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Sydney, our new ADHD capital

http://www.speedupsitstill.com/sydney_our_new_adhd_capital/

Everything that is now happening in Sydney has already happened and been exposed in Perth. Sydney hasn’t learned from Perth’s mistakes, it’s repeating them.

NSW Judge Speaks his Mind on ADHD Drugging

In April 2007 New South Wales (NSW) District Court Judge Paul Conlon, when sentencing a 21 year old man said that in his experience ADHD medications were causing a tide of criminality and drug abuse. ‘I have huge concerns. The tide of cases is amazing. I am starting to lose count of (the number of) offenders coming before the courts who were diagnosed at a very young age with ADHD for which they were “medicated”.’[1] Judge Conlon also said he had seen signs that children prescribed psycho-stimulant drugs like Ritalin went on to develop addiction to drugs like methamphetamine.

NSW ADHD Industry Reviews its Own Practice

Then New South Wales Health Minister Reba Meagher responded to Judge Paul Conlon’s comments by setting up a committee to review NSW ADHD diagnosing and prescribing. The review was conducted without public input and was restricted to a literature review, a survey of prescribers who described their prescribing practices and a review of the data from the NSW Stimulants Committee.

The review report identified that the review chairperson Professor Mitchell and two other committee members, Doctors Patrick Concannon and Paul Hutchins have served as advisors to manufacturers of ADHD drugs.[2] In addition many of the members were ADHD prescibers who were in part reviewing their own practice. All of the participants declared their connections to ADHD drug manufacturers but astonishingly claimed there were no conflicts of interest.

Predictably the review concluded that, ‘the overall impression was of conscientious doctors giving plenty of time trying to offer the best total management in these very complex situations, in spite of their frustration at the lack of additional resources when they felt that the child and family would have benefited from them.’[3]

The review, however, was hardly thorough or comprehensive. The audit of patients was restricted to 137 of the 19,382 (0.7%) patients and was restricted to a file review only. In other words only the clinician’s file notes were reviewed. There was no fresh diagnosis of the children by interviewing parents and teachers. Participation in the audit and the practice survey by prescribers was voluntary with only 207 of 367 prescribers cooperating.[4] The review described the 56% response rate of prescribers as ‘excellent’, despite the obvious bias that those who were confident in the rigour of their practices were more likely to participate.[5]

One of the most worrying aspects of the review was the wiilingness of clinicians to prescribe a cocktail of psychotropic drugs in conjunction with stimulants. The proportion of surveyed clinicians who prescribe other drugs with stimulants was; Clonidine (75%), Atypical antipsychotics (71%), SSRI antidepressants (66%), Anti-epileptic medications (55%), Tricyclic antidepressants (27%), Other antidepressants (14%), Conventional antipsychotics (12%).[6] Some of these drugs are contraindicated for stimulants and/or are not recomended for use in children.

The patterns of prescribing were similar to those in Western Australia with a minority of prescribers specialising in ADHD so that ‘for 7% of practices, patients with this condition comprised 51-90% of their patients and for one practice (0.5% of the sample) having patients with this condition accounting for more than 90% of their patients.’[7] The review also confirmed that New South Wales paediatricians, like their Western Australian colleagues, were far more likely to be frequent prescribers than a child psychiatrist.[8]

The review report stated that:

‘Many of the children and families were battling with very complex situations – in the diagnosis of the child, the comorbidities, and the interactions between the parents, siblings and the identified child. For many, the ADHD was a small part of the overall clinical picture but its ramifications were disproportionate — many children had significant learning difficulties, social problems, and other developmental conditions and were living in dysfunctional and sometimes chaotic families, including changes in carers. Several children were being reared by grandparents and a number were in foster homes or experiencing multiple placements. Domestic violence and parental substance abuse were not uncommon.’[9]

Typical of ADHD industry approach, these complexities were in practice ignored with pharmaceutical interventions being the simple solution to life’s complexities.

