View Full Version : "Drowned in a Stream of Prescriptions"


demuregeek
02-03-13, 10:24 AM
How come the NYT can pick up every abuse of meds scare story, but can't seem to pull together something on how many people suffer from not getting treatment, or how many people turn their lives around by using meds responsibly?!? :mad:

http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?pagewanted=all&_r=0

Dizfriz
02-03-13, 10:45 AM
How come the NYT can pick up every abuse of meds scare story, but can't seem to pull together something on how many people suffer from not getting treatment, or how many people turn their lives around by using meds responsibly?!? :mad:

http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?pagewanted=all&_r=0


I read it and it was pretty bad for the most part especially the emphasis on how addictive Adderol was. The main result of this article is that many parents will be frightened off of trying to use medication for their ADHD children.

The part focusing on how badly some physicians did their work was better but this was a complicated case and from the evidence shown in the article, we cannot tell if the medication was responsible for his problems.

Dizfriz

demuregeek
02-04-13, 12:34 PM
On one of the Scientific American blogs, Melody brings up some good points in her response to the NYT article.

http://blogs.scientificamerican.com/cargo-cult-contrarian/2013/02/04/adderall/

APSJ
02-04-13, 08:59 PM
I read this article, and actually thought it was more balanced than most, though that's not saying much. What I found somewhat exasperating was the fact that the author actually did a pretty good job at capturing some of the major problems with diagnosis and treatment, but didn't bother to examine them. The situation it describes is tragic, but hardly representative of what most people will experience if prescribed ADHD for adderall. I'd hate to think that in urging vigilance against such rare tragedies, it exacerbates the issues so many face finding a doctor to treat their ADHD, and making their family and friends understand its necessity.

The article highlights the actions of the doctors who prescribed medication to the subject of the article, seeming to suggest negligence on their part, and in doing so notes a couple of things:

1. The doctors did not heed the parents' warnings. One doctor assumed they were philosophically opposed to medication.

Certainly a doctor shouldn't discount information from parents, and maybe the doctors involved were negligent, if all occurred as described in the article. However, as a general matter, surely doctors shouldn't be expected to cease prescribing medication to a patient who reports positive results, and who they see no problems in, because a family member confronts them and insists the medication is having horrible effects.

The unfortunate fact is, many people are quite ignorant about ADHD and the medications that are prescribed for it, and do believe that they're rarely or never indicated, or have a high risk of serious side effects. It seems probable, particularly given some of the experiences we've seen on the forum, that the doctors had been confronted with such knee jerk anti-medication people before, and were thus not as alarmed as they should have been when these parents presented legitimate, but similar sounding concerns. So, while it was a problem that the doctors weren't more concerned about adverse effects, their lack of concern itself may be attributable in part to the general fear and stigma associated with the use of stimulant medication for ADHD.

2. The doctors only spent short periods with the patient.

Again, certainly doctors should spend whatever time is needed to ensure they are prescribing appropriate medication, and that it's well tolerated. However, realistically, there is greater demand for psychiatric care than there are psychiatrists in many areas, particularly child psychiatrists. My understanding is that reimbursement for medication management appointments from insurance companies is also quite low relative to others, and seems to assume quick appointments. So, you have doctors under significant pressure to see more patients more quickly. This doesn't excuse negligence in any given case, but on the larger scale, it does seem a situation that should be expected to lead to it.

3. They didn't do talk therapy in concert with the medication.

I often see the 'moderate position' on medication presented as being that it's sometimes necessary, but should never be used alone. In a perfect world, certainly talk therapy is a good idea, and probably will give some added benefit. However, therapy is time-consuming and expensive, and medication alone often *is* highly effective. Absent complicating factors, it seems entirely reasonable to prescribe medication to a patient with ADHD who, for whatever reason, isn't in a position to participate in talk therapy.

Dizfriz
02-05-13, 04:12 PM
I read this article, and actually thought it was more balanced than most, though that's not saying much. What I found somewhat exasperating was the fact that the author actually did a pretty good job at capturing some of the major problems with diagnosis and treatment, but didn't bother to examine them. This was my major issue with the article. While the physician shortcomings are real, they were not put into perspective.

The situation it describes is tragic, but hardly representative of what most people will experience if prescribed ADHD for adderall. I'd hate to think that in urging vigilance against such rare tragedies, it exacerbates the issues so many face finding a doctor to treat their ADHD, and making their family and friends understand its necessity.

The article highlights the actions of the doctors who prescribed medication to the subject of the article, seeming to suggest negligence on their part, and in doing so notes a couple of things:

1. The doctors did not heed the parents' warnings. One doctor assumed they were philosophically opposed to medication.

Certainly a doctor shouldn't discount information from parents, and maybe the doctors involved were negligent, if all occurred as described in the article. However, as a general matter, surely doctors shouldn't be expected to cease prescribing medication to a patient who reports positive results, and who they see no problems in, because a family member confronts them and insists the medication is having horrible effects. [This is true. If the physician did not have a release from the patient, then the doctor would not be allowed to discuss the case in any way under most state's rules. Even with that, many are reluctant to discuss an adult patient with family members. The consequences for breaking patient confidentiality can be pretty severe.

It is unfortunate but true that under the current laws an adult is given the right to be self destructive. Only when there is an immediate danger can action be taken. If the patient says he or she is doing ok, there is not much you can do. If a patient is put into a hospital involuntarily for suicide concerns, all they have to do is say that they are not thinking about hurting themselves and all the hospital can do is turn them loose with an appointment with a therapist or psychiatrist even if they are pretty sure the patient is planning to commit suicide.

