BC Medical Assn says ADHD Costing BC 500 Million Yearly. Asks Govt to Improve Access to Care for ADHD Patients

Post from: Adult ADD Strengths

UPDATE: the 500 million figure is incorrect, it’s actually Billions of dollars yearly. The BCMA underestimated the cost because they only counted the cost of children with ADHD ie 18 and under. They didn’t include adults with ADHD which are far more numerous than kids with ADHD, i.e., 19 years to 70, 80 etc. See page 7, 3rd paragraph of the report

So it’s costing BC MULTIPLE BILLIONS of Dollars Annually to deal with ADHD and the actual treatment cost is the smallest amount, and many are undiagnosed and untreated.

Finally. Finally. Still can’t believe it was written. Thought BC would remain the Canadian equivalant of Mississippi in terms of how they treat or ignore adults and children with ADHD. I.e., in last place.

Here’s the BCMC news release from February 23, 2009 BCMA recommends improved access to treatement for ADHD

Here’s the February 2009 – BCMA Policy Paper – Your Attention, Please: A Call to Improve Access to Care for ADHD Patients It’s a 16 page PDF conclusions, are on page 14 and I’ve pasted their 8 recommendations in below. I agree with all of them especially requiring the govt to treat adults with ADHD and it should have been done 20 years ago. The chair was Dr. Shelly Ross who is a GP in Burnaby.

But if you live in BC and have ADHD or have friends/family members or relatives with ADHD you should read all 16 pages and pass it around to as many people as you can.

I think it’s the most important document ever written on ADHD in BC, period.

The Vancouver Sun covered the story yesterday Feb 24th on p A5 and in their online edition, I was quoted by the reporter Amy O’ Brian. If you think it’s an important story, leave a comment on their site (or here) telling them why this report’s recommendations should be implemented or what’s it like being an adult with ADHD. You don’t have to use your full name.

You might consider writing a letter to your local paper, call in to your local talk show, leave a comment on your local blog about it, or tweet it, mention it on facebook etc. There’s a BC election in May. I’d also suggest contact your MLA as well as the various opposition parties about it and ask them if they agree with and will implement all 8 suggestions. Not just “we’ll study it”. As a political science major, I know governments often respond to public pressure. If ADDers and their family don’t bother to do so no one will, and we won’t get a better chance than this, possible not for a decade.

I’ll list some ways to contact politicians and the media after the recommendations and will blog about the policy document later. Here’s a few excerpts from the report.

In Canada, it takes more than 18 months for a patient with ADHD to be treated after first contact with a physician. Once diagnosed, only half of children and as few as 11% of adults receive treatment. As the waitlist for the BC Children’s Hospital ADHD Clinic shows, demand for such services greatly exceeds supply.

Taking into account the direct health, education, and justice-related costs associated with ADHD, the total costs to the government of British Columbia may exceed $500 million each year – enough money to pay for nearly half of BC’s $1.061 billion PharmaCare budget or more than all of the Ministry’s capital plan budget for 2008/09 (Ministry of Health 2008).

This policy paper on ADHD will propose ways to improve access to care for patients with ADHD. The first section begins by reviewing the economic and social costs of the disorder, followed by an examination of provincial policy and the delivery of care in British Columbia. The paper continues with a discussion of quality of care issues and concludes with recommendations for government and other health care stakeholders.

Simply writing a prescription for ADHD is woefully insufficient care, and practice guidelines universally acknowledge that treatment of ADHD with medication must be accompanied by psychoeducation about the disorder, appropriate environmental accommodations, and behavioural intervention. Prescription of medication without additional support has been shown to be associated with poor compliance, persistence and community-based outcomes. Within a year, almost 50% of parents discontinue their children’s medication.

BC Medical Associations’s List of Recommendations

1. The provincial government must restructure the Child and Youth Mental Health Network so that it meets more frequently, is supported with an adequate budget, and is responsible for producing tangible outputs outlined in a publicly-available strategic plan.

2. The provincial government should work with stakeholders to ensure that any new child mental health plan includes a strategic plan for the delivery of services specifically for patients with ADHD.

3. The provincial government must provide services for adults with ADHD and follow-up services for children who graduate from the ADHD clinic at age 18.

4. Funding for ADHD services should be increased to guarantee waitlists of less than three months for all ADHD patients.

5. A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

6. Medical professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice should endorse the Canadian Attention Deficit Disorder Resource Alliance (CADDRA) ADHD practice guidelines; or review, amend, and then endorse revised CADDRA guidelines. Such guidelines should be accompanied by the implementation, in primary care offices across British Columbia, of a ‘diagnostic toolkit’ for ADHD.

7. PharmaCare should expand coverage for long-acting ADHD medication in order to facilitate compliance, minimize stigma and prevent missed opportunities for focused learning.

8. In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the Ministry of Health and Ministry of Children and Family Development should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

I have been trying to get the word out on ADHD and why ADHD adults and children should get diagnosis and treatment for years. This report and the upcoming provincial election is our best shot to make a difference for people with ADHD and their family members.

If you want change, now’s the time to take action.

List of BC Liberal Party candidates

List of BC NDP candidates

List of BC Green Party Candidates

BC Minister of Health Services is George Abbott
Ministers direct phone # 250 953-3547
Toll-free in B.C.: 1 800 465-4911
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Here’s some helpful tips on writing a letter to the editor and a list of BC based newspapers websites and editor email addresses courtesy BC Liberal Party

Here’s a list of BC based talk radio shows with phone numbers, host names, times and online comments

I‘ll be blogging about the report in detail later in another post. I’ve asked the BC NDP, the BC liberal minister of health’s office and the Green party for comment. I’ve already got a response from the BC Liberals, they’re quicker than the other two. When I phoned the BC NDP party, I talked to a legislative assistant to MLA’s and said I was a blogger who would like to hear the NDP’s official position on the BCMA 8 recommendations, the NDP staffer said “what’s a blogger?” Wow. Not impressed. Maybe she should read this Obama McCain social media scorecard post or this Vancouver civic election social media scorecard post I did to see why social media is important in politics.

