Abuse of ADHD medication: ‘monitoring of patients must be better’ 18:49 in Binnenland Experts are concerned about the use of ADHD medication without a prescription among students. They are poorly aware of the side effects, but doctors also play a role in prevention.

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  • Annabel van Gestel

  • Annabel van Gestel

Taking medication for a condition that you (most likely) do not have at all: taking ADHD medication without a prescription is very popular, especially among students. They usually receive these medications from others, for example fellow students, who can obtain them with a prescription. This is illegal and experts strongly advise against it. There is also another problem behind it: the sometimes inadequate supervision of patients.

About 4 percent of all students have used ADHD medications without a prescription, according to research last year by, among others, the Trimbos Institute and the Institute for Responsible Medicine Use (IVM). They mainly obtain the resources through friends.

And that is far from innocent, say both the RIVM and experts. Child and adolescent psychiatrist Gigi van de Loo-Neus at Karakter, who specializes in ADHD problems, says that many people are not aware of the side effects. “It can affect your sleep, your metabolism, your blood pressure. Students who take it without a prescription think: I’ll take another one, while someone who uses it in a structured way knows how much he needs.”

Undiagnosed students use ADHD medication to be more awake and focused. “The question then is whether such a medicine works better than a good cup of coffee,” says Van de Loo. “And it can also have an adverse effect if it is not intended for you. For example, the risk of addiction is greater if you do not use medication properly and it can cause unpleasant side effects.”

Controls

Psychiatrists, general practitioners and pharmacists play a role in providing information about the side effects of ADHD medication, but must also monitor their use. The IVM’s guideline is that a six-monthly check-up is desirable for ADHD patients. This is done meticulously at some general practices and healthcare institutions, but at others much less or not at all, according to a tour by the IVM.

Pharmacist Marieke van den Berk-Bulsink, also an advisor at the IVM, says that not all healthcare providers are familiar with the improper use of ADHD medication. “In addition, psychological disorders are often not regulated in chain care. For example, in the case of cardiovascular disease or diabetes, it is established that patients visit the GP every three months. This is less strictly regulated in psychological care.”

Shaking and no feeling of hunger

Now 24-year-old student Anna was diagnosed with ADHD as a child and was prescribed methylphenidate. She said she received the ‘usual dose’. It turned out to be much too high. “I suffered a lot from side effects: I started shaking and I didn’t feel hungry, so I lost a lot of weight. I thought it was strange that I was so easily given such a high dose at once. They should have said better: we start low and then we will look further.”

Anna immediately stopped taking the medication and has now been taking dexamphetamine, another commonly used ADHD medication, for two years. “That works very well. I don’t have any side effects.”

Yet in the past two years, Anna has never been called by her doctor or the pharmacy asking whether she is experiencing side effects and whether the dosage is still correct. The clinical neuropsychology student says he has no need for that either, “but I can imagine that others would like it. Especially in the initial phase.”

No time at GPs

Psychiatrist Van de Loo-Neus recognizes the problems when diagnosing and carrying out checks. Regarding Anna’s comment that she was given the ‘usual dose’, she says that it doesn’t actually exist. “Some children need a low dose for the whole day, others may need ten times that amount to have an effect.”

About the lack of control, Van de Loo says that some general practitioners simply do not have time to do so. “They indicate: we cannot manage to do that every six months. If you have ten ADHD patients at your practice, your consultation hours quickly fill up, so that is understandable, but also worrying.”

Yet Van de Loo-Neus thinks that in most cases things are going well. ADHD patient Rosa (23) also says this. She went through a long process before the diagnosis was made and her pharmacy has a strict policy for repeat prescriptions. “I would prefer to take medication with me for a long period of time, because I find it a hassle to have to keep coming back. But that is not allowed. Then they are afraid that I will pass it on.”

Rosa says she finds this annoying, but also understandable: “Friends have sometimes asked me if I could give something to them. I think you can also make good money with it. But yes, I need it myself and so I can’t just get more medication.”

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