[1527.411] Physician Perceptions and Knowledge of Diversion of Stimulant Medications for ADHD

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

BACKGROUND: There are increased concerns about teens with ADHD misusing or diverting stimulant medication (SM). Few studies have examined physician (MD) perceptions of this issue. Little attention has been given as to whether MDs are adequately qualified to educate their ADHD patients on the health and legal consequences of diversion and misuse (D/M).
OBJECTIVE: To gauge perceptions and knowledge of D/M of SM among MDs who specialize in ADHD.
DESIGN/METHODS: A questionnaire focused on D/M 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 currently prescribe SM (n=815) were included in the analysis.
RESULTS: In the past 12 months, 59% of MDs suspected >1 of their teen ADHD patients were diverting their SM, and 54% believed >1 of their patients were exaggerating symptoms to obtain more SM for D/M. Differences were noted across SS: CN: 42%/42%; CP: 69%/62%, DP: 28%/23% (χ2; p<0.0001). Whereas 48% of all MDs believed it was common or very common for ADHD teens to divert SM to peers, SS again differed: CN: 23%; CP: 40%; DP: 42% (χ2 ; p<0.0001). When evaluating teens for an initial diagnosis of ADHD, 66% of MDs suspected that >1 patients in the past year were trying to obtain SM to improve their academic performance. Many MDs suspected that >1 patients were trying to gain an ADHD diagnosis and receive SM to either lose weight (40%), get high (38%), or divert their SM to others (39%). The majority of MDs received no training on prevention of prescription drug diversion in medical school (73%), residency (57%), or fellowship (51%). In terms of educating patients about the health consequences & legal consequences of D/M, 25% and 49% of MDs did not feel adequately qualified. When asked if there is a difference in the legal consequence of selling versus giving away SM, 19% of MDs chose the incorrect answer and 36% were unsure. No significant difference existed between SS in response to this question.
CONCLUSIONS: Many pediatric SS who treat ADHD are aware of D/M of SM; however, differences across SS were noted. While almost half of all MDs in this study believe diversion to be common among teens with ADHD, the majority of them never received training on this topic. Moreover, many MDs do not feel adequately qualified to counsel teens about the associated risks. The medical community must take measures to better prepare physicians to educate their ADHD patients about D/M of SM.
First Author is a Recent college graduate; applying for 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: 411
Course Code: 1527


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