HANSARD - Written questions and answers on Ritalin Prescription Rates - Pat Mc Mullan,MP,Wolverhampton SE

Pat McFadden MP: To ask the Secretary of State for Health 

(1) if he will estimate the number of children who have been prescribed Ritalin or a similar drug;

(2) if he will estimate the number of children under the age of six who have been prescribed Ritalin or a similar drug; and if he will assess trends in the number of such prescriptions in the last five years;

(3) if he will estimate the number of children under the age of six in Wolverhampton who have been prescribed Ritalin or a similar drug;

(4) what guidance (a) his Department and (b) the National Institute for Health and Clinical Excellence issues to practitioners on the prescription of Ritalin and similar drugs to young children.

Anne Milton: I refer the right hon. Member to the answer I gave the right hon. Member for Birkenhead (Mr Field) on 4 April 2011, Official Report, column 684W.

The Information Centre Prescribing Team has advised that this information is not available for children's prescriptions. They have however provided information on the numbers of all Ritalin prescriptions dispensed in the community as follows:

Ritalin is a branded version of the drug Methylphenidate Hydrochloride. The following table shows the total number of items dispensed for Methylphenidate Hydrochloride overall (including Ritalin) and for Ritalin separately for individuals of all ages.

Methylphenidate Hydrochloride prescriptions dispensed in the community in England


Thousand


  

Prescription items


  

Methylphenidate Hydrochloride

  

Of which : Ritalin

1997
  

92.1
  

92.1

1998
  

126.6
  

126.6

1999
  

158.0
  

157.9

2000
  

186.2
  

181.3

2001
  

208.5
  

180.6

2002
  

254.0
  

161.8

2003
  

314.5
  

124.5

2004
  

359.1
  

67.8

2005
  

389.2
  

30.7

2006
  

456.9
  

26.5

2007
  

535.3
  

25.5

2008
  

573.4
  

22.8

2009
  

610.2
  

20.2

Notes:

EVIDENCE ON PRESCRIPTION DRUG ABUSE IN U.S.- FROM NATIONAL INSTITUTE ON DRUG ABUSE'S DIRECTOR DR NORA VOLKOW TO SENATE SUBCOMMITTEE ON CRIME AND DRUG ABUSE IN 2008 + FACTSHEET FROM NIDA ON METHYLPHENIDATE

Nora D. Volkow, M.D.
Director of NIDA
U.S. Department of Health and Human Services


WATCH YOUTUBE VIDEO INTERVIEW ON LINK BELOW OR BY CLICKING ON TITLE THEN READ TRANSCRIPT OF EVIDENCE GIVEN TO SENATE SUB COMMITTEE.

http://www.youtube.com/watch?v=imCJSY06M40 

on
Scientific Research on Prescription Drug Abuse
before
Judiciary Committee
Subcommittee on Crime and Drugs
U.S. Senate

Mr. Chairman, Members of the Subcommittee, and Members of the Caucus:

Thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), an agency of the Department of Health and Human Services (HHS), to participate in this important hearing and contribute information about the growing problem of prescription drug abuse in this country. This problem is particularly complex because the benefits and the risks of prescription drugs are so closely intertwined. Thus, it is critical that we learn how to strike the right balance between providing maximum relief from suffering and minimizing associated risks and adverse effects. We must be deeply concerned by the fact that, according to the Monitoring the Future (MTF) study supported by NIDA, 7 of the top 11 most commonly abused drugs by high school seniors are either prescribed or purchased over-the-counter (see figure), but this challenge must also recognize the fundamental and unassailable role played by these medications in healing and reducing human suffering when properly used. Therefore, how we address the problem of abuse of drugs that have legitimate medical use must necessarily differ from how we address illicit drug abuse.

Several factors have recently contributed to the severity of prescription drug abuse, including drastic increases in the number of prescriptions written, greater social acceptance of using medications, and aggressive marketing by pharmaceutical companies. These factors together have helped create the broad “environmental availability” of prescription drugs. To illustrate, the total number of stimulant prescriptions in the U.S. has soared from around 5 million in 1991 to nearly 35 million in 2007. Prescriptions for opiates (hydrocodone and oxycodone products) have escalated from around 40 million in 1991 to nearly 180 million in 2007 (see figure), with the U.S. their biggest consumer. The U.S. is supplied 99 percent of the world total for hydrocodone (e.g., Vicodin) and 71 percent of oxycodone (e.g., OxyContin).

