As prescriptions for stimulants to treat ADHD increased, so did pharma payments to doctors, study finds

As prescriptions for stimulants, such as those used to treat attention-deficit/hyperactivity disorder (ADHD) in children, increased, so did payments to the doctors who often care for children and adolescents, a new study found.

In a five-year period, 1 in 18 physicians appears to have received payments for stimulants, most typically high-frequency, low-dollar payments in the form of food or beverage, according to a study published in JAMA Pediatrics.

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Pediatricians, psychiatrists and family physicians received the greatest share of the payments from drug companies marketing the drugs, according to the study, which looked at pharmacy payments between January 2014 and December 2018 reported in the Open Payments database. Those financial payments may have partly contributed to the increase in prescriptions, the researchers suggested.

In the U.S., prescription stimulant use doubled from 2006 to 2016, resulting in the highest pharmaceutical expenditure for children compared to any other medication class, researchers aid.

They also noted that the rise in stimulant use parallels increasing ADHD diagnosis rates, but said stimulants, even when appropriately prescribed, are commonly diverted and used nonmedically.

"Our study results indicate that the marketing of stimulants by pharmaceutical companies could be contributing to the increased prescribing of both generic and brand name stimulant medications for children with ADHD," said Scott Hadland, M.D,  the study's lead author who is a pediatrician and addiction specialist at the Grayken Center for Addiction at Boston Medical Center.

"Given the potential for the misuse of these medications—and the fact that misuse often starts during adolescence and young adulthood—we need to more closely examine whether there should be standards in place limiting the marketing of stimulant medications directly to providers,” Hadland said.

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Between 2013 and 2018, almost 592,000 payments that totaled more than $20 million were made to physicians who prescribed stimulants, according to the study. Just over 55,000 physicians received payments from pharmaceutical companies. The median value of a payment was $14.

While that doesn’t sound like much, a 2016 study found free meals for physicians pay off for drug companies. Doctors who get a free meal from a drugmaker have an increased rate of prescribing the brand-name medication the company is promoting, the study found.

"As previous studies have shown, marketing—even its most subtle form—can influence prescribing, so doctors should be aware that even something as seemingly benign as a meal from a drug company could be affecting the clinical decisions they make," said Hadland, who also is an assistant professor of pediatrics at Boston University School of Medicine.

Pediatricians as a group received the most marketing payments (40.4%). The researchers estimate that as many as 1 in 5 pediatricians in practice during the study period may have received marketing for stimulants from pharmaceutical companies.