Department of Veterans Affairs prescriptions for attention-deficit/hyperactivity disorder, more commonly known as ADHD, should be made tougher to obtain in the future, according to a new report by the VA inspector general.
The inspector general found that VA providers aren't always documenting patient assessments before prescribing the stimulant drugs used to treat ADHD, such as brand-name drugs Adderall and Ritalin. In some cases, they are relying on the patient's self-reporting without even conducting an assessment.
For veterans, there is a high risk of abuse and addiction to the prescribed drugs. Stimulants such as those used to treat ADHD are classified by the Food and Drug Administration as Schedule II drugs -- the same category as fentanyl and oxycodone -- and are tightly regulated and not recommended for patients who struggle with alcohol or substance abuse.
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The inspector general -- the agency's independent watchdog -- recommended that VA primary-care providers refer patients who may need ADHD medications to mental health providers before writing prescriptions, as well as checking for other conditions that could be confused with ADHD symptoms.
There's no genetic or biological testing available for ADHD, meaning a medical provider's assessment is the only method for diagnosis.
Within the VA's health care system, the number of patients with an ADHD diagnosis increased almost 60% from 2018 to 2022, from almost 70,000 patients to nearly 111,300.
During the same period, VA stimulant prescription rates for ADHD patients jumped 53%, from almost 41,000 to nearly 62,500.
According to the Mayo Clinic, adult ADHD symptoms start in childhood and can include problems such as difficulty paying attention and impulsive behavior. It can contribute to challenges at work and in relationships.
Troops may have higher rates of ADHD compared to their civilian counterparts, though military service can be a benefit for those with ADHD, since rigid structure and routine exercise can help stave off symptoms (so can caffeine).
Many vets who receive an ADHD medication also often have other pre-existing conditions, such as anxiety or depression, according to a 2020 study of ADHD medication prescription practices in a Kentucky VA health care region. Symptoms of anxiety and depression can be mistaken for ADHD.
That same study also noted a trend of stimulant prescribing inconsistencies; the practice of "prescriber-hopping," in which patients get the same medications from multiple providers; and unsupported ADHD diagnoses. In many cases, patients use the stimulants for off-label uses such as weight loss, depression treatment and performance enhancement.
Military recruits with recent documented histories of ADHD are still largely barred from enlisting, thanks to the complicated rollout of the MHS Genesis medical records system, which has unnecessarily flagged some recruits for childhood conditions such as ADHD.
The recommendation to tighten stimulant prescriptions within the VA also comes as the U.S. has entered the second year of shortages for ADHD medications caused by supply chain and manufacturing issues. As the supply for ADHD medications has decreased, the nationwide demand has ballooned, leaving many patients without reliable access to the drugs.
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