Quebec leads the nation in ADHD prescriptions, says a report

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The number of prescriptions issued for the treatment of attention-deficit/hyperactivity disorder (ADHD) continues to rise in Quebec, and the province leads the nation in the number of prescriptions issued, according to a study released this week by the Institut national de santé publique Quebec (INSPQ).

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The study finds that between 2000 and 2020, prescriptions for patients under the age of 24 enrolled in Quebec’s public drug insurance plan increased from 1.9 percent to 7.7 percent, and the rate is rising steadily.

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“This trend of increased prescribing is consistent with that of ADHD diagnosis in Quebec,” the report said.

This trend was apparent in every region of Quebec over the 20 years studied, although the rate per region varies from 2.1 percent to 11.9 percent, the report said. This variance could be explained by regional differences in the prevalence of ADHD, different clinical approaches from one region to another, and cultural differences in perceptions of ADHD.

According to the Institut national d’excellence en santé et en services sociaux, between 2017 and 2018, a total of four percent of patients across Canada under the age of 24 were taking medication for ADHD.

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According to the Institut national d’excellence en santé et en services sociaux (INESS), about four percent of Canadians under the age of 25 were taking ADHD medication in 2017-18, compared to 8.1 percent in Quebec.

The INESSS suggests that the higher prescribing rate in Quebec could also be explained by a better understanding of the disease in that province, as well as a greater appreciation of the drugs’ potential efficacy.

Another explanation might be that ADHD medication is free for Quebecers under the age of 18 and full-time students ages 18-25.

In 2019-2020, just under 10 percent of boys and just under 6 percent of girls under the age of 24 covered by the public drug plan received prescriptions for ADHD drugs. More than half of the first prescriptions were issued by GPs and about a third by paediatricians.

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INSPQ warns that data on prescriptions could also under-represent the magnitude of the problem. The study notes that “it is possible that ADHD may not be reported in the presence of comorbidities (because) only a single diagnosis code is allowed for billing a medical service.”

dr Alain Lesage, a professor in the Department of Psychiatry at the Université de Montréal, says this means “we are prescribing less than the prevalence of the disease. So there are people who could possibly be treated but are not being treated.”

The report finds that fewer prescriptions were being issued to youth in affluent areas as well as disadvantaged areas, possibly because “parents of higher-income, well-educated children are more able to access specialized medical, educational and community services in their regions.” .

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Lesage said it has been “shown by a number of studies that drug treatment is a treatment that is efficient, safe and unparalleled.”

Treating children with ADHD as soon as possible can prevent problems later in life, he added, from dropping out of school to self-confidence issues, drug addiction, or anxiety or depression.