[1527.410] Physician Practices To Prevent Diversion of ADHD Stimulant Medications

Natalie Colaneri, Majnu John, Andrew Adesman. Developmental-Behavioral Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY; Feinstein Institute of Medical Research, North Shore LIJ Health System, Manhasset, NY.

BACKGROUND: The number of ADHD teens treated with stimulant medication (SM) has risen sharply, along with an increase in SM diversion & misuse (D/M). Few studies have examined the role of physicians (MDs) and clinical strategies to prevent D/M of SM.
OBJECTIVE: To examine practices employed by MDs to prevent D/M of SM.
DESIGN/METHODS: A questionnaire was mailed to 3 sub-specialties (SS): all child neurologists (CN), child psychiatrists (CP), and developmental pediatricians (DP) in the US. Only responses by MDs who prescribe SM (n=815) were analyzed.
RESULTS: When prescribing SM to ADHD teens, 1/3 of MDs rarely or never educate patients about health (31%) or legal (32%) consequences of D/M, with significant differences noted across SS: CN: 49%/48%, CP: 26%/28%, DP: 38%/38% (χ2; p=0.0001, 0.0002). Overall, 22% of MDs rarely or never counsel patients about D/M in their pre-college visit; SS differed: CN: 44%, CP: 19%, DP: 20% (χ2; p<0.0001). 89% don't have brochures or posters available on this topic. In general, when treating teen ADHD patients, the majority of MDs rarely or never uses a medication (Rx) contract (93%), distribute print materials on SM D/M (89%), limit Rx to a smaller # of pills (64%), or employ pill counts (60%). Most MDs sometimes prescribe non-stimulants (NS) instead of SM (56%) and at least often prescribe long-acting over immediate release (IR) SM (87%). 20% of all MDs have never suspected D/M in ADHD teens they treat with SM (CN: 53%, CP: 17%, DP: 48%). Among MDs who have previously suspected D/M, most rarely or never use a Rx contract (85%) or distribute print materials (82%) to patients suspected of D/M. Also, when they suspect D/M, the majority of MDs don't often use pill counts (56%), limit Rx to a smaller # of pills (61%), or refer for drug counseling (55%). Most MDs do at least often prescribe NS instead of SM (73%) and prescribe long-acting over IR SM (79%) when they suspect D/M. The majority of MDs rated most D/M prevention strategies as not effective/somewhat effective: Rx contracts (45%/31%), print materials (12%/58%), limiting pill quantity (10%/53%), pill counts (12%/58%), and not prescribing IR SMs (3%/49%). 65% of MDs said prescribing NS instead of SM was very effective.
CONCLUSIONS: About 1/3 of MDs rarely counsel ADHD teens about health & legal consequences of D/M. Even though doctors are encouraged to utilize D/M prevention strategies, the majority don't often use them. Besides prescribing NS, most MDs don't believe these strategies to be very effective.
First Author is a Recent college graduate; applying to med school

Session: Poster Session: Developmental / Behavioral Pediatrics (1:00 PM - 4:00 PM)
Date/Time: Saturday, May 3, 2014 - 1:00 PM
Room: Exhibit Hall C - Vancouver Convention Centre
Board: 410
Course Code: 1527


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