ADHD
Lauren Howell, PharmD
Most pharmacists were taught that ADHD is associated with increased risks of adverse health outcomes, including premature death. However, new data from a study published in the March 10, 2024, issue of JAMA suggest that pharmacotherapy may decrease the risk of mortality for patients with ADHD.
Initiation of ADHD medication was associated with significantly lower all-cause mortality and unnatural cause mortality, according to the study findings. Natural cause mortality was also found to be lower.
Results of the study indicate that initiation of pharmacotherapy can lower the risk of death due to unnatural causes, such as unintentional injuries, suicide, and accidental poisonings, in patients diagnosed with ADHD.
The study
An observational nationwide cohort study conducted in Sweden assessed all-cause mortality within 2 years of a patient’s ADHD diagnosis, as well as natural cause and unnatural cause mortality.
Individuals aged 6 years to 64 years with a diagnosis of ADHD between the years of 2007 and 2018 were identified. To be included, patients could not have been dispensed ADHD medication prior to diagnosis. Follow-up continued until death, emigration, 2 years after diagnosis, or the end study period date, depending on which one came first for the individual.
Of the patients included in the study, 56.7% initiated ADHD medication and the median age at diagnosis was 17.4 years. The 2-year mortality risk was found to be lower in the group of individuals who received medication (39.1 per 10,000 individuals) than in those who didn’t (48.1 per 10,000 individuals). However, the difference between the two study groups was not statistically significant.
The role of the pharmacist
Pharmacists can play a role in making sure patients with ADHD are properly prescribed pharmacotherapy and have access to the medications that they need.
Whether practicing in a community pharmacy, hospital setting, or ambulatory care setting, many pharmacists have an opportunity to impact the pharmacotherapy of patients with ADHD. Pharmacists can break down barriers to access by helping patients find discount cards and patient assistance programs to make medications affordable. They can also help by monitoring adherence, reminding patients when prescriptions are ready, and calling providers when a new prescription is needed or when the therapy doesn’t seem optimized.
In addition, pharmacists can make themselves more knowledgeable of standards of care and proper pharmacotherapy in the field of psychiatry. While these topics are covered in pharmacy school curriculum, new drugs coming to the market and advances in the field can cause knowledge gaps that pharmacists must take initiative to fill.
Mental health conditions, such as ADHD, are seen across practice settings and specialists such as psychiatric pharmacists are not the only pharmacists who need to be knowledgeable of the pharmacotherapy that is available.
As one of the most accessible health care providers, pharmacists can have conversations with patients and may notice potential ADHD symptoms. In this situation, the pharmacist can refer these patients to receive a formal diagnosis.
Pharmacists have the ability to reduce the stigma that surrounds mental health disorders and the medications used to treat them. Pharmacists can also meet with patients who are already taking medication to minimize adverse effects and maximize clinical benefit. ■
ADHD medication shortage continues
With the increasing number of drug shortages seen in recent years, pharmacists can play a vital role in navigating shortages that affect medications for ADHD. This may look like finding a pharmacy that can dispense the medication or speaking to the provider about alternative options. While some medications, such as Adderall, have been on the FDA shortage list since 2022, other ADHD medications like the generic versions of Vyvanse and Concerta were added during 2023. ■