This greater availability of prescription drugs has been accompanied by increases in their abuse. 
 To clarify our terminology here, when we say “prescription drug abuse” or “nonmedical use,” this includes use of approved prescription medications without a prescription, use for purposes other than prescribed, or use simply for the experience or feeling the drug can cause. Unlike illicit drug use, which shows a continuing downward trend, prescription drug abuse, particularly of opioid pain medications, has seen a continual rise through the 1990s and has remained stubbornly steady among persons 12 or older during recent years.[1] Because prescription drugs act directly or indirectly on the same brain systems affected by illicit drugs, their abuse carries substantial abuse and addiction liabilities. They are most dangerous when taken to get high via methods that increase their addictive potential (e.g., crushing the pills, then snorting or injecting their contents, or combining them with alcohol or illicit drugs). Some people also take prescription drugs for their intended purpose, though not as prescribed, thus heightening the risk of dangerous adverse reactions; and still others may become addicted even when they take them as prescribed. Given that more than 30 million people suffer from chronic pain in this country, even if a fraction of this group takes prescription drugs for their pain and becomes addicted, it could affect a large number of people.

I am pleased to have the opportunity today to share with you what we know about this complex multi-faceted problem.

Which medications are being abused, and what do they do to the brain and body?

The psychotropic prescription drugs[2] that present abuse liability (i.e., have potential for abuse relative to their pharmacological and behavioral effects) fall into three broad categories: opioids (analgesics), stimulants, and central nervous system (CNS) depressants (anxiety and sleep medications). How they work is described briefly below:

    Opioids, mostly prescribed to treat moderate to severe pain, include drugs such as OxyContin and Vicodin.  Opioids act on the brain and body by attaching to specific cell surface proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors, they can block the perception of pain. These drugs also can induce euphoria by indirectly boosting dopamine levels in the brain regions that influence our perceptions of pleasure. This feeling is often intensified by abusers who snort or inject the drugs, amplifying their euphorigenic effects and increasing the risk for serious medical consequences, such as respiratory arrest, coma, and addiction. Combining opioids with alcohol can exacerbate these consequences.

    Stimulants, prescribed to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, include drugs such as Ritalin, Adderall, and Concerta. These prescription medications stimulate the central nervous system, with effects similar to but more potent than caffeine. When taken orally, as prescribed, these stimulants elicit a gradual and sustained increase in the neurotransmitter (brain chemical) dopamine, which produces the expected therapeutic effects seen in many patients. In people with ADHD, stimulant medications generally have a calming and "focusing" effect, particularly in children. However, because these medications affect the dopamine system in the brain (the reward pathway), they are also similar to drugs of abuse. For example, Ritalin, or methylphenidate, has much in common with cocaine––the two drugs bind to similar sites in the brain and both increase dopamine through the same molecular targets (see figure). When administered intravenously, both drugs cause a rapid and large increase in dopamine, which a person experiences as a rush or high. For those who abuse stimulants, the range of adverse health consequences includes risk of dangerously high body temperature, seizures, and cardiovascular complications.

    CNS depressants, typically prescribed for the treatment of anxiety, panic, sleep disorders, acute stress reactions, and muscle spasms, includes drugs such as Valium, Librium, and Xanax. Most CNS depressants act on the brain by affecting the neurotransmitter gammaaminobutyric acid (GABA). GABA works by decreasing brain activity. Although the different classes of CNS depressants work in unique ways, it is through their ability to increase GABA activity that they produce a drowsy or calming effect that is beneficial to those suffering from anxiety or sleep disorders. These drugs are also particularly dangerous when mixed with other medications or alcohol; overdose can cause breathing problems and lead to death. Although the newer sleep medications—such as Ambien, Lunesta, and Sonata––appear to have reduced dependence and abuse liabilities, they still react with some of the same receptors in the brain, so they may share some of the risks.

Over the counter medications, such as certain cough suppressants containing dextromethorphan (DXM), are also abused for their psychoactive effects, producing hallucinations and dissociative (“out-of-body”) sensations. However, overdose of DXM can also produce confusion, disorientation, motor impairment, blurred vision, nausea, rapid or irregular heartbeat, high blood pressure, and loss of consciousness.

What is the scope of the prescription drug problem in this country?

Several indicators show that prescription drug abuse is a significant problem in the United States. According to the National Survey on Drug Use and Health (NSDUH), conducted by HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA), in 2006 approximately 7 million persons 12 and older took a psychotherapeutic drug for non-medical purposes in the 30 days before the survey. Most reported abusing opiate pain relievers in particular. In fact, 2.2 million persons aged 12 and over initiated abuse of pain relievers in the past year (see figure). Young adults (ages 18-25) by far showed the greatest use overall and the largest increases in past month, past year, and lifetime use between 2002 and 2006, compared to all other age groups (NSDUH, 2007). Still, even by the time they graduate from high school, roughly a quarter of 12th graders report having abused a prescription drug (MTF, 2007). Other significant indicators of the prescription drug problem include the following:

    In 2006, more than half a million adolescents aged 12-17 used stimulants nonmedically in the past year (NSDUH, 2007).

