If you were hoping to get some medications prescribed for attention deficit hyperactivity disorder (ADHD) while in college or at university, you might be in for a rude surprise.
Colleges and university are cutting back on their involvement with ADHD, primarily due to abuse of the psychiatric medications — stimulants like Ritalin — prescribed to treat the disorder. Students — whether they are malingering the symptoms or actually have it — are prescribed a drug to treat ADHD (sometimes from different providers in different states), then sell a few (or all the) pills on the side. Profit!
Now universities are becoming wise to the epidemic nature of the problem, as some studies have suggested up to a third of college students are illicitly taking ADHD stimulants.
This might help curb the abuse problem, but will it also make it harder for people with actual ADHD to receive treatment?
The short answer is, yes, of course. Students with a pre-existing diagnosis of attention deficit or attention deficit hyperactivity disorder will still often be able to get their prescriptions filled while at school. The university just doesn’t want to do the diagnosing of ADHD any longer.
I’ve long wondered at the wisdom of universities getting into the ADHD business in the first place. University counseling centers generally shrug off long-term treatment of serious mental illness. So it’s never been clear to me why they were comfortable prescribing medications for ADHD.
The New York Times notes — in a well-written take on this issue by Alan Schwarz — that the changes are sweeping campuses throughout the country:
Lisa Beach endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract — promising to submit to drug testing, to see a mental health professional every month and to not share the pills. […]
The University of Alabama and Marist College, like Fresno State, require students to sign contracts promising not to misuse pills or share them with classmates. Some schools, citing the rigor required to make a proper A.D.H.D. diagnosis, forbid their clinicians to make one (George Mason) or prescribe stimulants (William & Mary), and instead refer students to off-campus providers. Marquette requires students to sign releases allowing clinicians to phone their parents for full medical histories and to confirm the truth of the symptoms.
“We get complaints that you’re making it hard to get treatment,” said Dr. Jon Porter, director of medical, counseling and psychiatry services at the University of Vermont, which will not perform diagnostic evaluations for A.D.H.D. “There’s some truth to that. The counterweight is these prescriptions can be abused at a high rate, and we’re not willing to be a part of that and end up with kids sick or dead.”
Not everyone is convinced:
“If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners,” Ms. Hughes [CEO of CHADD, an advocacy organization] said. “Nonprescribed use of stimulant medications on campus is a serious problem that can’t just be punted to someone else outside the school grounds.”
She has a point. The 2010 suicide death of Kyle Craig, who abused Adderall prescribed by his local physician at home and not by the university he attended, suggests the problem is more wide-ranging than perhaps some university officials understand.
However, this sort of effort on the part of Fresno State is amazing and should be applauded:
And in a rare policy among colleges, students receiving prescriptions to treat A.D.H.D. must see a Fresno State therapist regularly — not for a cursory five-minute “med check” but for at least one 50-minute session a month.
Psychotherapy required for ADHD treatment? Nice — finally an institution that listens to the research and understands that medications are, for most, not a life-long answer.
I think that, by and large, this is a measured response to a very serious problem of stimulant abuse among college students. Students have long enjoyed free healthcare on campus, with counseling an additional free service they receive. But student counseling centers mostly refer students with serious, ongoing mental health or mental illness to local providers in the community — they’re simply not well-equipped to treat people with such concerns. I see no reason why ADHD should be an exception.
What this does for the colleges that are mostly getting out of the ADHD business is to limit the overall amount of prescriptions floating around for these stimulant meds. That should drive down supply, drive up prices, and make it less attractive as a “study” option for students without ADHD.
As for the students who actually have attention deficit disorder? I think they will still be able to get the treatment they need. Having seen people at community mental health centers, I know that if there’s a will, people will find a way to pay for mental health services.
Read the full article: Colleges Tackle Illicit Use of A.D.H.D. Pills
6 comments
You conclude your article with: “As for the students who actually have attention deficit disorder? I think they will still be able to get the treatment they need. Having seen people at community mental health centers, I know that if there’s a will, people will find a way to pay for mental health services.”
That assumption is not correct. I first began to suspect I had ADHD in grad school, after reading a list of the DSM-IV symptom criteria in my educational psychology textbook and recognizing myself in almost every criterion. I went to the counseling center and was told that they did not diagnose ADHD, that I would have to go to a private center and get psychoeducational testing, and that I probably didn’t have ADHD anyway, or I wouldn’t have gotten in to grad school.
