When Ben Mitchell was first diagnosed with ADHD (attention-deficit hyperactivity disorder), he waited four months to see a psychiatrist for medication, and the appointment cost him $600.
By Zoe Madden Smith for Re: news
A year after that appointment, Ben says he needs to switch his ADHD medication because it’s triggered some side effects — but he can’t afford to see a psychiatrist.
Ben Mitchell says there’s no point ADHD drugs being singled out when other addictive substances like prescription painkillers don’t have the same restrictions. Photo: Delivered.
“Changing my meds scared me a lot,” he says.
“I just can’t afford to pay that much right now. I’ll probably just have to wait until my next two-year appointment comes around and then ask. It’s really ridiculous.”
ADHD medication under control
ADHD is a neurodevelopmental disorder that can make it difficult for someone to stay focused, control compulsive behaviors, or be overly active.
ADHD experts are calling on Pharmac to allow GPs to prescribe ADHD medication so people can afford access to their medication.
This happened when an Auckland GP and ADHD expert, Dr. Tony Hanne was found guilty in October of professional misconduct of prescribing ADHD medication without the consent of a pediatrician or psychiatrist.
Hanne declined to be interviewed by Re:News about his ongoing court case, but told the hearing his caring for his patients motivated his action and if he hadn’t acted, hundreds of patients would have missed critical care in an overburdened health system .
Currently in New Zealand, medication to treat ADHD can only be prescribed by a psychiatrist or pediatrician.
And someone who has an ADHD diagnosis must see a psychiatrist or pediatrician to have their prescription renewed every two years.
The Medical Director of the Royal New Zealand College of General Practitioners (RNZCGP), Dr. Bryan Betty says the glaring problem with this is that access to psychiatrists and pediatricians is incredibly difficult and expensive – if you can access them at all.
In some parts of Aotearoa, there was no access to psychiatrists and pediatricians at all, he says.
“We’re hearing patients being told the only way to access psychiatrists is to go through the private sector, and those appointments cost hundreds of dollars if you can get on a waiting list.”
Waiting times range from six months to two years, and some people have to shell out $1,400 to $3,000 to see someone in the private healthcare sector, according to the nonprofit ADHD New Zealand.
“And because their family doctor is not allowed to prescribe the current medication,” says Betty, “patients fall right through the cracks.”
The requirement that GPs be able to prescribe ADHD medication
The decision to register GPs as primary health specialists so they can effectively diagnose ADHD and prescribe medication is long overdue, says Nurse Robin Wynne-Williams.
Wynne-Williams has worked with adults and children with ADHD for 30 years.
“There is no ethnic group, occupational group, or social class that is immune to ADHD. But the way it’s diagnosed and treated discriminates against many who don’t have access to that support,” she says.
Wynne-Williams says undiagnosed ADHD costs the healthcare system more because it can increase the risk of other health problems like type 2 diabetes and mental illness.
Adults with ADHD are twice as likely to have type 2 diabetes as their non-ADHD counterparts.
Nearly one in four women with ADHD has attempted suicide, and adults with ADHD are five times more likely to commit suicide than those without ADHD.
Why don’t GPs treat ADHD?
A spokesman for the Ministry of Health – Manatū Hauora – says: “Any suitably qualified and trained health professional, such as a pediatrician, psychologist, psychiatrist or general practitioner, can diagnose ADHD.”
However, because diagnosing ADHD requires a detailed examination that can take one to three hours, the clinical capacity of primary care physicians to diagnose someone in a typical 15-minute appointment makes this difficult.
But even if a GP could diagnose someone, only a pediatrician or psychiatrist could prescribe ADHD stimulants like methylphenidate — known as Ritalin — because they’re classified as a Class B drug under the Misuse of Drugs Act 1977.
Even with a primary care physician’s diagnosis, someone with ADHD would need to repeat that diagnosis with a pediatrician or psychiatrist anyway.
Doctors are ready to help
Bryan Betty says, “There are already a number of GPs who are interested in ADHD and want to go down that path if the system allows them to.”
“There is no reason someone who has been correctly diagnosed with ADHD and is responding appropriately to medication, over time seeing the same specialist for their problem who knows what is happening and their medical history, should not be treated by their primary care physician can.
“It’s unacceptable what’s going on here,” Betty says.
Two-year repeat prescription criteria must be reviewed
Betty says RNZCGP is focusing its energies on allowing GPs to repeat prescriptions every two years and has written to Pharmac to quickly address this issue.
“ADHD medication is the only area where this biennial re-prescribing by a psychiatrist actually happens,” says Betty.
Pharmaceutical Operations Manager Lisa Williams said she has agreed to review eligibility criteria for renewal and restrictions on prescribing physicians for the funded ADHD drugs methylphenidate and dexamfetamine.
“Before changes are made, we need clinical, legal and health economic input to help us assess potential impacts. We would also review and ensure that any changes would support broader changes in how health services are delivered to ensure equitable and safe access to treatment.”
A Medsafe spokesman says the misuse and abuse of ADHD drugs like methylphenidate (Ritalin) is an “ongoing challenge in many countries, including New Zealand,” which is why it’s heavily controlled.
“The decision to take ADHD drugs, which are currently classified as narcotics, out of the Drug Abuse Act and classify them as prescription-only drugs can only be made through an amendment to the law.”
Other ways to minimize ADHD drug abuse are needed
Ben Mitchell says it doesn’t make sense to him why ADHD meds are being singled out.
“There will always be people abusing drugs or abusing the system,” he says.
“But it doesn’t make sense why people with ADHD have to go through all this when people who leave the hospital are often handed potent prescription painkillers — which we know are addictive — and no one seems to bat an eyelid.
“So there has to be a better way to know that people are abusing the drug than to make it extremely difficult for everyone to get the drugs they need,” he says.
Work to improve ADHD diagnosis and treatment in progress
Department of Health officials have begun working with ADHD New Zealand and other agencies including Pharmac, Te Whatu Ora and Whaikaha to determine what can be done to support people with ADHD.
“Although this work is still in its very early stages, it will ultimately help people have access to early diagnosis and consistent treatment, which is key to reducing the impact the condition has on people with ADHD.” , says a spokesman for the Ministry of Health.
“While stimulants are often a core element in treating ADHD, other treatments in combination with medications are effective or may be helpful on their own; This includes cognitive behavioral therapy, parent/family training, and adjustments and support in educational and employment settings.”