What do you think of the BCMA’s 8 ADHD recommendations?

ADHD and Addictions 5 more Clinical Studies

Post from: Adult ADD Strengths

As a follow up to my last post,

Here are 5 more studies on the well known (among those familiar with ADHD) links between ADHD and Addictions.

Or 5 more reasons why governments should start properly diagnosing and treating adults and children with ADHD now, or pay 100 times the price later in addictions and all the associated costs; crime, incarceration, additional health care costs, career costs, family damage, etc. And I’m not even mentioning the links between ADHD and tobacco and marijuana, which are the #1 and #3 most popular drugs for children and adults with Attention Deficit Hyperactivity Disorder to abuse.

You can also look at my check 3 part series of posts on ADHD and Crystal Meth Part One as well as Part Two and Part Three.

1. 35% of Cocaine Abusers had ADHD

Comprehensive Psychiatry. 1993 Mar-Apr;34(2):75-82

35% of 298 treatment-seeking cocaine abusers met DSM-III-R (the previous version of DSM IV)
criteria for childhood ADHD. Those that had ADHD were 78% male, 93% had conduct disorder and 47% had antisocial personality disorder and report a history of conduct disorder in first-degree relatives.

Cocaine abusers with childhood ADHD were younger at presentation for treatment and reported more severe substance use, earlier onset of cocaine abuse, more frequent and intense cocaine use, intranasal rather than freebase or intravenous use of cocaine, higher rates of alcoholism, and more previous treatment. This pattern of cocaine use is consistent with clinical descriptions of self-medication of residual symptoms of ADHD in cocaine abusers. Data from this study suggest that there may be more cocaine abusers with a history of ADHD than previously recognized in clinical samples of cocaine users, and that these individuals may differ in clinically meaningful ways from those without childhood ADHD. Moreover, the poorer outcome of subjects with ADHD in this sample underlines the importance of identifying and treating residual symptoms of ADHD in cocaine abusers.

2. 24% of Psychoactive Substance Abusers had ADHD

J Clin Psychiatry. 2000 Apr;61(4):244-51

Two hundred one participants were selected randomly from 2 chemical dependency treatment centers

Forty-eight (24%) of the participants were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95; NS). Seventy-nine participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse.

CONCLUSION: A significant overrepresentation of ADHD exists among inpatients with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comorbidities identified here were attributable largely to the presence of conduct disorder. Individuals who manifest conduct disorder and/or ADHD represent a significant proportion of those seeking treatment for psychoactive substance use disorders. They appear to have greater comorbidity and may benefit from a treatment approach that addresses these comorbidities specifically through medical and behavioral therapies.

3. 32% of Cocaine Users and Alcoholics had ADHD

American Journal of Drug Alcohol Abuse. 1999 Aug;25(3):441-8

Of 136 inpatients with an SUD (substance use disorder) diagnosis (cocaine vs. alcohol vs. cocaine/alcohol) 32% had ADHD.

There were no significant differences in the percentage of ADHD between the SUD+ groups divided by drug choice…. Patients with cocaine use were more likely to have ADHD in childhood only when compared to the alcohol or cocaine-alcohol groups. The findings of this study indicate that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.

4. 70% of Crystal Meth (Methamphetamine) Inpatients had ADHD

Journal of  Addiction Disorders. 2005;24(3):133-52.

Methamphetamine-dependent inpatients (N = 51) were screened for childhood attention deficit hyperactivity disorder (ADHD) using the Wender Utah Rating Scale upon admission to 30-day inpatient treatment. Baseline assessments included neuropsychological tests of executive function, memory, information processing, verbal fluency, attention, motor skills, and the Brief Symptom Inventory (BSI), a measure of psychiatric symptomatology. The thirty-six participants (70.6%) screening positive for ADHD reported significantly more frequent methamphetamine use prior to baseline. Baseline cognitive functioning was similar between groups, but the presumptive ADHD participants exhibited significantly worse psychiatric symptomatology. At three-week follow- up, 41 participants (80.4%) repeated the neuropsychological battery and BSI. All 10 non-completers screened positive for ADHD. The entire sample improved with abstinence in most neuropsychological domains except memory. The presumptive ADHD group failed to improve on tests of attention. All participants demonstrated significant reductions in psychiatric symptoms with abstinence.

Methamphetamine-dependent individuals with ADHD symptoms are common and pose a significant treatment challenge.

5. 83% of Inhalant Abusers and 55% of Methamphetamine Mbusers in Japan had ADHD.

Psychiatry Clinical Neuroscience. 2005 Feb;59(1):102-5.

They examined the childhood histories of 54 methamphetamine users and 12 inhalant abusers in Japan using the Wender Utah Rating Scale.

The inhalant abusers experienced initial drinking at a younger age than methamphetamine abuser…83.3% of inhalant and 55.6% of methamphetamine abusers had higher scores than the cut-off for ADHD. These findings suggest that drug abuse is associated with childhood ADHD, and that inhalant abusers have a higher incidence of childhood ADHD than methamphetamine abusers.

There’s more on the links between ADHD and addictions on this page of my 100+ ADD resource website