Given Professor Mitchell’s and Doctors Hutchins and Concannon’s pharmaceutical company connections, the findings of the review were hardly suprising. However, the treatment of Judge Conlon, subsequent to making his comments, was suprising and reflects the ADHD industry’s desperation to shut down debate. On February 25, 2008, The Sydney Daily Telegraph reported that as a result of a complaint, by an undisclosed ADHD support group, Judge Conlon was ‘gagged’ from making further comments on his experience of ADHD medications leading to drug abuse and criminality.[10] Judge Conlon had called on the medical profession to apply greater ‘professional vigour’. His reward was a ‘gag’ and a whitewash review by ADHD industry insiders.

Sydney Repeats Perth’s Mistakes

Everything that is happening in Sydney has happened and been exposed in Perth. Sydney hasn’t learned from Perth’s mistakes it is repeating them. During the 1990s through to 2003 Western Australian child prescribing rates were much higher than New South Wales rates.[11] Since 2003 Western Australian child prescribing rates have fallen dramatically however, rates in New South Wales have skyrocketed. For 2007 child prescribing rates were roughly equivalent.[12]However, since 2007 New South Wales total Pharmaceutical Benefit Scheme subsidised scripts rates have more than doubled.[13] All the available evidence strongly indicates per capita child prescribing rates in NSW, now exceed those in WA, making Sydney Australia’s new ADHD child drugging capital.

[1] Janet Fife-Yeomans, “The Ritalin Generation – Top judge condemns the ADHD explosion”, The Daily Telegraph, 26 April 2007: p4

[2] Clinical Excellence Commission, Attention Deficit Hyperactivity Disorder in Children and Adolescents in New South Wales – 2007: Final Report of the Special Review, Sydney, December 2007: p64. Available at http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0017/135710/adhd_080211.pdf (accessed 27 December 2011)

[3] Clinical Excellence Commission, p32

[4] Clinical Excellence Commission, p20

[5] Clinical Excellence Commission, p25

[6] Clinical Excellence Commission, p24

[7] Clinical Excellence Commission, p20

[8] Clinical Excellence Commission, p27

[9] Clinical Excellence Commission, p32

[10] Janet Fife-Yeomans, ‘Go sit in the corner – Judge who spoke out against Ritalin kids gagged’. Daily Telegraph, 25 February 2008: p7

[11] In 2003, WA dispensed 86,980 prescriptions for dexamphetamine (WA pop = 1,969, 046) compared to 61,390 in NSW (pop = 6,716,277) which was 44.2 prescriptions per 1000 pop in WA compared to NSW at 9.1/1000 and the Australian average 12.5/1000. Department of Parliamentary Services, Medication for Attention Deficit/Hyperactivity Disorder (ADHD): an Analysis by Federal Electorate (2001-03), Current Issues Brief 16 November 2004, No. 8 2004-2005, Parliament of Australia: p7

[12] There were 15,466 boys and 3872 girls aged four to 17 on ADHD medication in NSW in the survey period, between June 1, 2006, and May 31 last year. Clinical Excellence Commission, Attention Deficit Hyperactivity Disorder in Children and Adolescents in New South Wales – 2007: Final Report of the Special Review, Sydney, December 2007: p12 This meant approximately 0.28% of the NSW population were aged 4 to 17 and were on stimulant medication. There were 6188 West Australian Children (4 to 17) on stimulants in the 2007 calendar year. Department of Health, Western Australian Stimulant Regulatory Scheme 2007 Annual Report, Pharmaceutical Services Branch, Health Protection Group, Department of Health, Western Australia (2008): p41. This meant approximately 0.29% of the WA population were aged 4 to 17 and were on stimulant medication. Note: NSW popn 6926990 , WA 2130797 Australian Bureau of Statistics Population, Australian States and Territories, December 2007

[13] For NSW from 1/6/2006 to 31/5/2007 there were 75,932 scripts and from 1/7/2008 to 30/6/2009 there were 170,634 scripts for ADHD drugs subsidised by the PBS. For WA from 1/1/2007 to 31/12/2007 there were 67,202 scripts and from 1/7/2008 to 30/6/2009 there were 77,305 scripts for ADHD drugs subsidised by the PBS. Source Medicare Australia website self generated report prepared by Martin Whitely on 29/8/2009 at the Medicare website.