    Although abuse of sedatives decreased among high school seniors between 2005 and 2007, it is still near peak levels, at over 6 percent among this group (MTF, 2007).

    Nearly 6 percent of 12th graders reported abusing cough medicine to get high in 2007 (MTF, 2007).

    Data on drug-related emergency department visits that involved prescription opioids show a 153 percent increase from 1995–2002, from 42,857 to 108,320 (SAMHSA’s Drug Abuse Warning Network, 2004).

    Treatment admissions for opiates other than heroin surged from 16,121 in 1995 to 67,887 in 2005, a 321 percent increase (SAMHSA’s Treatment Episode Data Set, 1995–2005).

    Prescribed pain medications are driving the upward trend in drug poisoning mortality. The number of deaths involving prescription opioid analgesics increased 160 percent in just 5 years from 1999 to 2004. By 2004, opioid painkiller abuse deaths outnumbered total deaths involving heroin and cocaine (HHS’s Centers for Disease Control and Prevention, 2006).

What factors are driving abuse of prescription drugs?

The far-ranging scope of prescription drug abuse in this country stems not only from the greater prescribing of medications, but also from misperceptions of their safety. For example, many students, and even some parents, see nothing wrong in the abuse of stimulants to improve cognitive function and academic performance. In fact, being in college may even be a risk factor for greater use of amphetamines or Ritalin nonmedically, with reports of students taking pills before tests and of those with prescribed medications being approached to divert them to others. Pain relievers show a similar link with regard to access. Evidence suggests that parents sometimes provide their children with prescription medications not prescribed by a physician for the child to relieve their discomfort.[3] According to the 2006 NSDUH, 55.7 percent of those 12 and older who misused pain relievers said they received their medications from a friend or family member, the vast majority of whom had gotten the drugs from just one doctor. Only 3.9 percent cited obtaining these drugs from a drug dealer or stranger, and only 0.1 percent cited an internet purchase. Notably, the leading reason for the abuse is to relieve pain, although other top motives include intent to get high and experimentation.

Similar motivations characterize younger groups, with high school students reporting that they primarily abuse prescription drugs for the medications’ intended purpose, albeit without a prescription. Using these medications without a prescription or in ways other than prescribed poses multiple risks, including dangerous interactions with other medications, accidental poisoning, and risk of addiction.

Nonmedical use among children and adolescents is particularly troublesome, given that adolescence is the period of greatest risk not only for drug experimentation but also for developing addiction. At this stage, the brain is still developing and exposure to drugs could interfere with these carefully orchestrated developmental changes. Today we know that the last part of the brain to fully mature is the prefrontal cortex, a region that governs judgment and decision-making functions. This may help explain why teens are prone to risk-taking and to experimentation with alcohol and other drugs.

Research also shows that adolescents who abuse prescription drugs are twice as likely to have engaged in delinquent behavior and nearly three times as likely to have experienced an episode of major depression compared to teens who did not abuse prescription medications over the past year. Finally, several studies link the illicit use of prescription drugs with increased rates of cigarette smoking, heavy drinking, and marijuana and other illicit drug use in adolescents and young adults in the U.S.

Older adults represent another area for particular concern. Although this group currently comprises just 13 percent of the U.S. population, they receive approximately one-third of all medications prescribed in the Nation. In a culture in which medications are considered a “quick fix” for whatever ails you, combined with the greater rates of lifetime drug abuse among the “baby boom” generation as compared to those in the current older generation relative to its size, it is possible that the number of persons aged 50 or older abusing prescription drugs could increase 190 percent over the next two decades, from 911,000 in 2001 to almost 2.7 million in 2020.[4] Because older adults also experience higher rates of other illness as well as normal changes in drug metabolism, it makes sense that even moderate abuse or unintentional misuse of prescription drugs by elderly persons could lead to more severe health consequences. Therefore, physicians need to be aware of the possibility of abuse and to discuss the health implications with their patients.

What is NIDA doing about it?

Recognizing the dangerous trend of prescription drug abuse as well as the need to promote additional research on the subject and to inform the public, physicians, pharmacists, and others, NIDA first launched its prescription drug abuse public health initiative in 2001. Through NIDA’s support of surveillance instruments, including our Community Epidemiology Work Group and the Monitoring the Future survey, we continuously monitor trends in all forms of drug abuse, including the abuse of prescribed medications. In addition, NIDA and ONDCP are co-sponsoring an initiative on designing appropriate questions for screening and brief interventions for prescription drug abuse. Identifying trends as soon as they begin to surface in the population helps NIDA continue to lead the effort to surmount increasing abuse through a multi-pronged strategy intended to complement and expand our already robust portfolio of basic, preclinical, and clinical research and educational and outreach initiatives targeting the prescription drug phenomenon.

