This March issue of Psychiatric Annals features a series of articles, guest edited by Robert DuPont, MD, focusing on the nonmedical use of stimulant medications. This is a timely and difficult issue. With the increasing recognition of the handicap and damage caused by untreated childhood attention-deficit/hyperactivity disorder, as well as the increasing awareness of cases of adult attention deficit disorder, the problem of prescribing stimulants that effectively treat these disorders while minimizing the inappropriate use and diversion of these medications grows. These articles address these issues from several different perspectives.
This specific problem occurs in a climate of increasing patient pressure toward nonmedical prescription of treatment. Patients are taking more “self-prescribed” treatments, such as a vast array of “alternative treatments” and Internet-available medications, often for self diagnosed ailments. Nonmedically trained psychologists are using the argument of a dearth of psychiatrists in certain geographic areas and political force to gain the “right” to prescribe psychoactive medications. Many people make “drug runs” to Mexico to pick up prescription medications over-the-counter for economic savings. Patients are being bombarded by televsion adds telling them “Ask your doctor if this medication would be right for you” or present self-diagnosed syndromes and treatment suggestions gained from the Internet or the many medical news articles being printed.
In an age where medical care is being marketed and delivered as if it were a product like toothpaste by “health companies,” physicians have less control over the treatment their patients receive. “Medical” treatment is more and more becoming a case of caveat emptor.
Maybe it's good for people to know more about medical illnesses in this age — even if this “knowledge” is often incorrect, incomplete, or distorted. It is a challenge for us to take time to find out what assumptions the patient's new knowledge has lead to, and to explain what we believe is correct for the patient and why. We also have to spend more time reviewing the risks of the medications we prescribe and how they should be safely used, including pointing out the risks of abuse or sharing of medications with others.
Another challenge! Keeps life interesting, doesn't it?
Don't forget to join us in Manhattan April 1–3 for the third annual Psychiatric Annals Symposium. Our subject this year will be treatment-resistant and bipolar depression. For more information, see the advertisement on pages 248–249 of this issue.