Emergency Department Visits Involving ADHD Stimulant Medications
According to the Drug Abuse Warning Network (DAWN) for 2004:
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Studies in recent years have noted a rise in the number of children and adults who meet the criteria for a diagnosis of attention-deficit/hyperactivity disorder (ADHD), and more prescriptions are being written for the stimulants used to treat ADHD.1,2,3 In 2006, a Food and Drug Administration (FDA) advisory panel recognized the danger of side effects for ADHD stimulants and recommended that these medications carry a warning of an increased potential for cardiac problems, such as hypertension, cardiac arrest, and stroke.4 Increased prescribing of ADHD drugs will likely lead to more people experiencing these potential side effects and to increased use of these drugs for nonmedical purposes.5 The potential for greater access to these medications by persons without a prescription is supported by research, which has shown that peers are a common source of ADHD medications.6 The potential for medical problems may be exacerbated by the improper use of ADHD drugs or their use in combination with alcohol and other drugs.
The 2002 National Survey on Drug Use and Health (NSDUH) reported that an estimated 7.3 million persons aged 12 years or older in 2002 used ADHD stimulants nonmedically at some time in their lives. Among persons aged 12 to 17 years, 2.6 percent used ADHD stimulants nonmedically at some time in their lives; among those aged 18 to 25 years, the figure is 5.9 percent.7
The Drug Abuse Warning Network (DAWN), which collects data from a national sample of short-term, general, non-Federal hospitals,8 provides estimates of drug-related emergency department (ED) visits. The findings presented in this issue of The DAWN Report are based on ED visits related to two of the pharmaceuticals commonly used to treat ADHD—methylphenidate and amphetamine-dextroamphetamine. DAWN includes both generic and branded drugs, including methylphenidate (marketed as RitalinTM and ConcertaTM) and amphetamine-dextroamphetamine (marketed as AdderallTM). Based on 2004 DAWN data, this report examines the reasons for the ED visits involving ADHD drugs, the relative frequency of these ED visits for different age groups, and the use of alcohol and other drugs in combination with ADHD medications.
Overview
About 106 million ED visits occurred in short-term, general, non-Federal hospitals in the United States in 2004.9 DAWN estimates that about 2.5 million of these ED visits were drug related. The ADHD drugs examined in this report were implicated in less than 1 percent of those drug-related visits. Methylphenidate was involved in an estimated 5,148 ED visits, and amphetamine-dextroamphetamine was involved in an estimated 5,119 ED visits. A total of 10,146 ED visits involved one of these two drugs. (A few visits involved both drugs, so the total is slightly less than the sum of the drug-specific estimates.)
Reason for ED visits
Among the 10,146 ED visits involving these ADHD medications, nonmedical use accounted for 47 percent of the visits, and medical use accounted for 35 percent (Table 1). Nonmedical use includes cases where a higher than prescribed dose was used, a drug prescribed for another person was used, or there was other evidence in the medical record of drug misuse or abuse. An adverse reaction is a drug-related ED visit that represents the negative health consequences of using a medication as prescribed (medical use). The balance of visits were accounted for by accidental ingestions (11%) and suicide attempts (7%).10
Reason for visit | Methylphenidate ED visits |
Methylphenidate % of visits |
Amphetamine- dextroamphetamine ED visits |
Amphetamine- dextroamphetamine % of visits |
Totala ED visits |
Totala % of visits |
---|---|---|---|---|---|---|
a A few visits involved both drugs, so the totals are slightly less than the sum of the drug-specific estimates. b The total includes only the four types of ED visits shown. This excludes patients who presented to the ED specifically to seek admission to the hospital's detoxification or substance abuse treatment unit. Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update). |
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Totalb | 5,148 | 100% | 5,119 | 100% | 10,146 | 100% |
Nonmedical use | 2,446 | 48% | 2,303 | 45% | 4,747 | 47% |
Medical use | 1,768 | 34% | 1,760 | 34% | 3,523 | 35% |
Accidental ingestion | 601 | 12% | 668 | 13% | 1,154 | 11% |
Suicide attempt | 333 | 6% | 388 | 8% | 721 | 7% |
Patient age
The rates for nonmedical and medical use of the ADHD drugs generally decreased with age and were highest in persons aged 12 to 24 years. For persons aged 12 to 17 years, the rate of nonmedical and medical use for methylphenidate was the same, at 2.2 per 100,000 persons. The rate of nonmedical use for the two ADHD drugs combined was more than three times higher than for medical use for persons aged 18 to 24 years (5.5 vs. 1.6 per 100,000 population, respectively) (Figure 1).
Findings from another Office of Applied Studies (OAS) survey, NSDUH, suggest that nonmedical use of ADHD drugs is more frequent among those aged 18 to 25 years than among younger (e.g., aged 12 to 17 years) or older (aged 26 years or older) age groups. In contrast to NSDUH, DAWN found that the number of ED visits resulting from nonmedical use was essentially the same for those aged 12 to 17 years and those aged 18 to 25 years (5.3 and 5.5 per 100,000 population, respectively). A difference was found for medical use, though, where the rate of ED visits resulting from medical use for patients aged 18 to 24 years was just half that found for patients aged 12 to 17 years (1.6 vs. 3.3 visits per 100,000 population, respectively). DAWN had a similar finding as NSDUH in that the rate of ED visits resulting from nonmedical use among older persons (aged 26 years or older) is lower than that found for those aged 12 to 24 years.
Combining nonmedical and medical use, the rate of ED visits resulting from methylphenidate was similar for patients aged 12 to 17 years and those aged 18 to 24 years (both are 4.4 per 100,000 population), while ED visits resulting from the use of amphetamine-dextroamphetamine were higher for those aged 12 to 17 years, compared with those aged 18 to 24 years (4.3 vs. 2.7 per 100,000 population, respectively).
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update). |
Drug | Medical use | Nonmedical use |
---|---|---|
12-17 | 2.2 | 2.2 |
18-24 | 1.1 | 3.3 |
25-34 | 0.3 | 0.6 |
35+ | 0.0 | 0.3 |
Drug | Medical use | Nonmedical use |
---|---|---|
12-17 | 1.2 | 3.1 |
18-24 | 0.5 | 2.2 |
25-34 | 0.3 | 0.4 |
35+ | 0.2 | 0.5 |
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update). |