Through the Correct Lens: Understanding Overprescription of Stimulant Drugs, Their Abuse, and Where the Remedies Lie

Abstract

This paper argues that stimulant drugs, such as Ritalin and Adderall, are overprescribed for the treatment of Attention-Deficit/Hyperactivity Disorder. Overprescription is viewed through a physician-centered lens. That is, physicians overprescribe stimulant drugs to the extent they inadequately evaluate a patient before prescribing. The physician-centered approach contrasts sharply with a patient-centered approach which defines as overprescription the extent to which stimulant drug prescription rates exceed the actual prevalence of ADHD. Overprescription is important to address because it contributes to stimulant drug abuse among young adults. Legitimate patients with valid prescriptions, particularly on college campuses, are giving away or selling their stimulant medication to their peers. Overprescription contributes to this problem by unnecessarily inflating the number of prescriptions available for diversion. In light of such stimulant abuse, this paper considers four potential solutions for reducing overprescription: (1) decreasing stimulant drug production quotas; (2) changing stimulant drug labeling; (3) monitoring physician prescribing via state prescription drug monitoring programs; and (4) restricting the speech of external actors, such as school personnel and pharmaceutical companies, who may pressure parents to seek medication for their children. After evaluating and rejecting each of these approaches, two alternative strategies for reducing overprescription of stimulant drugs are offered: (1) conducting research investigating the practical problems physicians face when evaluating patients for ADHD and, then, incorporating the insights gleaned into educational efforts and (2) promoting more active leadership and oversight by state medical associations and boards. To provide a background for discussing overprescription, stimulant abuse, and possible remedies, the paper begins reviewing Attention Deficit/Hyperactivity Disorder, the practice of treating the disorder with prescription stimulants, and the import of stimulant drugs being Schedule II controlled substances.