WEDNESDAY, March 13, 2013 — Doctors need to reconsider prescribing memory- and focus-enhancing ADHD drugs to healthy children and teens, the American Academy of Neurology said in a position statement in the journal Neurology. The statement addresses the growing trend of taking ADHD medication, such as Adderall or Ritalin, as a study aid – something the AAN says poses not only health risks for patients, but ethical risks for doctors.

ADHD drugs help alleviate symptoms in people with ADHD, but more and more healthy people are using the drugs to help their school or work performance, according to the report. The practice of prescribing these drugs off-label (for a use for which they have not been approved by FDA) to people without ADHD is known as neuroenhancement. While it is completely legal, said William Graf, MD., lead author of the statement and professor of pediatrics and neurology at Yale School of Medicine, it is ethically questionable.

Use of ADHD medication is growing steadily, according to the 2012 Drug Trend Report by Express Scripts, a pharmacy benefit management organization. The report found that in 2012, spending on ADHD medication rose 14.2 percent over 2011 levels, and that, starting at age 19, nearly 60 percent of people prescribed ADHD medications have not been diagnosed with the condition.

There are rare cases when prescribing ADHD drugs for neuroenhancement would be okay, said Dr. Graf, for example, for a patient with a legitimately diagnosed cognitive problem.

“When we talk about neuroenhancement, the AAN has said that we will respect individual autonomy, and it would be permissible to prescribe stimulants off-label,” Dr. Graf said.

In the vast majority of cases, he added, people with slight memory or focusing problems don’t need ADHD medications.

"What these people really need is a good night's sleep and breakfast,” Graf said, “not ADHD medication.”

Ethical and Professional Issues: Giving Rx Drugs to Healthy People

The fundamental issue with prescribing ADHD medications to healthy individuals, especially to children and teens whose bodies are still developing, is that long-term use of these drugs can harm any patient's health, said Graf. And doctors who prescribe ADHD meds to healthy people need to even more concerned with potential side effects.

“It can lead to dependency, mental health changes and suicidal thoughts,” he explained. “The standards of safety have to be higher in healthy people.”

Prescribing drugs to people who are not diagnosed with an illness may also create a situation in which doctors are seen as drug dealers, the AAN statement said.

“Physicians remain the gatekeepers of prescription drugs, and their diagnostic decisions affect usage,” the authors wrote. “Prescribing drugs for healthy pediatric patients who are requesting neuroenhancement, either openly or covertly, may jeopardize the integrity of the profession.”

Graf also believes that students who use these drugs to help them study are at an unfair advantage.

“You have other ethical principles like justice,” he said. “If some are getting it in the classroom and others aren’t, is it fair?”

ADHD-Drug Use – A Growing Problem

The Express Scripts report indicates that the older the patient the more likely they will be given off-label prescriptions of ADHD meds.

“The proportion of patients using medications indicated for ADHD who actually had a claim with a diagnosis for the condition decreases with age after a peak of 80 percent for children 4-5, to a low of 27 percent for patient ages 41 and older,” the report found.

In 2003, the number of prescriptions for ADHD medication nearly reached 30 million, according to IMS Health, an organization that tracks such numbers for the healthcare industry. In 2011, the last year data for which data is available, the number of prescriptions skyrocketed to approximately 55 million. Over that same time span, the number of diagnoses of ADHD increased by about 3 percent every year, according to the U.S. Centers for Disease Control and Prevention.

Rachel Klein, PhD, professor of child and adolescent psychiatry in the department of Child and Adolescent Psychiatry at New York University Langone Medical Center, said the ADHD prescription trend is likely to continue.

“The medications are very effective, and when we have an effective treatment it tends to be overused,” Dr. Klein said. “The problem is that these medications work in people who don’t have ADHD, so people try to reframe the issue to get a diagnosis of ADHD so they can get the medication.”

Graf said the numbers make it clear that doctors need to become more judicious in prescribing ADHD medications, especially when parents are pushing for the drug for their kids.

“Physicians need to be on their toes a little more,” said Graf.

On the other hand, parents sometimes leave the doctors' office feeling pressured to give their child ADHD medication.

“I’ve talked to parents who are surprised at how much physicians want to prescribe the medication," he said.

AAN stressed in the statement that they weren’t seeking to make any policy changes, but were simply educating doctors about the potential dangers of neuroenhancement.

However, said Graf, “The question is, do we draw the line at some point and say this is not a good idea? This a discussion that I think we should be having as a society.”