Quebec doctors decry the province's high rate of prescribing ADHD drugs to children and teens

A group of Quebec doctors is sounding the alarm about the high rate of prescribed medication used to to treat attention deficit hyperactivity disorder (ADHD) in teens in the province.

Patients between 13 and 17 are prescribed ADHD drugs at more than twice the rate of any other province, the doctors say.

More than 45 Quebec doctors signed an open letter made public Thursday, calling on the public to take a hard look at the issue.

The letter says there's an urgent need to consider not only why drugs are being prescribed at such a high rate, but also why so many young people are showing symptoms of inattention, hyperactivity, impulsivity and anxiety.

We feel a lot of pressure as pediatricians working with a vulnerable population to solve that problem with medication only — which is not a good solution.- Dr. Gilles Julien, expert in social pediatrics

The group backs its claim with data from the province's Institut national d'excellence en santé et en services sociaux (INESSS) — data that shows Quebec's rate of prescribing ADHD drugs is rising at an alarming rate.

For youth aged 13 to 17 who are covered by the province's drug insurance plan, prescription rates jumped from 3.4 per cent to 9.9 per cent between 2006 and 2015.

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

In that 0-to-25 group, regardless of whether they had private or public drug insurance, INESSS data shows that in 2014-2015, the percentage of children with ADHD treated with medication was 6.4 per cent in Quebec, compared to 2.4 per cent in the rest of Canada.

The highest rate of medication is prescribed to children in the 10-to-12 age group, the letter states, where 14 per cent of children are on medication for ADHD, compared to just over five per cent in the rest of Canada.

The doctors say drug treatment can be effective in the short term but can have negative effects over the long term.

They want teachers, parents and health care professionals to think about why they are opting for medicating children and teens, while psychosocial intervention and parental support are neglected.

'We feel a lot of pressure'

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

He told CBC Montreal's Daybreak Thursday that medications such as methylphenidate, commonly sold under the Ritalin trade name, work in many cases, but such drugs prove to be less effective when the patient's condition is more complex.

"For people, the medication is like a solution," he said. "It's not the only solution. We feel a lot of pressure as pediatricians working with a vulnerable population to solve that problem with medication only — which is not a good solution."

It's not clear why Quebec prescribes drugs at more than twice the rate of other provinces, he said.

However, there is clearly a lot of pressure on doctors to prescribe medication coming from schools, parents and others who work with children.

That kind of pressure isn't felt in Europe or other parts of Canada, he said.

Listen to Dr. Gilles Julien's full interview here:

According to Julien, children are becoming increasingly anxious. They're not getting the support they need in schools, he said, and they don't have the same access to activities such as music and sports as previous generations had.

Such activities can help children reduce anxiety, he said.

Doctors warn of over-prescription, over-diagnosis

In an interview on Radio-Canada's Gravel le matin, Dr. Valérie Labbé, who also signed the letter, said she would like a full-scale public debate on the medicating of children for ADHD.

Society as a whole needs to reflect on the issue rather than putting all the blame on doctors or parents, she said.

Quebec's tendency to over-prescribe could be related to the fact that drugs like Ritalin are paid for by the province's universal drug insurance plan, which other provinces don't have. 

"When we speak, when [doctors] meet, everyone is alarmed by this high rate of medication," Labbé said.

"There is a social phenomenon that causes children to have difficulty sitting still, concentrating and managing their emotions."

Dr. Stacey Bélanger, an expert in pediatric mental health at Montreal's Sainte-Justine Hospital, cautioned that more research needs to be done on the cause of the discrepancy across the country in prescription rates — and on the effects of the drugs.

One of the key factors, she said, is that some drugs aren't covered in other provinces, rendering them unaffordable to many Canadians outside Quebec.

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

Inform yourself, mother says

Both of Lisa Wolanski's children, who are now in their 20s, have been taking medication for ADHD since elementary school.

She says her children tried different kinds of medications before settling on one that worked for them.

When Wolanski's daughter was in Grade 1, she told her mother that her new pills helped her listen in class and play at recess.

"I thought, OK, even a six-year-old could understand the benefits of getting that extra help that allowed her to behave the way she wanted to behave in the classroom and enjoy herself outside of the classroom," Wolanski said.

Both her children have chosen to stay on medication as adults, she said, because they prefer the way they behave when they're taking it.

She said she agrees with the Quebec doctors who say parents need to proceed with caution when it comes to medicating their children.

"I think that people should not just put their kids on medication because they're misbehaving or because the teacher says so," she said.

It's important to get a psycho-social educational assessment, she said, and to work with the child's pediatrician and the school, since medication alone might not provide the desired result.

"Then you can make a wise decision for your own kid," Wolanski said.