Are we over-prescribing ritalin and similar drugs to our children? One study, Are Stimulants Overprescribed? Treatment of ADHD in Four U.S. Communities, found that 5.1% of children would fully meet the criteria for ADHD. Of which, only 12.5% of children were receiving medication. They concluded

Medication treatments are often not used in treating ADHD children … suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of these treatments

The results of the study suggest that there are over three million children and teenagers who have ADHD. Of which just under 400,000 are using prescription medicine. Depending on the type of drug therapy used, costs range from $41 (Ritalin) to $94 (Strattera) for a month supply. But for how long do these drugs have to be taken? The drugs are not design to treat or cure ADHD, they simply reduce the symptoms. In some children this respite from symptoms may give them the time to normalise their behavior so they can remain in control after they stop taking the drugs. However the majority of children face a long-term dependency on these drugs that will carry on through college, university and into the work place. There is very little research on long-term usage of methylphenidate based drugs like Ritalin but a study earlier this year found evidence that it is a carcinogen. This study was too small to give definate answers so futher study is need.

In addition to any direct health risks, there is contradictory evidence on whether Ritalin users face a higher risk of drug abuse, either illegal drugs or legal ones such as smoking or alcohol. An article on PsychiatricTimes.com covers two different studies. The first showed a risk:

Childhood use of [Central Nervous System] stimulant treatment is significantly and pervasively implicated in the uptake of regular smoking, in daily smoking in adulthood, in cocaine dependence, and lifetime use or abuse of cocaine and stimulants. The severity of ADHD and early onset of tobacco use are significant risk factors for adult use and dependence on substances with stimulant properties, namely tobacco, cocaine, and stimulants.

However the other study found:

Treating the underlying disorder, even if with stimulants, significantly reduces the probability they will use drugs later on

The rise of stimulant usage for ADD / ADHD (its currently a $2.7 billion industry) has an effect on non-sufferers. There is rising concern over the non-prescribed use of ritalin and other stimulants by college and university students. A study, Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey found about 5% of students had used prescription stimulants illegally. (See also Ritalin, Use and Abuse [PDF]).
A straw poll conducted in forum for students with ADD / ADHD revealed that many had used stimulants for some years and foresaw using them indefinitely. There was some concern over the long-term effects but generally the ability to overcome their ADD / ADHD symptoms was far more important than any long-term health risks. About half reported that they had been approached by others asking for some tablets.

So are we over-prescribing ritalin and similar drugs to our children? There is no easy answer. Spending $2.7 billion on drugs that do not treat the underlying problem is worrying. So are the questions of the long-term health risks and the rise of the stimulant-usage culture in schools. Yet. for the most part, the people who take the drugs are happy to escape from damage done by ADD / ADHD, regardless of the cost to their finances or health.

In the US, the Food and Drug Administration’s Pediatric Advisory Committee  is considering strengthening the side effects warnings on Concerta. The drug was introduced in 2003 and the committee is doing a routine review of the drug’s safety.  In 2004 thirteen deaths and 243 serious events were linked to Concerta including "aggression, agitation, abnormal behavior, anxiety, depression, visual hallucination, and suicidal ideation".
Pediatric Advisory Committee’s Memorandum briefing papers.

A brief report on Pharmaceutical Business Review notes the current market is $2.7 billion per year and that this is expected to rise to $3.3 billion by 2015. The article also notes: “Although ADHD drugs have demonstrated significant efficacy in improving the three main symptoms of ADHD – inattention, hyperactivity and impulsivity – none have shown efficacy in treating the cognitive deficits of ADHD.“
Given the amount of money involved its not surprising that manufacturers are keen to see as many children on Ritalin as possible.

Coverage on Myomancy.com: Ritalin May Lead To Depression in Later Life, New ADHD Drug Approved in UK

Other sites: Death From Ritalin, NIDA InfoFacts: Methylphenidate (Ritalin), Drug makers find ways to circumvent an advertising ban and promote psychiatric drugs for children, ADHD Info sponsored by Novartis, makers of Ritalin.

BBC Radio 4’s Today Programme had a piece this morning on ADHD and a new drug, amoxetine, that has been approved for us it UK. There is also coverage on the BBC News site.
Amoxetine (marketed as Strattera) main selling points are that a single dose lasts 24 hours (significantly longer than Ritalin), it apparently has no side effects and it is less prone to being abused as it is not a stimulant, unlike Ritalin.

Medco Health Solutions Inc. have a press release on their report detailing the increase in spending on behavioral and other drugs prescribed to young childen.

Key findings are:

Prescription drug spending for behavioral conditions rose 77 percent between 2000 and 2003 due to both increased costs and increased use of these medications.

In 2003, spending on behavioral medications to treat children overtook both the antibiotic and asthma categories, which are traditionally high-use categories in pediatric medicine.

The number of children on behavioral medications has jumped more than 20 percent between 2000 and 2003, outpaced only by the increase of children on drugs to treat gastrointestinal conditions, which increased by nearly 28 percent.

Among the largest increases were medications primarily used to treat attention deficit/hyperactivity disorder (ADHD) — where spending increased by 183 percent for children overall, and by 369 percent increase for children under age 5. Utilization in preschoolers was up 49 percent from 2000 to 2003.

Spending on antidepressants for children grew 25 percent, while use of these drugs rose 27 percent between 2000 and 2003. A review of 2004 data shows that of the children on at least one prescription medication in the first quarter of this year, the number of children using antidepressants increased by 15 percent over the first three months of 2003.

The number of children on medications to treat severe behavioral conditions related to autism and conduct disorders increased by more than 60 percent from 2000 to 2003, while spending on these drugs rose 142 percent in the pediatric group. Among children ages 5 through 9, utilization was up 85 percent, while spending in this category grew 174 percent.

Although children continue to predominantly use antibiotics, allergy and asthma drugs, the rate of increase in utilization and cost for these categories has been more moderate over the past four years than for behavioral medications; antibiotics showed no change in utilization and a 24 percent increase in spending; the use of allergy treatments increased 3 percent, while spending decreased by 7 percent; and asthma medications showed a 12 percent increase in utilization and a 24 percent rise in costs.

One other interesting snippet:

Surprisingly, the average unit cost per child per day is more than 60 percent higher than that of seniors. Although children take fewer medications than seniors, medications used by children have the highest average cost — $2.12 per day for children versus $1.29 per day for seniors.