ADHD prescriptions on the rise in Quebec, most in Canada

Attention deficit disorder (ADHD) prescriptions are on the rise in Quebec, and the province is writing the most prescriptions in Canada, according to a report released this week by the Quebec Institute of Public Health (INSPQ).

Between 2000 and 2020, prescriptions rose from 1.9 per cent to 7.7 per cent among young people aged 24 and under who are registered with the public drug insurance plan, the document says, citing a "steady increase."

"This trend of increasing prescribing is consistent with the trend of ADHD diagnosis in Quebec," the report said.

There was an increase in ADHD medication prescriptions in the 24 and under age group in all regions of Quebec between 2000 and 2020, with the increase per region ranging from 2.1 per cent to 11.9 per cent. Geographic differences in the epidemiological prevalence of ADHD, different clinical approaches to treatment across the province, and cultural differences in the perception of ADHD between regions are cited as explanations for these disparities.

According to the Quebec Institute of Excellence in Health and Social Services, 4 per cent of youth aged 25 and under were taking medication for ADHD in Canada in 2017-2018, compared to 8.1 per cent of youth in Quebec.

Several hypotheses can explain these disparities between Quebec and the other Canadian provinces, according to the report. Given the higher prevalence ADHD diagnoses in Quebec, the increase in prescribing likely represents an increased recognition of ADHD and the potential effectiveness of medication.

The difference could also be explained by the fact that medication for ADHD is free for Quebecers aged 18 and under and full-time students aged 18 to 25, it adds.

In 2019-2020, just under 10 per cent of boys and just under 6 per cent of girls aged 0-24 covered by the plan received prescriptions for ADHD. More than half of the initial prescriptions are written by the family doctor and about one-third by a paediatrician.

The prescription data may also underestimate the true extent of the situation, explains the INSPQ, "since ADHD may not be reported in the presence of associated disorders since only one diagnosis code is allowed for billing a medical service."

"We are prescribing less than the prevalence of the disease," said Dr. Alain Lesage, who is a full professor in the Department of Psychiatry at the University of Montreal. "So there are people who could potentially be treated who are not treated."

The paper also found that fewer prescriptions were given to young people from high economic and socially disadvantaged backgrounds, possibly because "parents of better-educated children with higher incomes are better able to identify the specialist medical, school and community services available in their areas."

Problems accessing health care and a fear of further stigmatization due to their socially disadvantaged status are also cited as reasons.

"It has been shown through a series of studies that treatment with medication is a treatment that is effective, safe, and there is no equivalent," said Lesage.

Treating children with ADHD as early as possible can prevent many problems later in life, he added, from dropping out of school, to self-esteem problems, to substance abuse, anxiety and depression.

This report by The Canadian Press was first published in French on Oct. 21, 2022.