Targeted research initiatives. Although opioid medications effectively treat pain, their addiction risk presents a dilemma for healthcare providers who seek to relieve suffering while preventing drug abuse and addiction. Little is yet known about the risk for addiction among those being treated for chronic pain, or how basic pain mechanisms interact with prescription opioids to influence addiction potential. Therefore, NIDA recently launched a research initiative on "Prescription Opioid Use and Abuse in the Treatment of Pain," which encourages a multidisciplinary approach using both human and animal studies from across the sciences to examine factors (including pain itself) that predispose or protect against opioid abuse and addiction. Funded grants cover clinical neurobiology, genetics, molecular biology, prevention, treatment, and services research. This type of information will help develop screening and diagnostic tools that physicians can use to assess the potential for prescription drug abuse in their patients. Because opioid medications are prescribed for all ages and populations, NIDA is also encouraging research that assesses the effects of prescription opioid abuse by pregnant women, children, and adolescents, and how it might increase the lifetime risk of substance abuse and addiction.

Another important initiative pertains to the development of new approaches to treat pain, which reduce the potential for abuse. For example, compounds are being developed that act on a combination of two distinct opioid receptors (mu and delta), preclinical studies showing them to induce strong analgesia without producing tolerance or dependence. Researchers are also getting closer to developing a new generation of non–opioid-based medications for pain that would circumvent the brain reward pathways, thereby greatly reducing abuse potential. Included are compounds that work through a cannabinoid receptor subtype located primarily in the peripheral nervous system. NIDA is also exploring the use of “neurofeedback,” where patients learn to regulate neural activity in specific brain regions by getting pictorial representations from the activity in those areas fed back to them in real-time. This technique has shown promising results for altering the perception of pain in healthy adults and chronic pain patients and could even evolve into a powerful psychotherapeutic intervention capable of rescuing the circuits and behaviors impaired by addiction.

NIDA is also leading efforts in the treatment of addiction to prescription pain relievers. Our Clinical Trials Network is sponsoring the first large-scale, multi-site national study on the treatment of addiction to prescription pain medication, testing the effectiveness of buprenorphine/naloxone, a medication used in the treatment of heroin addiction, along with different models of drug counseling.

Education and Outreach. Education is a critical component of any effort to curb the abuse of prescription medications and must target every segment of society. For example, NIDA is advancing addiction awareness, prevention, and treatment in primary care practices, including the diagnosis of prescription drug abuse, having established four Centers of Excellence for Physician Information. Intended to serve as national models, the Centers will target physicians-in-training, including medical students and resident physicians in primary care specialties (e.g., internal medicine, family practice, and pediatrics). In a more general vein, we will also continue our close collaborations with the Office of National Drug Control Policy, SAMHSA, and other Federal agencies, as well as professional associations with a strong interest in preserving public health. NIDA recently sponsored a 2-day meeting in conjunction with the American Medical Association and the NIH Pain Consortium (an NIH initiative established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain), where more than 500 medical professionals, scientific researchers, and interested members of the public had a chance to dialogue about the problems of prescription opioid abuse and to learn about new areas of research.

Prevention strategies. Because prescription drugs are safe and effective when used properly and are broadly marketed to the public, the notion that they are also harmful and addictive when abused can be a difficult one to convey. Thus, we need focused research to discover targeted communication strategies that effectively address this problem. Reaching this goal may be significantly more complex and nuanced than developing and deploying effective programs for the prevention of abuse of illicit drugs, but good prevention messages based on scientific evidence will be difficult to ignore.

Conclusion

In conclusion, it is hardly surprising that the availability of more, new, better, and safer psychotherapeutics has been followed by a huge upswing in the prevalence of their non-medical use and abuse by varied populations. We should be seriously concerned: for although prescription drugs can be powerful allies, they also pose serious health risks related to their abuse, which can lead to addiction and to death. It will be a question of balance, difficult to achieve, so that people suffering from chronic pain, ADHD, or anxiety can get the relief they need while minimizing the potential for abuse.

Consistent with one of NIDA's most important goals, our response has been framed by our commitment to translate what we know from research to help the public better understand drug abuse and addiction, and to develop more effective strategies for their prevention and treatment.

Thank you for the opportunity to provide this information to you.



[1] The NSDUH Report: Patterns and Trends in Nonmedical Prescription Pain Reliever Use: 2002 to 2005, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, 2007.

