The drug dealers of today are no longer thugs at street corners; rather, they are accredited physicians. To further complicate matters, the physicians may not even realize that they are being used as a tool by patients seeking to obtain illegitimate prescriptions.
It is getting remarkably easier and easier to visit a physician’s office and feign an illness to get scheduled medications. In addition, an unfortunate consequence of this practice is that an illegitimate increase of demand can cause shortages of medications. To combat this crisis, stricter prescription procedures are required.
To begin analyzing this issue, we should start with one of the most commonly feigned illnesses, attention deficit hyperactivity disorder (ADHD), for which the treatment is the prescription of Adderall. Adderall is a stimulant consisting of a racemic mixture of amphetamine salts, and in the United States, Adderall is a Schedule II controlled substance on the Controlled Substances Act for its high potential of abuse and psychological or physical dependence.
Despite the serious adverse effects of misusing Adderall, the diagnosis of ADHD and prescription of Adderall has risen 66 percent in the last decade. In 2000, just 6.2 million physician office visits resulted in a diagnosis of ADHD, but by 2010, that number had jumped to 10.4 million office visits.
One consequence of increasing the diagnosis of ADHD and prescription of Adderall is that it has caused a shortage of the drug. A January 2012 survey found 96 percent of the nation’s independent pharmacists had experienced a drug shortage in the past six months. Medicines for ADHD, especially Adderall and Ritalin, topped the list of drugs in adequate supply.
The shortage of ADHD medication is extremely devastating for individuals that actually require the medication to be functional. Patients that are not on their medication behave similarly to bipolar individuals during a mania phase, often suffering from an extreme inability to focus on one task, an elevated or irritable mood, and obsessive-compulsive tendencies.
Now then why are more and more psychiatrists diagnosing patients with ADHD? One reason is the dynamics behind how psychiatry in the United States is practiced. After establishing a diagnosis during a new patient’s first visit, the subsequent psychiatry visits are for medication management only. These visits often last only 10 minutes--just long enough to make sure that the patient is responding well to the medication prescribed for their symptoms. Psychiatrists are paid per session, so the more patients they can fit into a day the more they will get paid.
So then, if a new patient complains of ADHD symptoms financially it is in the psychiatrist’s best interests to begin treatment of the disorder immediately, as opposed to spending another two to three longer visits in order to obtain a better diagnosis of the patient’s disorder. Unfortunately, this also makes it extremely easy for patients to feign disorders. Psychiatrists would be much more likely to catch malingering patients if they were able to devote more time to obtaining a diagnosis, but spending more time not only presents them with a financial burden, it also leaves them inaccessible to their other patients.
To worsen matters, there are not very many measures or systems in place to help psychiatrists become aware of patients who are feigning a disorder. Presently psychiatrists can only hope that they catch malingering patients in a lie, and even then there is no legal obligation for the psychiatrist to report the patient to the authorities.
Before we continue on our search to fix this problem, we must recognize that it is not the psychiatrists’ fault for the rise in prescriptions of scheduled substances. The truth of the matter lies in the fact that the current dynamics of how psychiatry is practiced in the United States can easily be manipulated by drug-seekers. Chronic stimulant users acknowledge that they can satisfy their amphetamine cravings by feigning ADHD symptoms and psychiatrists will not know they are lying. In order to stay in business, psychiatrists must meet with a certain number of patients per day, and as a result they do not have the time to catch patients feigning illnesses. Unfortunately as we discussed previously, this has severe consequences for those who do have ADHD, leading to drug shortages which create difficulty in obtaining medications.
To prevent the continuing of malingers using psychiatrists as their drug source, it is in the patient’s best interests to have more intensive testing before the initial prescription of scheduled medications. At first glance, some may argue that this would be detrimental to the time of both patients and psychiatrists, but in actuality by reducing both the number of false diagnoses and malingerers we will be ensuring that there will be a steady supply of medication for those who truly need it.
One route for more intensive testing would be to require a second opinion of another accredited psychiatrist before the initial prescription of scheduled medications. While this may not be a perfect solution to the problem, it is one solution that has been gaining a noticeable amount of publicity in the field of medicine and should be more thoroughly examined.
As we continue to fight the problem of patients feigning illnesses to acquire certain medications, we must remember that whatever regulations we implement should be in the patients’ best interests. The realm of medicine was created to provide care for the people, and establishing regulations that treat patients solely as malingerers would be an extreme disservice to the purpose of the health care field. It is far worse to not provide care for those who need it, than to care for those who do not.