As a student living off loans, I certainly couldn’t afford psychoeducational testing. I didn’t even feel I could afford an off-campus psychiatrist appointment, as the college health plan had a $500 deductible and only limited benefits. Because of this, my ADHD diagnosis was delayed for several years, resulting in a number of difficult life circumstances that could have been prevented had the college counseling center been willing to recognize ADHD when they saw it.
College kids are poor, and they generally pay at least $500/year for on-campus physical and mental health services. Student insurance plans usually have higher out-of-pocket costs because the insurance company expects students to be able to use those campus health services for the majority of their health-related concerns. If the health center and counseling centers between them are willing to diagnose and treat students for everything from asthma to bipolar disorder, then I see no reason why those of us with ADHD who pay for the same health services should be discriminated against to the extent that we cannot even receive a diagnosis for our condition.
I just spent a grueling 24 hr ride home with my dad who suspects everything from having “Chemical pneumonia” to the Mexican mafia, in cohoots with the aliens to take him out, to All real doctors don’t know anything, but “the internet” has all the answers. He disowned me 3 times on the trip. The reality is that you will find what you seek when it comes to health issues especially. Its called “confirmation bias”. The more my dad seeks, them more he finds what he is looking for, which drives is anxiety, which cases him to seek more, which causes him to find more….. The guy has a pace maker most his doctor at home thinks was not needed, but if you go to enough of them in Florida. ADHD is a myth. Not that the symptoms are not real, but the level of their dysfunction is. Read a book called “I Hate You, Don’t Leave Me.” I guarantee you will find plenty of stuff in there you can relate to as well. But they are a product of the stimulus from our internment, not the result the fictitious “chemical imbalance theory”.
Great article! I am so tired of the med seeking for quick fix cognitive struggles from other issues like sleep disorders or anxiety distracting situations, you know how I feel about people looking for strict abuse needs!
Psych testing and releases from alleged past providers should be the standards of care for people claiming to have adult ADD and resuming care, if not seeking it out for the first time as an adult.
Remember this: Rx opiates and stimulants are the SAME thing as speedballing with heroin and cocaine.
The only difference is now you, the prescribing doc, is the dealer, and oh, now at risk for litigious matters if/when the patient has consequences. Can’t sue a dealer, eh?
Dr. Grohol, this is off-topic, but still: Can you please do a blog post on the Oregon Medicaid story that broke yesterday?
http://www.nytimes.com/2013/05/02/business/study-finds-health-care-use-rises-with-expanded-medicaid.html
There is information that Medicaid did not help overall health to speak of, but that depression was diagnosed at a 30 percent lower rate through screening when people had Medicaid. Does that ring true for you? Maybe you can get inside the numbers a little bit as you do so well. I think the NYT article has links to the original data.
For those thinking that ADHD is a myth…I can tell you first hand…without a doubt, it is not. As a single father and skeptic dad to the over medication of many perceived modern ills..I was very reluctant nod hesitant when my sons psychiatrist (whom my son had been seeing for over a year because at his mothers insistence) suggested he begin medication for ADHD. However, I’m not a specialist and so agreed to it as long as the dosage was very minimal…the result was night and day, within weeks my son went from mostly F’s to A’s and B’s as well as a host of other positive social differences. Unfortunately, the program was discontinued, and as a single father I had no insurance…meds stopped coming in and I couldn’t afford the long, lengthy process to get him back on his medication…to this day, when possible, I have to buy the drugs irregularly and illegally because I can’t afford to do it legally…psychiatrist are too cautious and skeptical…claiming as mentioned above, that it is like cocaine…he’ll no it isn’t, no more than a poppy seed bagel is gonna get you high…the dosage is much too small, but it is a controlled substance, so out of fear I cannot provide proper treatment for my now adult son….I’m not looking for sympathy, and surely don’t need judgement from others…I know this medication works wonders on him, I would just like to see a rational ease on the grip of this medication so that at least I could purchase the meds without being deemed a criminal in society for buying medication.
Im currently in college. I was previously diagnosed with ADHD. I was on meds but went of for a year or two simply to get into the military. The military did not follow through, I went off to college, and my old doctors office went out of practice (AKA I cant get my medical records sent to my university). So basically, I have no way to get the medication that I need for studies now and my grades are suffering due to this restrictive policy. I think that not diagnosing or helping patients with an actual need for the medication is wrong and unethical simply because there is a large amount of people abusing the system. To deny treatment is completely wrong no matter the case.