9 This paediatrician was ‘encouraged’ to retire from prescribing and his subsequent retirement was immediately followed by a significant decrease in child prescribing rates.
History appears to be repeating itself although the major difference is this psychiatrist is prescribing primarily dexamphetamine to adults and there is every reason to be concerned that much of this taxpayer subsidised amphetamine is being abused. At the very least there needs to be a prescribing audit of this practitioner and ideally they need to be encouraged to find an alternate vocation.
Geography- Geraldton with the highest child and second highest adult prescribing rates is the ADHD capital of WA.10 Geraldton has long had very high ADHD prescribing rates and concerns have long been raised about prescription drug abuse in the Mid-West Port Town. In 2010 a Geraldton mother of seven with a history of abusing a variety of prescription drugs, including dexamphetamine, died from an overdose of prescription methadone. (Refer to Prescription drug abuse – A large and growing problem with a very simple solution )
The Oceanic Health District (Perth’s City and wealthy western suburbs) has the highest adult rate but an average child prescribing rate. The considerable anecdotal evidence of high rates of diversion of amphetamines in Perth’s Western suburbs is supported by these high adult prescribing rates.
Conclusion- Western Australia’s scheme provides detailed publicly available (although de-identified) information. This information has been vital in highlighting anomalies, especially the prescribing records of rogue prescribers. It is a system worth replicating in other jurisdictions.
Cathy O’Leary, The West Australian, More kids prescribed ADHD drugs, October 17, 2012 page 4. http://au.news.yahoo.com/thewest/a/-/breaking/15137786/rise-in-new-adhd-drug-use/
- 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. ↩
- Department of Health and Ageing Pharmaceutical Benefits Scheme figures prescribing of ADHD medications provided to Martin Whitely on request. ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Page 63 http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Page 41 http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Pages 28 and 43. http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Pages 41. http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Page 19 http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Pages 21 and 37 http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩
- Stimulant Prescribing and Usage Patterns for the Treatment of ADHD in Western Australia 1 August 2003 – 31 December 2004 Western Australian Department of Health page 17 http://www.public.health.wa.gov.au/cproot/3609/2/03-04_Report.pdf ↩
- WA Stimulants Regulatory Scheme 2011 Annual Report Pages 27 and 42 http://www.public.health.wa.gov.au/cproot/4883/2/stimulant-annual-report-2011.pdf ↩