Prescribing stimulants for ADHD
Diagnosing and prescribing for ADHD is on the rise
Attention-deficit/hyperactivity disorder (ADHD) diagnosis for children and adults has increased worldwide, particularly in North America. Both diagnostic rates and stimulant prescribing rates have increased as ADHD has gained national and international attention in the news and social media.
ADHD is a complex diagnosis. There are unmet needs in our communities, particularly among vulnerable populations. There is also a lack of resources for recognizing and appropriately treating people with ADHD. Diagnosing ADHD is complicated and can take time and effort. CPSBC is reminding registrants to follow best practice guidelines to improve patient outcomes and avoid harm.
CPSBC's role in this issue
CPSBC recognizes prescribing opioids, sedatives, antimicrobials and stimulants can cause potential harm to patients.
There are risks in prescribing stimulants because of:
- patients' overvaluation of their benefits
- potential for dependence and addiction
- diversion of these drugs for non-medical use
- their popularity in popular culture and social media
While CPSBC cannot address these risks directly as a regulator, it has a duty to advise registrants to navigate these issues cautiously to reduce the potential harm to patients and the 17³Ô¹Ï.
Benefits and risks
Registrants must evaluate both potential benefits and risks when prescribing stimulants to patients with ADHD.
- Improved executive functioning:
- better learning, higher academic achievement
- improved job performance
- Reduced disruptive behaviours and impulsivity at school or work
- Improved self image and confidence
- May protect against substance use and traumatic accidental injury
- Possible decreased growth velocity in height and weight with long term use
- Prolonged or inappropriate use can lead to psychosis, seizures, and cardiac complications, particularly for those with pre-existing medical conditions
- Risk of misuse and abuse
- Risk of harm to others if stimulants are diverted and misused or abused
While patients may experience short-term improvement in their general mental health and emotional symptoms, the goal of stimulants should always be to achieve sustained improvement throughout the course of a health condition. Proper ADHD treatments should be viewed as chronic treatments.
Prescribing stimulants should occur after careful consideration of comorbid conditions such as:
- substance use disorder
- cardiac conditions
- neurological conditions
- psychiatric comorbidities
Starting a patient on stimulants must be accompanied by a commitment to:
- the long-term care of the patient and their family, and
- follow through on the therapeutic alliance until the patient’s needs are addressed.
Recommendations from CPSBC
Is this the best course of action for my patient?
The patient’s best interests must be at the centre of all decision making.
While CPSBC does not direct the clinical use of these or other drugs, it holds all registrants to a high standard of care when they prescribe stimulant or other psychoactive medication.
Virtual care
Virtual care alone does not meet the expected and acceptable standard of care for the diagnosis of ADHD and longitudinal care for patients with ADHD (refer to CPSBC practice standard Virtual Care).
Professional obligations
Treating ADHD in children and adults can become part of a registrant's competent scope of practice.
All registrants must be able to address their patients' concerns, even if it is beyond their scope to diagnose and treat ADHD. This includes simply offering advice on where to seek help. Some registrants may not feel confident diagnosing or treating this condition, but it is important to recognize this condition and their patients' concerns about it.
CPSBC encourages registrants to learn more about this emerging issue and the ongoing scientific research on this topic.
See Navigating the tensions of stimulant prescribing for ADHD