WELLINGTON: A stimulant drug used to treat ADHD has become the fastest-growing script on the Pharmaceutical Benefits Scheme, prompting concerns that a trend of “diagnosis on demand” is driving widespread overprescription.
Vyvanse last year overtook Ozempic as the fastest-growing prescription in Australia, with almost 2.2 million scripts issued to treat attention deficit hyperactivity disorder, the latest PBS data shows.
Independent analysis of PBS data by the consultancy Provocate shows taxpayer-subsidised prescriptions of Vyvanse – a central nervous system stimulant that contains the active ingredient lisdexamfetamine dimesylate – have exploded since access was widened in 2021 to include people diagnosed with ADHD as adults.
PBS-subsidised scripts issued to patients for Vyvanse increased by about 653,000 last year, at a total cost to the federal government of $167,623,993.
The drug is now the fifth-highest PBS brand by subsidised prescriptions.
The Royal Australian and New Zealand College of Psychiatrists is now sounding the alarm that the nation is seeing a significant trend emerging of misdiagnosis or overdiagnosis of ADHD, and is calling for only specialists to guide complex cases while stable patients can be managed in primary care.
This comes amid the use of brief or online-only check-box tools that act as “confirmatory diagnostic assessments” as many people turn to online neurodiversity self-rating scales and social media fuels ADHD “over-identification” by patients.
Social media influencers, such as radio personality Abbie Chatfield, have helped glamorise the condition and create a sense of identity around it for many people.
ADHD symptoms can overlap with a wide range of psychiatric and physical conditions, including mood and anxiety disorders, autism spectrum disorders, learning difficulties, trauma-related presentations and substance use disorders. Stimulant medication comes with significant possible side-effects including appetite suppression, sleep disruption, cardiovascular complications, dependency and worsening of psychiatric conditions such as anxiety, mania or psychosis.
“This increase we are seeing in ADHD diagnosis cannot be completely related to previous underdiagnosis,” RANZCP president Astha Tomar said. “I think we are seeing overdiagnosis, but there is still a cohort of people who are possibly underdiagnosed.
“People need to understand that stimulant medications are not without risk. They do lead to side-effects, psychiatric and physical. They can lead to cardiac problems, even psychosis, and they need to be properly monitored.”
ADHD is the most common neurodevelopmental disorder, affecting around 800,000 Australians, including approximately 281,000 children and young people aged under 19.
The federal government in 2022 moved to issue the Australian Evidence-Based Clinical Practice Guideline for diagnosis, support and treatment of ADHD to improve early diagnosis and quality treatment, and state governments are now expanding provider access to diagnose and prescribe stimulant drugs for ADHD to general practitioners.
Provocate managing director Troy Bilsborough warned the rapid growth in uptake of ADHD drugs – and the cost – could slim chances for their expanded use amid overdiagnosis fears. But Mr Bilsborough said the trend of “social media scripts” was helping to increase community awareness and reducing stigma, while continuing to create a headache for traditional advertising bans on prescription medicines in Australia.
Some child psychiatrists believe the rapid rise in the issue of Vyvanse “may be indicative of a worrying oversimplification of a whole range of issues” that mask other factors affecting people’s lives and society at large.
“I think the self-diagnosis phenomenon is troubling,” said child psychiatrist and Adelaide University school of medicine professor Jon Jureidini. “It looks as if an awful lot of people are turning to services that are providing, at very high cost, diagnosis on demand, where people go in with the preconception that they have the condition and they’re just seeking validation of that.
“The increase in prescription of stimulant medications is indicative of a worrying oversimplification of a whole range of issues, including people trying to make sense of their life not being as it should, or people looking for identification, some kind of identity.
“We’re living in a world mediated by screens and devices; we’re often participating in highly stimulating activities, attention-demanding activities.
“Anybody can go through and tick the boxes for the 15 different symptoms that you’re supposed to have to have ADHD. It’s not making the diagnosis that is difficult. By that, I mean trying to understand what else might actually be underpinning the person’s distress.”
Professor Jureidini said there was no convincing evidence that stimulant medications were associated with long-term benefits for patients. Their effect, he said, appeared to be generic, meaning everyone would feel more focused if they took a stimulant drug.
“It’s not the case that somebody with ADHD will have a different response to stimulants than somebody who doesn’t have ADHD,” he said. “These drugs give a subjective experience of being more competent. So what we have is a symptomatic improvement, which may be more subjective than objective, and no convincing evidence of long-term benefit.”