The unfortunate fact is, many people are quite ignorant about ADHD and the medications that are prescribed for it, and do believe that they're rarely or never indicated, or have a high risk of serious side effects. It seems probable, particularly given some of the experiences we've seen on the forum, that the doctors had been confronted with such knee jerk anti-medication people before, and were thus not as alarmed as they should have been when these parents presented legitimate, but similar sounding concerns. So, while it was a problem that the doctors weren't more concerned about adverse effects, their lack of concern itself may be attributable in part to the general fear and stigma associated with the use of stimulant medication for ADHD.

2. The doctors only spent short periods with the patient.

Again, certainly doctors should spend whatever time is needed to ensure they are prescribing appropriate medication, and that it's well tolerated. However, realistically, there is greater demand for psychiatric care than there are psychiatrists in many areas, particularly child psychiatrists. My understanding is that reimbursement for medication management appointments from insurance companies is also quite low relative to others, and seems to assume quick appointments. So, you have doctors under significant pressure to see more patients more quickly. This doesn't excuse negligence in any given case, but on the larger scale, it does seem a situation that should be expected to lead to it. The insurance pay rates are such that many psychiatrists allot only 15 minutes for a med check. Some do longer but 15 minutes is common.

3. They didn't do talk therapy in concert with the medication.

I often see the 'moderate position' on medication presented as being that it's sometimes necessary, but should never be used alone. In a perfect world, certainly talk therapy is a good idea, and probably will give some added benefit. However, therapy is time-consuming and expensive, and medication alone often *is* highly effective. Absent complicating factors, it seems entirely reasonable to prescribe medication to a patient with ADHD who, for whatever reason, isn't in a position to participate in talk therapy.Again due to pay rates, most psychiatrists no long do talk therapy. It just doesn't pay and there is often a long (months) waiting list for any kind of appointment. Unless the psychiatrist is committed to doing therapy, most farm it out to a mental health therapist.

This is not the way it should be perhaps, but it is the way it is.

Maybe the article can wake up some physicians but on the whole, while the article was not really all that bad, it was not all that good either. Not bad enough to condemn but not good enough to endorse.

What we don't know from the article is whether the death was due to the medication or if the medication abuse was a symptom of another disorder. Sometimes, if access to one drug is not available then another will be found to abuse or at least self medicate.

Don't have any answers though, just some thoughts.

Dizfriz

ana futura
02-05-13, 05:00 PM
Wow, Dr Parker was one of his doctors!

I'm going to have to collect my thoughts about this- it's upsetting to me that the Dr. Parker, who goes on and on about how hard dosing and meds are to figure out, is doing 15 minute med checks.

I personally have found Dr Parker's descriptions of the "med window" very useful. Yet here he his handing out 80mg IR to a kid who clearly should not have been on a dose like that...


Anyway, this is a dense article. It's going to take me a while to get through it. But so far, my first impression is that it's actually pretty good. What happened to Richard is a real problem, and it does seem to me like far too many doctors are unknowledgeable about dosing, to the point of being cavalier with a potentially dangerous medication.

However, it would have been nice if Richard's case was contrasted with someone who does well on stimulants.

demuregeek
02-06-13, 11:55 PM
The president of the American Academy of Child and Adolescent Psychiatry has <a href="http://www.nytimes.com/2013/02/07/opinion/treatment-of-adhd.html?_r=0">written the NYT a letter to the editor</a>. There's <a href="http://www.nytimes.com/2013/02/05/opinion/a-tale-of-adderall-abuse-and-suicide.html">collection of other replies</a> as well.

More reaction -- stories & opinion pieces that explicitly reference the NYT article:

<a href="http://www.huffingtonpost.com/larry-diller/richard-fee-adderall_b_2612410.html">Is an ADHD/Adderall Ice Age Ending?</a>
<a href="http://www.redandblack.com/views/our-take-illicit-adderall-use-not-without-consequences/article_05d0ee2c-6fe3-11e2-b4ff-001a4bcf6878.html">Our Take: Illicit Adderall use not without consequences</a>
<a href="http://www.ubspectrum.com/opinion/running-for-the-shelter-1.2983537">Running for the shelter: Prevalence of Adderall use in college should incite regulation discussion</a>
<a href="http://www.lsureveille.com/opinion/columnists/article_fc2898ae-70c1-11e2-b46c-001a4bcf6878.html">Adderall: Is the risk worth the reward?</a>
<a href="http://guardianlv.com/2013/02/over-the-counter-drugs/">Over-The-Counter Drugs </a>

...and stories about Adderall abuse that <em>just coincidentally</em> happened to be published immediately after the NYT piece went up:

<a href="http://www.downtownpublications.com/Articles-features-c-2013-02-06-214674.112113-ADHD-drugs-students-little-helper.html">ADHD drugs: students' little helper</a>
<a href="http://www.ctvnews.ca/health/canadian-students-abusing-adderall-to-get-edge-in-studying-1.1143205">Canadian students abusing Adderall to get edge in studying</a>
<a href="http://bc.ctvnews.ca/students-turn-to-campus-crack-for-competitive-edge-1.1142845">Students turn to ‘campus crack’ for competitive edge</a>
<a href="http://www.lawyersandsettlements.com/articles/adderall/interview-adderall-lawsuit-heart-attack-10-18445.html">Adderall: A Mother’s Heartbreak</a>
<a href="http://www.bgnews.com/campus/adderall-may-be-abused-for-studying/article_49896e0c-6e92-11e2-bec0-001a4bcf887a.html">Adderall may be abused for studying</a>

demuregeek
02-28-13, 07:45 AM
One more: Dr Kenny Handelman did a podcast episode on this story, recommending a few ways for prescribing doctors to try to head off this kind of problem. His take on the article is much more charitable than mine, :o

http://drkenny.com/adderall-addiction