[2] For purposes of this testimony, the focus will be only on psychotherapeutic drugs, so even though NIDA’s prescription drug portfolio includes work on other prescribed drug categories, such as anabolic steroids, these will be excluded from this discussion.

[3] Boyd et al. Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district. Drug and Alchol Dependence 81:37-45, 2006.

[4] Colliver JD, Compton WM, Grroerer JC, Condon, T. Projecting drug use among aging baby boomers in 2020.

Ann Epidemiol. 2006 Apr;16(4):257-65

Last revised: April 19, 2011
  

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NIDA InfoFacts: Stimulant ADHD Medications - Methylphenidate and Amphetamines

Stimulant medications (e.g., methylphenidate and amphetamines) are often prescribed to treat individuals diagnosed with attention-deficit hyperactivity disorder (ADHD). ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. This pattern of behavior usually becomes evident in the preschool or early elementary years, and the median age of onset of ADHD symptoms is 7 years. For many individuals, ADHD symptoms improve during adolescence or as age increases, but the disorder can persist into adulthood. In the United States, ADHD is diagnosed in an estimated 8 percent of children ages 4–17 and in 2.9–4.4 percent of adults.1,2,3
How Do Prescription Stimulants Affect the Brain?

All stimulants work by increasing dopamine levels in the brain—dopamine is a brain chemical (or neurotransmitter) associated with pleasure, movement, and attention. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine, which are similar to the natural production of the chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. However, when taken in doses and routes other than those prescribed, stimulants can increase brain dopamine in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.
What Is the Role of Stimulants in the Treatment of ADHD?

Treatment of ADHD with stimulants, often in conjunction with psychotherapy, helps to improve the symptoms of ADHD, as well as the self-esteem, cognition, and social and family interactions of the patient. The most commonly prescribed medications include amphetamines (e.g., Adderall®, a mix of amphetamine salts) and methylphenidate (e.g., Ritalin and Concerta—a formulation that releases medication in the body over a period of time). These medications have a paradoxically calming and “focusing” effect on individuals with ADHD. Researchers speculate that because methylphenidate amplifies the release of dopamine, it can improve attention and focus in individuals who have dopamine signals that are weak.4

One of the most controversial issues in child psychiatry is whether the use of stimulant medications to treat ADHD increases the risk of substance abuse in adulthood. Research thus far suggests that individuals with ADHD do not become addicted to their stimulant medications when taken in the form and dosage prescribed by their doctors. Furthermore, several studies report that stimulant therapy in childhood does not increase the risk for subsequent drug and alcohol abuse disorders later in life.5,6,7 More research is needed, however, particularly in adolescents treated with stimulant medications.
Why and How Are Prescription Stimulants Abused?

Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high). For the former, they suppress appetite (to facilitate weight loss), increase wakefulness, and increase focus and attention. The euphoric effects of stimulants usually occur when they are crushed and then snorted or injected. Some abusers dissolve the tablets in water and inject the mixture. Complications from this method of use can arise because insoluble fillers in the tablets can block small blood vessels.
What Adverse Effects Does Prescription Stimulant Abuse Have on Health?

Stimulants can increase blood pressure, heart rate, body temperature, and decrease sleep and appetite, which can lead to malnutrition and its consequences. Repeated use of stimulants can lead to feelings of hostility and paranoia. At high doses, they can lead to serious cardiovascular complications, including stroke.

Addiction to stimulants is also a very real consideration for anyone taking them without medical supervision. This most likely occurs because stimulants, when taken in doses and routes other than those prescribed by a doctor, can induce a rapid rise in dopamine in the brain. Furthermore, if stimulants are used chronically, withdrawal symptoms—including fatigue, depression, and disturbed sleep patterns—can emerge when the drugs are discontinued.
How Widespread Is Prescription Stimulant Abuse?

Monitoring the Future Survey*
Each year, the Monitoring the Future (MTF) survey assesses the extent of drug use among 8th-, 10th-, and 12th-graders nationwide. For amphetamines and methylphenidate, the survey measures only past-year use, which refers to use at least once during the year preceding an individual’s response to the survey. Use outside of medical supervision was first measured in the study in 2001; nonmedical use of stimulants has been falling since then, with total declines between 25 percent and 42 percent at each grade level surveyed. MTF data for 2008 indicate past-year nonmedical use of Ritalin by 1.6 percent of 8th-graders, 2.9 percent of 10th-graders, and 3.4 percent of 12th-graders.

