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Quebec doctors condemn the high rate of prescribing ADHD medicines for children and teenagers



A group of doctors in Quebec warns of a high rate of prescribed medication for treatment of ADHD in teenagers in the province.

ADHD medicines are prescribed for patients aged 13 to 17 years who are twice as big as any other province, say doctors.

More than 45 doctors from Quebec signed an open letter on Thursday, urging the public to seriously address this issue.

The letter says that there is an urgent need to consider not only why medicines are prescribed at such a high rate, but also why so many young people have symptoms of neglect, hyperactivity, impulsiveness and anxiety.

We feel great pressure as pediatricians working with vulnerable populations to solve this problem only with drugs – which is not a good solution.– Dr. Gilles Julien, a specialist in social pediatrics

The group backs its claims from the National Institute of Excellence and Health Services (INESSS) – data showing that the rate of prescribing drugs for ADHD in Quebec is disturbing.

For teenagers aged 13 to 17 covered by the drug insurance plan in the province, recipe prices jumped from 3.4 percent to 9.9 percent between 2006 and 2015.

And for the age group 0 to 25 in Quebec, numbers far outnumber the rest of the country.

In this group of 0 to 25, regardless of whether they have private or public insurances, INESSS data show that in the period 2014-2015, the percentage of children with ADHD treated drugs was 6.4 percent in Quebec, compared with 2.4 percent in the rest of Canada.

The highest rate of medication is prescribed for children aged 10 to 12, according to a letter, where 14 percent of ADHD medicines are children, compared to just over 5 percent in the rest of Canada.

Doctors say that drug treatment can be effective in the short term, but it can have negative effects for a longer period of time.

They want teachers, parents and health professionals to think about why they opt for the treatment of children and teenagers, while psychosocial intervention and parental support are neglected.

"We feel great pressure"

Dr. Gilles Julien, a pioneer in the field of social pediatrics in Quebec, is one of those who signed the letter.

He told the CBC in Montreal Dawn On Thursday, drugs such as methylphenidate, commonly sold under the trade name Ritalin, have worked in many cases, but such drugs have proved less effective when the condition of the patient is more complex.

"For people, the drug is a solution," he said. "This is not the only solution, we feel a great deal of pressure as pediatricians working with vulnerable populations to solve this problem only with drugs – which is not a good solution."

Dr. Gilles Julien, a pioneer in the field of social pediatrics in Quebec, among those who have signed an open letter. (Charles Contant / CBC)

It is not clear why Quebec prescribes drugs more than twice as much as other provinces, he said.

However, there is obviously a great pressure on doctors to prescribe drugs coming from schools, parents and others working with children.

Such pressure is not felt in Europe or other parts of Canada, he said.

Listen to a complete interview with Dr. Gillas Julien here:

In an open letter, nearly fifty health professionals, including 45 pediatricians, give warnings about what they consider to be excessive by prescribing ADHD medicines for children. They invite parents, teachers, and health professionals to conduct some "soul tests" about their reasons for drug selection. The prescribing of ADHD drugs in Quebec is almost three times more than in the rest of Canada. We talk to Dr. Gilles Julien, a pediatrician and one of the signatories to that letter. 09:49

According to Julien, children are becoming worried. They do not get the support they need in schools, he said, and have no access to activities such as music and sports as they had previous generations.

Such activities can help children to reduce anxiety, he said.

Doctors warn of excessive prescription, too much diagnosis

In an interview for Radio Canada Gravel le matinDr. Valérie Labbé, who also signed the letter, said she would like to have a full public discussion on medicines for children with ADHD.

The society as a whole has to think about it, not blame on all doctors or parents, she said.

Quebec's over-presumptive presumption could be related to the fact that drugs like Ritalin are paid by a universal drug insurance plan in the province, which other provinces do not have.

"When we talk, when [doctors] everyone is upset by that high drug rate, "Labbé said.

"There is a social phenomenon that causes difficulties in sitting children, concentrating and managing emotions."

Dr. Stacey Bélanger, a psychiatric mental health specialist at Sainte-Justine Hospital in Montreal, warned that more research is needed on the causes of countrywide disproportion in terms of prescription rates – and on drug effects.

One of the key factors, she said, is that some drugs are not covered by other provinces, making them unavailable to many Canadians outside of Quebec.

"For example, long-lasting psychostimulants are not included in British Columbia," she said in a statement.


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