Why We Should Be Concerned With the Recent ADHD Prescription Boom
The use of medication for the treatment of attention deficit disorders, such as Attention Deficit Hyperactive Disorder (ADHD), is growing. The recent recognition of ADHD as a condition that can also afflict adults has provided a boom to the industry, and health care reform has enabled more children to access behavioral health services, resulting in more patients being able to have their ADHD identified and treated.
That’s the conclusion of a new report published by IBISWorld, a market research firm, which showed that ADHD medication sales have grown 8 percent each year since 2010 and will grow another 13 percent this year to $12.9 billion.
The report also projects that this growth will continue over the next five years at an annualized rate of 6 percent, and take in $17.5 billion in the year 2020, making it one of the top psychopharmaceutical categories on the market.
Sales outside of the U.S. – especially in Israel, China and Saudi Arabia –are increasing twice as fast as in the United States, according to Richard Scheffler, professor of health economics and public policy at the University of California, Berkely, in an article he penned in the Wall Street Journal with Stephen Hinshaw, professor of psychology and psychiatry at UC Berkeley and UC San Francisco.
Why the growth?
One major reason for ADHD drug revenue’s recent growth within the United States is health care reform. The Affordable Care Act (ACA) and Medicaid now require insurance providers to cover mental health services, including behavioral disorder assessments and treatments. The Department of Health and Human Services reported that this expansion of mental health benefits will affect more than 60 million people, including 27 million who were previously uninsured.
With more people assessed and diagnosed, Scheffler expects an increase in ADHD treatment to follow. According to his analysis of data from the Centers for Disease Control and Prevention (CDC), around 70 percent of children diagnosed with ADHD are prescribed medication in the U.S. ACA and Medicaid also cover ADHD medication costs, which can set consumers back more than $200 a month.
Another reason? The addition of formal guidelines for diagnosing adults with ADHD in the most recent edition of the Diagnostic Statistical Manual of Mental Disorders (DSM).
The American Psychiatric Association (APA), which publishes the DSM, added specific descriptions of adult ADHD symptoms for the first time, putting to rest lingering beliefs that ADHD was only a childhood condition. It also determined that only five symptoms from the DSM's symptom list need to be present to diagnose someone 17 years old or older, compared to 6 symptoms for children.
According to Hinshaw, “Adult diagnosis is skyrocketing.”
A report released last year by Express Scripts calculated that the number of adults using ADHD medication increased more than 50 percent from 2008 to 2012. The IBISWorld report mirrored this prediction and furthermore predicted this number to continue growing “at a rapid pace” through 2020.
This year, adults over the age of 19 will make up approximately 44 percent of the ADHD medication market, the report stated.
Quick to Prescribe
Some physicians predict that the adult diagnostic criteria combined with the Affordable Care Act could lead to overdiagnosis – and, as a result, overmedication. That's worrisome, considering that stimulants like amphetamine—which account for nearly 90 percent of ADHD medications—have proven to be ineffective and even harmful for those misdiagnosed with ADHD, or who have ADHD but do not receive other therapies, as well.
“Where I get worried is if we continue to allow quick and dirty diagnoses,” wrote Hinshaw. “Then I fear some of the increase is going to be based on people who don't really have symptoms of enough severity to meet ADHD. And then we are into trouble.”
“How are most people in the United States diagnosed with ADHD?” he continued. “A 10 to 15 minute visit with a pediatrician or a general practitioner. That's it; there is no reimbursement for a long, careful, thorough assessment.”
According to Scheffler, there is no evidence that Obamacare will enforce more stringent guidelines for diagnoses or reimburse doctors for the time needed for a thorough assessment. “It can take multiple tests and visits,” he said. “These are not adequately financed.”
“This is a real condition, it causes serious impairment,” added Hinshaw. “But you only know that if you diagnose carefully and thoroughly, and if we don't take the time do it we are going to pay the price.”
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.