Since its peak in the mid-1990s, annual prevalence of amphetamine use fell by one-half among 8th-graders to 4.5 percent and by nearly one-half among 10th-graders to 6.4 percent in 2008. Amphetamine use peaked somewhat later among 12th-graders and has fallen by more than one-third to 6.8 percent by 2008. Although general nonmedical use of prescription stimulants is declining in this group, when asked, “What amphetamines have you taken during the last year without a doctor’s orders?” 2.8 percent of all 12th-graders surveyed in 2007 reported they had used Adderall. Amphetamines rank third among 12th-graders for past-year illicit drug use.
Other Information Sources

For more information on treating ADHD, visit the Web site for the National Institute of Mental Health, National Institutes of Health, at www.nimh.nih.gov.
For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy.gov/.

WISE UP JOURNAL - BEHAVIOUR DRUGS GIVEN TO FOUR YEAR OLDS PROMPTS CALL FOR INQUIRY.

Behaviour drugs given to four-year-olds prompt calls for inquiry

Guardian

18.03.2011
By Rowenna Davis

ets.ADHD medication given in breach of NHS guidelines as professor says parents putting pressure on GPs

Children as young as four are being given Ritalin-style medication for behavioural problems in breach of NHS guidelines, the Guardian has discovered, prompting the leading psychological society to call for a national review.

Family-based therapy is recommended for treating children with ADHD (attention deficit hyperactivity disorder), with prescription drugs used only for children over six years old and as a last resort.

The figures, based on data from 479 GPs, show prescription rates were highest for children aged six to 12, doubling to just over eight per 1,000 in the five years up to 2008. Children aged 13 to 17 had the second highest rate at six per 1,000, while those aged 25 and over had less than one per 1,000.

Concern is greatest over children under six who should not be receiving drugs at all, says the National Institute for Health and Clinical Excellence (Nice).

There are no reliable figures for how many children under six have been given Ritalin. But Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who chaired the Nice guideline committee, confirmed that he had heard reliable reports of children in nursery and pre-school being prescribed medication unnecessarily, and that it was often parents who were putting pressure on GPs.

He said: “There are two reasons why parents go shopping for a diagnosis. The first is to improve their child’s performance at school, and the second is to get access to benefits. There are always GPs that will do it, but it’s wrong to give a child a diagnosis without also consulting schools and teachers.”

In one case seen by the Guardian, a five-year-old from the West Midlands was found to be receiving a double dose of methylphenidate, commonly known by the brand name Ritalin, the drug used to treat ADHD, despite his school insisting that he is “among the best-behaved children in his class”.

In notes seen by the leading educational psychologist in the case, the boy’s headteacher reports that the school does not believe he has ADHD, but that the medication is being prescribed “to help mum at home”.

In another case in the West Midlands a five-year-old was put on the drugs for three years at the request of his parents without any consultation with teachers or psychologists.

Speaking on behalf of the British Psychological Society, Peter Kinderman, chair of the division of clinical psychology, said he supported calls for a review, saying he would be concerned if children were being prescribed medication as a quick fix.

He added that mental health services were already “grossly under-resourced” and that cuts were likely to put services to children at risk.

Kinderman expressed particular worries about the cases uncovered by the Guardian. “Many psychologists are very concerned at the use of psychiatric and medical diagnoses in cases such as mild social anxiety or shyness, not only because of doubts about the validity of many of the diagnostic approaches, but because of the possible adverse effects.”

But Dinah Jayson, consultant child and adolescent psychiatrist at Trafford general hospital and a spokesperson for the Royal College of Psychiatrists, insisted that in some cases it could be “cruel” not to treat children of any age if all other options had been exhausted.

She said: “With every child there is a risk of doing something but there is also a risk of doing nothing. We know early [medical] intervention can help children who would otherwise be losing out.”

“GPs and psychiatrists are much more aware of mental illness, and the drugs are so effective and have such a big effect that it’s tipped the balance. They [drugs] can make a real difference not just to the child but to households and classrooms where children may be causing real disruption.”

According to Nice guidelines, between 1% and 9% of young people in the UK now have some form of ADHD, depending on the criteria used. NHS figures show a rise in all methylphenidate prescriptions across all age groups by almost 60% in five years, rising from 389,200 in 2005 to 610,200 in 2009.

Side-effects include sleeplessness, appetite loss and reduced growth rates. Wong, who says the long-term effects are inconclusive, recently received a €3m (£2.6m) grant from the European commission to investigate side-effects further.

Professor Paul Cooper, a psychologist and professor of education based at Leicester University, who has completed qualitative research with adolescents on psychostimulant medication, expressed concerns about the possible effects of the drugs on personality development.

“Some young people say that it affects their personality but accept it because it gets mum and dad off their case or stops them getting into trouble,” he said. “They don’t like it, but take it for the benefit of other people.”

