"The West Australian experience makes a mockery of the ADHD industry claims that amphetamines, when prescribed to ADHD children, prevent drug abuse. The evidence is unequivocal, it clearly supports the common sense proposition that prescribing amphetamines facilitates the abuse of amphetamines."
ADHD and Drug Abuse in WA
There is significant statistical evidence from WA that ADHD drugs are frequently diverted for illicit use. The 2005 Australian Secondary Students' Alcohol and Drug Survey (ASSAD) data indicated a reduction 'in last 12 month amphetamine abuse' by WA school children, 12 - 17 year olds, from 10.3% in 2002 to 6.5% in 2005.[1] This 38% reduction occurred over a similar time period as the massive fall in ADHD child stimulant prescribing rates (refer to The rise and Fall of ADHD in WA). This evidence supports the contention that excessive legal prescribing rates link with dexamphetamine diversion and amphetamine abuse.
Other data from the 2005 ASSAD survey also confirms that at least for teenagers ADHD drugs are frequently diverted for illicit use. 84% of 12 to 17 year olds who had abused amphetamines in the previous year had abused diverted dexamphetamine. Additionally only 55% percent of WA secondary students who had ever used dexamphetamines or Ritalin were prescribed them by a doctor and 27% of students who were prescribed dexamphetamines or Ritalin had given away or sold their drugs.
Interstate comparisons of dexamphetamine prescription rates and amphetamine abuse rates also confirm that high prescribing rates are associated with high amphetamine abuse rates. In the 2003 Commonwealth Department of Health and Aged Care Survey the Australian average of dexamphetamine prescriptions was 11.3 per 1000 population, Victoria reported the lowest rate of 6.7, while Western Australia was clearly the highest with a rate of 43.2 per 1000.[2] In 2004 Western Australia had the highest level of amphetamine abuse of all states, with a rate of 4.5% of the population aged 14 years and over having abused amphetamines in the past year. This was well above the national average of 3.2%. Victoria had one of the lowest rates of just 2.8%.[3]
The proportion of people presenting for treatment with amphetamine abuse as the principal drug of concern in 2005/6 also confirms this trend. The Australian average was 11% of all treatment episodes with amphetamines identified as the principal drug of concern, while Western Australia reported the highest rate of 24.6% and Victoria the lowest with a rate of 6.3%.[4]
Far from supporting the assertion that medicating for ADHD prevents illicit drug abuse by self-medicating untreated ADHD sufferers, the West Australian experience is that there is a positive correlation between amphetamine abuse rates and the legal prescribing rates for amphetamines for the treatment of ADHD. This experience makes a mockery of the ADHD industry claims that amphetamines, when prescribed to ADHD children, prevents drug abuse. The evidence is unequivocal, it clearly supports the common sense proposition that prescribing amphetamines facilitates the abuse of amphetamines.
This view was accepted by the Western Australian Government with the then Premier Alan Carpenter telling the W.A. Parliament on 27 September 2007 "The evidence shows that if amphetamine prescribing rates are decreased, abuse rates are decreased."[5] Whilst the positive correlation between prescribing rates and abuse rates seems obvious the Premier's statement was very significant and made necessary by the failure of senior figures, including Health Minister Hon Jim McGinty, to recognise the damage created by the diversion of illicit amphetamines.
The Ice Summit Clinics to reduce ADHD drugging rates
In 2007 the State Government called an "Ice Summit" to create community generated solutions to the problem of amphetamine abuse. The Ice Summit was the catalyst for Premier Carpenter's recognition of the diversion problem and for the commitment of significant resources to clinics designed to reduce ADHD prescription rates.
