It has been reported that during the past decade the prevalence of attention-deficit/hyperactivity disorder (ADHD) (ICD-9-CM code 314.00 or 314.01) and its pharmacologic treatment have increased dramatically in the United States. Herein, a single national data source is used to discern trends in the prevalence of U.S. office-based visits resulting in a diagnosis of ADHD, and trends in the prescribing of stimulant pharmacotherapy (including methylphenidate) for its treatment. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1995, for children aged 5 through 18 years, were utilized for this analysis. Results indicate that the number of office-based visits documenting a diagnosis of ADHD increased from 947,208 in 1990, to 2,357,833 in 1995. Between 1990 and 1995, the number of visits by girls diagnosed with ADHD rose 3.9-fold (p < 0.05), and the mean patient age increased by more than 1 year, from 9.7 in 1990, to 10.8 in 1995 (p < 0.05). The percentage of office-based visits resulting in a diagnosis of ADHD increased from 1.1% of all visits in this age group in 1990, to 2.8% by 1995. We discerned a 2.3-fold increase (p < 0.05) in the population-adjusted rate of office-based visits documenting a diagnosis of ADHD; a 2.9-fold increase (p < 0.05) in the population-adjusted rate of ADHD patients prescribed stimulant pharmacotherapy; and a 2.6-fold increase (p < 0.05) in the population-adjusted rate of ADHD patients prescribed methylphenidate.

No abstract

Over the time frame 1990 to 1998, the rate of ADHD as well as the prescribing of stimulant medications for its treatment increased significantly among children aged 5 to 18 years. Between 1991 to 1992 and 1997 to 1998, the increased rate of diagnosis of ADHD among girls contributed to the overall upward trend. The rapidly increasing rate of ADHD among girls, and the prolonged nature of the disorder, represent significant public health problems. There exists a need for additional research examining both the aetiology and treatment of ADHD by gender.

Despite modest effects of gabapentin overuse alone, overuse of gabapentin with opioids may increase risk of harm and health-service utilization, supporting calls to make gabapentin a controlled substance in the USA.

Upward trends in ADHD diagnosis and treatment have continued but vary markedly by group. Studies of undertreatment/overtreatment are needed.

A pharmacist-nurse collaboration designed to identify and resolve medication-related discrepancies in patients transitioning from the hospital to home health care led to significant improvement in medication discrepancy resolution.

The abuse potential of gabapentin is well documented; with gabapentin having been noted as an agent highly sought after for use in potentiating opioids. When combined with opioids, the risk of respiratory depression and opioid-related mortality increases significantly. In the US, gabapentin was approved by the Food and Drug Administration as a non-controlled substance. To date, and in spite of empirical evidence suggestive of diversion and abuse with opioids, gabapentin remains a non-controlled substance at the federal level. This has forced individual US states and jurisdictions – often significantly impacted by the opioid epidemic – to forge ahead with legislative initiatives designed to reclassify and/or monitor the use of gabapentin. Since August 1, 2016, 14 of 51 US states and jurisdictions have either implemented legislative mandates requiring pharmacovigilance programs, amended rules and regulations, are in the throes of crafting policy, or are in the midst of gathering additional data for decision making. This fragmented geographic approach yields only a modest benefit in combating the abuse of gabapentin and/or the national opioid epidemic. Herein, we report state-by-state efforts to enhance pharmacovigilance and call for a re-evaluation of the schedule status of gabapentin at the federal level, and design and implementation of a national pharmacovigilance program.

No abstract