Medical experts in the West Midlands say over-prescription continues to be a problem. “This whole area needs public scrutiny – there has to be some kind of review,” said the educational psychologist who oversaw the cases but did not want to be named. “Handing out strong psychotropic drugs to children should be a last resort, but they’re being handed out like sweets.”

BIOSOCIETIES - JUNE 2007- HOW A SOCIETY CONSTRUCTS THE NORMS OF MENTAL ILLNESS AND MENTAL HEALTH - " IL BAMABINO E LE DROGHE "

I Bambini e le Droghe’: The Right to Ritalin vs the Right to Childhood in Italy
Giovanni Frazzettoa1 c1, Sinéad Keenana1 and Ilina Singha1
a1 BIOS, London School of Economics and Political Science, Houghton Street, London WC2A 2AE UK

DRUG AN INFANT OR STROKE A DOG TO STAY CALM?

Abstract

Despite the widespread consumption of stimulant drugs such as Ritalin (methylphenidate) for the treatment of children with attention deficit/hyperactivity disorder (ADHD), understanding of the differing national realities of the ADHD/methylphenidate phenomenon is especially impoverished. In this article, we give an introductory description of the scientific-historical, cultural and ideological factors that have shaped the diagnosis of ADHD and its treatment in Italy. Qualitative empirical analysis of the national debate on the use of methylphenidate and of parents’ experiences with the drug reveals that, in the Italian context, the evolution of the ADHD/Ritalin phenomenon has been largely shaped by dynamics within the country’s psychiatric practices and health system, as well as by attitudes towards mental illness. We suggest that in Italy, the current dynamics in the regulation of methylphenidate inscribe ADHD diagnosis and stimulant drug treatment as moral choices. On both the political and the familial level, these choices are grounded in sometimes opposing conceptions of vital civil rights and national ideals: the ‘right to medication’, the ‘right to mental health care’ and the ‘right to childhood’. Our study illustrates that close analysis of specific cultural contexts can be useful in understanding how attitudes towards mental disorders and the use of psychotropic drugs can be shaped by the social practices and medical habits of a country.

National Institute for Clinical Excellence (NICE) - Psychiatrists call for greater access to NICE-recommended psychological therapies

Access to psychological therapies in hospital wards "falls far short of acceptable standards", according to a new report.
While most wards provide training in basic psychological therapies, research suggests that less than half (38%) of patients have been offered supportive counselling. Furthermore, figures show less than a third (29%) of patients receive access to talking therapies, and almost a quarter of patients that request such therapy do not actually receive it.
The figures come from a report published by the Royal College of Psychiatrists, which outlines ten standards that it says are essential for the treatment of working-age adult inpatients in mental healthcare wards.
One standard calls for access to psychological treatment, stating that psychological therapies are "an integral part of the recovery process”.
It adds that hospital wards should provide patients with access to a range of psychological therapies, and that this treatment should be provided by staff that have the appropriate skills and experience.
This follows NICE's updated guideline on interventions in the treatment and management of schizophrenia in primary and secondary care.
The guideline recommends the use of psychological interventions, such as cognitive behavioural therapy (CBT), family interventions and arts therapies for the treatment of people with schizophrenia. It also recommends that healthcare professionals providing psychological treatment should have the appropriate skills and competence to deliver it.
'Psychological therapies' is the general term used to describe meetings with therapists to discuss feelings and thoughts and how these might affect a person's life and wellbeing.
NICE's updated guideline on schizophrenia recommends that cognitive behavioural therapy (CBT) - a form of psychological therapy - should be offered for all people with schizophrenia. This can be started at an acute phase or at later stages in inpatient settings.
The updated NICE guideline on schizophrenia was published in March 2009, and includes a range of implementation tools designed to help support its use.
This includes a guide to resources, which is aimed at assisting healthcare professionals put the guideline into practice.
Among the resources listed, are journals on arts therapies that provide helpful information on the use of arts therapies, as recommended the NICE guideline.



Access to therapeutic services should also be available as the first 'port of call' for children thought to have ADHD before they were given medication.
 
30 June 2011

CHILDREN AND YOUNG PEOPLE NOW - CRITICS CALL FOR A REVIEW OF PSYCHOTROPIC DRUGS FOR CHILDREN - JUNE 2011

Critics call for review of ADHD drugs
By Joe Lepper Monday, 06 June 2011

Educational psychologists have criticised the use of psychotropic drugs such as Ritalin to treat children with behavioural disorders including ADHD.

SEE ABOVE THE "BLACK BOX WARNING" MAKING IT ILLEGAL TO HAVE DRUG WITHOUT PRESCRIPTION AS IT IS DANGEROUS

http://www.channel4.com/news/adhd-drugs-prescribed-to-under-6s-against guidelines

SEE "SPECIAL REPORT" ON CHANNEL 4 NEWS BY CLICKING ON LINK ABOVE.

