A new Ontario drug class review on medications used in the management of ADHD in adults was released today by the Ontario Drug Policy Research Network (ODPRN): Drugs Used in the Management of Attention-Deficit/Hyperactivity Disorder in Adults. The reviews are part of an initiative to modernize the public drug formulary in Ontario. CADDRA provided substantial feedback and commentary to the ODPRN at various stages of the report development, which began in Spring 2015.
Some of the main points in the report:
- 17,482 adults were prescribed provincially-funded stimulant or atomoxetine medication in Ontario in 2014.
- There has been an increase in the number of prescriptions and costs of ADHD medications for adults across Canada. Utilization has gone up 119% and cost 153% during the 5 year study period.
- The transition from adolescent to adult can be a challenge when accessing mental health services for patients with ADHD, and can include breaks in coverage for medication through the ODB.
- Coverage varies considerably from province to province. [Table showing public plan listings by province for stimulants and non-stimulants for treatment of ADHD]
- A review of the literature indicates that misuse/abuse/ diversion occurs, and is especially prevalent in college-age students. However, the number of potentially inappropriate prescriptions in Canada is low (<0.3% in 2013/14) and more research is needed.
- There were no published economic evaluations identified that examined the comparative cost-effectiveness of adult ADHD medications. However, findings from studies on the societal impact of adult ADHD on employment and criminality indicate an association between adult ADHD and increased unemployment and poorer work performance. In addition, pharmacological treatment of ADHD symptoms is associated with improved work performance and reduced likelihood of criminal behavior.
Report Recommendations:
- Make atomoxetine available as “Limited Use” (for adults) instead of through the Exceptional Access Program (EAP);
- No age restriction should be applied to stimulants or atomoxetine;
- Monitor the cardiovascular health of those using the drugs, especially older adults with medical conditions;
- Health care practitioners should remain vigilant about the potential for misuse/abuse/diversion of stimulant medications;
- Remove the requirement in the current Therapeutic Notes for long-acting preparations for adults that patients must first be tried on methylphenidate immediate release or methylphenidate slow release or Dexedrine IR or Dexedrine SR before prescribing long-acting preparations.