Prescriptions for medications commonly used to treat ADHD have increased over the past 5 years in Ontario
Approximately 1 in 78 Ontarians received a prescription stimulant in 2017 (180,699 individuals), with nearly half of those being children and youth (46 per cent were 18 years old and younger), a new study has found.
Stimulants are controlled substances in Canada, approved for the treatment of attention deficit/hyperactivity disorder (ADHD) and sleeping disorders (e.g., narcolepsy). These medications act on the central nervous system to increase alertness, attention and energy, with common brands including Ritalin, Adderall and Concerta.
The report found that in 2017, methylphenidate (e.g., Ritalin, Concerta) products and long-acting formulations of stimulants were the most common types of prescription stimulant dispensed to individuals (60.3 per cent and 90.0 per cent of individuals, respectively).
The use of prescription stimulants has increased 29 per cent across Ontario over the past 5 years, from 4.7 individuals per 1,000 residents in January 2013 to 6.0 individuals per 1,000 residents in December 2017, according to a new report led by a Citizens’ Panel and researchers at the Institute for Clinical Evaluative Sciences (ICES), St. Michael’s Hospital and the Ontario Drug Policy Research Network (ODPRN).
“Stimulant use was consistently highest among school-aged children and youth, which is expected given their use to manage ADHD symptoms. Further, use was particularly high among boys aged 13 to 18 where 1 in 20 were prescribed a stimulant in 2017,” says Tara Gomes, a scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and a principal investigator of ODPRN. “The increased use over the past five years could be reflective of improved access for some children, or over-prescribing in some cases. More work needs to be done to understand what is driving these trends.”
But Gomes also points out that there has been a trend recently towards growing prescription stimulant use among adults, with the greatest increase in use among adults between the ages of 25 and 44, that should be monitored to determine if these medications are being used appropriately and whether there are any associated risks among this population. Importantly, the report also examined the proportion of potentially inappropriate stimulant prescriptions (early prescription refills from a different doctor and pharmacy) and found it was low and decreased by half between 2013 and 2017 (0.12 per cent to 0.06 per cent). This decrease may be due to the introduction of the Narcotics Monitoring System in 2012, which flags potentially inappropriate prescriptions.
This is the first study of its kind in Ontario to quantify prescription stimulant use and is unique because the work was led by members of the ODPRN Citizen’ Panel. The volunteer citizens were involved in selecting the research question, choosing the measures to be included in the report, as well as providing feedback for interpretation, decision making and knowledge translation.
“The Citizens’ Panel brings a different perspective to the report, from the use of language to ensuring that the analysis reflects the challenges of everyday Ontarians accessing these medications,” says Jane Sanders, chair of the Citizens’ Panel. “I think the individual members of the panel gain considerable satisfaction from knowing that our perspectives are positively contributing to health policy and access to safe and effective medications for Ontarians.”
The report “Landscape of prescription stimulant use: patterns, trends and geographic variation in Ontario, Canada” and interactive maps were published today on the ODPRN website.
Author block: Diana Martins, Simon Greaves, Mina Tadrous, Dana Bandola, Jane Sanders, Kris Lee, Donna May, Josephine Quercia, Michael Paterson, Muhammad Mamdani, David Juurlink and Tara Gomes on behalf of ODPRN citizen’s panel.
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
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