The Association of Educational Psychologists (AEP) has said there is "insufficient knowledge" about the effect of such drugs on children, in particular their brain development.

It said that further research is urgently needed and is calling on the government to carry out a review into the use of these drugs on school-aged children.

The AEP also fears that new broader diagnostic criteria for mental health, which are due to be introduced in 2013, will make it easier for health professionals to prescribe psychotropic drugs to children.

AEP general secretary Kate Fallon said: "There is a danger that we rely on the ‘quick fix’ for children with conditions such as ADHD, which frequently means the prescription of medication such as Ritalin instead of a number of other possible interventions.

"These are very powerful drugs that should not be prescribed lightly and really should be a last resort. We need a collaborative approach to the treatment of these conditions, which includes further research into the effect of prescribing such potent medications to such young children."

A Department of Health spokesman said: "When diagnosing and treating children for ADHD, clinicians should follow guidelines set out by the National Institute for Health and Clinical Excellence.

"Putting together the right treatment plan is the responsibility of a number of clinical experts, working as a multidisciplinary team with the individual concerned and their family."

NURSING IN PRACTICE - 7TH JUNE 2011-AEP CALLS FOR NATIONAL REVIEW

http://www.channel4.com/news/adhd-drugs-prescribed-to-under-6s-against-guidelines

TO WATCH "SPECIAL REPORT" ON CHANNEL 4 NEWS CLICK ON ABOVE LINK.
 
Tuesday 7th June 2011
The effect of drugs used to treat children with behavioural issues must be re-evaluated, according to psychologists.

It is not fully known how a child's development could be affected by the use of medication for conditions such as Attention Deficit Hyperactivity Disorder (ADHD), it was revealed.

The Association of Educational Psychologists (AEP) is urging the government to re-examine the use of strong psychotropic drugs and undertake more research.

This follows concerns that such drugs are being used as a 'quick fix' to treat young children.

The call came as a Channel 4 News investigation found that children under six years of age are being 'chemically coshed' with drugs after being diagnosed with conditions like ADHD.

The investigation, due to be aired on Monday, found a massive increase in the amount of ADHD medicine being prescribed in Britain.

The investigation also claims that drugs are increasingly being prescribed to children aged under six, which is against manufacturers' guidelines, and those issued by the National Institute for Health and Clinical Excellence (NICE).

AEP General Secretary, Kate Fallon, said: "There is a danger that we rely on the 'quick fix' for children with conditions such as ADHD, which frequently means the prescription of medication such as Ritalin instead of a number of other possible interventions."

In a statement, the AEP said: "The Association of Educational Psychologists considers that a national review into the use of psychotropic drugs, such as Ritalin, on school-aged children in the UK is urgently needed."

Copyright Press Association 2011Home


Highlighting the need for alternatives to psychotropic drugs in the treatment of ADHD
June 14th, 2011

Many thousands of children in Britain are being routinely prescribed Attention Deficit Hyperactivity Disorder drugs such as Ritalin.  A staggering 389,000 prescriptions for ADHD medications were handed out by doctors in 2005; since then, these figures have nearly doubled.    Furthermore, children under the age of six are being prescribed these stimulants against the guidelines issued both by the manufacturers and the National Institute for Health and Clinical Excellence (NICE), as reported in a recent article on Channel-4 news.

Kate Fallon, General Secretary of the Association of Educational Psychologists (AEP), said: “We are calling for an urgent national review of the use of psychotropic drugs, like Ritalin, and how they are being used, because we are concerned about the long-term effects on children’s brains.”

The majority of prescriptions for ADHD work to ease symptoms, which include inability to concentrate, hyperactivity and impulsivity.  However, whilst these drugs can be effective in many cases, it must also be emphasised they are not positive in all, and the side effects experienced by the user can have serious, even devastating consequences.  Darren Hucknall’s son Harry hanged himself last year when he was just 10 years old, having been prescribed Prozac for depression and Ritalin for ADHD.  Speaking to Channel 4 News, Mr Hucknall explained how his son had “managed OK” before being put on the drugs, and when questioning his doctor about the need for such powerful drugs at such a young age was told that Harry had “a chemical imbalance in his brain.”  While the coroner said that it was difficult to know whether the drugs had contributed to Harry’s death, he strongly queried the ethics of such practice.

A similar approach to a diagnosis of ADHD came across overwhelmingly in the film, with information on alternative treatment options and dietary advice given to the parents of these children almost nonexistent.  N.H.,  from the West Midlands, stated that his son was first prescribed a psychotropic drug when he was five, without any offer of counselling or therapy before he was given the drugs, which again is against all national guidelines.