In media coverage and throughout the Summit the terms 'amphetamine' and 'Ice' were used as if they were interchangeable and amphetamine abuse statistics were misrepresented as Ice abuse rates. Professor Bruce Maycock of Curtin University and Martin Whitely attended the Summit as uninvited delegates. They conducted a series of interviews and Martin wrote to invited Summit participants highlighting the illicit diversion data and the fact that the Government had not recognised that diverted prescription amphetamines represented a very significant proportion of illicit amphetamine use.[6]
The Ice Summit had narrowed public debate about amphetamines abuse to Ice. The aim of the letter to delegates and subsequent lobbying was to emphasise the importance of the nexus between amphetamine prescribing and abusing that had been briefly acknowledged and then virtually ignored at the summit and to build support for state run multidisciplinary clinics designed to reduce ADHD prescribing rates. It worked.
Clinics to reduce ADHD drugging rates
Within 6 weeks of the Ice Summit the Premier Carpenter issued a press release stating, "Studies show that dexamphetamine accounts for a substantial amount of amphetamine use by young people in WA" and announcing funding of $9million over 4 years "to establish two 14-member specialist teams for ADHD, co-located with existing community-based mental health services. The teams will include professionals from a range of disciplines including psychiatrists, paediatricians, clinical psychologists, clinical nurses, speech pathologists, occupational therapists and social workers."[7] The Premier was persuaded by the statistics that giving amphetamines to teenagers lead to amphetamine abuse by teenagers. These clinics, which were first recommended to the Court WA state government in July 1996, and that had been key recommendation of the 2004 WA Parliamentary Inquiry into ADHD, finally received funding.
In September 2008 the Carpenter Labor Government lost office to the Barnett Liberal/National Government. Martin Whitely was, however, re-elected as an opposition backbencher to the West Australian Parliament. In order to fund election commitments a general 3% cut to all departmental budgets, including Mental Health was instituted. Mental Health bureaucrats identified halting the roll out of the clinics as a means of helping to achieve the desired cuts. After a discussion between Martin and the new Minister for Mental Health, the Honourable Graham Jacobs, the Minister directed his department to fully fund and continue to establish the clinics. As a consequence of this bi-partisan commitment the first of two multidisciplinary clinics will open in 2009 with the second to follow in 2010.
These clinics, if they adopt a diagnose slowly - drug as a last resort philosophy, should further reduce the reliance on drugs to control behaviour. However, caution is warranted. If the wrong clinicians are put in charge, with inadequate time available for diagnosis, the clinics could exacerbate the very problems that they were set up to address.
Restrictions on Pharmacists dispensing Amphetamine Prescriptions
Another recommendation of the 2004 WA Parliamentary Inquiry into ADHD, designed to address the problem of diversion of prescription amphetamines, was implemented in 2006.[8] This recommendation was made in response to evidence of a teenager receiving 175 days worth of repeat scripts in 13 days and an adult patient receiving 125 days worth of repeat scripts in 40 days. The recommendation was that Western Australia copy the New South Wales restrictions on the frequency with which schedule 8 prescriptions can be dispensed, by ensuring that all repeat scripts for a patient's psycho-stimulants were held by one pharmacist and could only be filled as required for prescribed dose usage. Implementation of this initiative post-dated the fall in teenage amphetamine in W.A. teenage abuse rates between 2002 and 2005. Therefore, unlike the end to block authorisation, it cannot be viewed as a likely cause of this decline.
[2] Paul Mackey and Andrew Kopras, Medication for Attention Deficit Hyperactivity Disorder (ADHD): an Analysis by Federal Electorate, Canberra, Parliament of Australia (2001): p4
[3] Australian Institute of Health and Welfare, 2004 National Drug Strategy Household Survey: State and territory supplement, Canberra, AIHW (2005): p7
[4]Treatment Episodes Principle Drug of Concern 2005/2006, Alcohol and other Drug Treatment Services in Australia: Report
[5] Western Australian Hansard Hon. Alan Carpenter Thursday, 27 September 2007 p5946c-5948a
[6] Elephant in the Schoolyard unpublished paper 2009 by Professor Bruce Maycock and Martin Whitely MLA
[7] Carpenter, A. (2007). State Government invests $16 million in 'ice' fight. Media Release, 19 August.
[8] WA 36 Parliament Education and Health Standing Committee Report No. 8 "ADHD in WA."