ADHD drugs send thousands to the ER
Nearly two-thirds of hospital visits due to overdoses, accidental use

The Associated Press
Updated: 7:18 p.m. ET May 24, 2006


Accidental overdoses and side effects from attention deficit drugs likely send thousands of children and adults to emergency rooms, according to the first national estimates of the problem.

Scientists at the U.S. Centers for Disease Control and Prevention estimated problems with the stimulant drugs drive nearly 3,100 people to ERs each year. Nearly two-thirds — overdoses and accidental use — could be prevented by parents locking the pills away, the researchers say.

Other patients had side effects, including potential cardiac problems such as chest pain, stroke, high blood pressure and fast heart rate.

Concerns over those effects have led some doctors to urge the Food and Drug Administration to require a "black box," its most serious warning, on package inserts for drugs such as Ritalin, Concerta and Adderall. Yet even doctors advising the FDA don't agree on whether that's warranted.

The issue was discussed in a series of letters in Thursday's New England Journal of Medicine, including some from doctors worried about the dangers of not treating attention deficit hyperactivity disorder.

"The numbers (of side effects) are puny compared to the numbers of stimulant prescriptions per year," said Dr. Tolga Taneli, a child and adolescent psychiatrist at University of Medicine and Dentistry of New Jersey in Newark. "I'm not alarmed."

3.3 million on ADHD pills
An estimated 3.3 million Americans who are 19 or younger and nearly 1.5 million ages 20 and older are taking ADHD medicines. Ritalin is made by Novartis Pharmaceuticals Corp. of East Hanover, N.J.; Concerta by Johnson & Johnson of New Brunswick, N.J., and Adderall by Shire US Inc. of Newport, Ky.

Twenty-five deaths linked to ADHD drugs, 19 involving children, were reported to FDA from 1999 through 2003. Fifty-four other cases of serious heart problems, including heart attacks and strokes, were also reported. Some of the patients had prior heart problems.

Still, there hasn't been a clear estimate of the scope of side effects. The CDC report, while not a rigorous scientific study, attempts to provide that by using a new hospital surveillance network.


From August 2003 through December 2005, the researchers counted 188 ER visits for problems with the drugs at the 64 hospitals in the network, a representative sample of ERs monitored to spot drug side effects.

Doctors linked use of stimulant ADHD drugs to 73 patients with side effects or allergic reactions. Another 115 accidentally swallowed ADHD pills, including a month-old baby, or took too much.

"These are cases where a young child took someone else's medication or they took too much of their own," CDC epidemiologist Dr. Adam Cohen said of the second group.

Nearly 1 in 5 patients was admitted to the hospital, 1 in 5 needed stomach pumping or treatment with medicines, and 1 in 7 had cardiac symptoms. Sixteen percent of the side effects involved interaction with another drug.

Besides cardiac problems, common symptoms included abdominal pain, rashes and spasms, pain or weakness in muscles, according to Cohen. No patients died.

Extrapolating to all U.S. hospitals, the researchers estimated 3,075 ER visits occur each year.


In another letter in the journal, the heads of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry wrote they are concerned a black box warning would discourage use of ADHD drugs, raising patients' risks of academic failure, substance abuse and other problems.

Drug safety debated
This past February, an FDA drug safety advisory panel voted 8-7 for a black box warning. The next month, another FDA panel instead recommended data on cardiac and other risks go in a new "highlights" section the agency plans to add to the top of drug inserts.

Dr. Marsha Rappley, pediatrics professor at Michigan State University, and two other doctors on the advisory panels believe the vote for a black box was premature.

She said studies show the drugs raise blood pressure and pulse rates a bit, but it's unknown whether that would harm children taking them for years, and that cardiac risks may be higher for adults.

Dr. Steven Nissen, cardiology chief at the Cleveland Clinic, who had pressed for a black box warning at the FDA panel meeting, said ADHD drugs are powerful stimulants and inherently risky. Nissen and other doctors say the drugs are being prescribed to some who don't need them.

This week, the FDA said it is "working diligently" on "labeling changes that we feel accurately reflect the available data and the advice of the committees." The agency declined interview requests.

I like this topic alot because its true. So many teens are in the ER everyday because they OD on ADHD medicines. People with ADHD need to realize and their doctors need to realize it to if they dont already know..that a person with ADHD is most likely to have another mental disorder and problem like depression or anxiety so its def. a great topic.

it is true. you know, when i was first diagnosed with ADD OCD and depression, my dr. diagnosed dextrostat for my ADD. three days later i was throwing up. nobody told me it was SPEED! i am very careful about this now becuase dr.'s are pill pushuers and dont tell you much about what you are taking or that they are prescribing to you and if i would have known, i would have chosen to find a different treatment. since i was deppressed and there are two different types of pills for this (so i hear) which are stimulants and anti dpressants, i thought, well gee, im already depressed, why couldnt we have just killed two birds with one stone and use anti deapressants for my add instead of making me sick with speed!? whatever....

People around here get nagged to death and have had their places broken into for Adderall ..... so that doesn't suprise me, sadly. I guess using it like an upper could be fun .... ughhh I hate Adderall except for the first few hours. Maybe someone will break into my place and steal mine, give me a reason to not study.

It's basically dextroamphetamine, which isn't speed. Speed is a street drug with some of the same chemical properties, but I assure you, dextrostat is not the street drug "speed." Some people can't take a certain dose, or a certain type of stimulant medication. This makes it no different than any other medication in any realm of the doctor-patient world. Some ADHD patients have bad reactions, but the majority of them do not. Some of the side effects go away in a few days, and sometimes the dose is too high. Other times, one medication will work better than another. For instance, many people who take methylinphenidate, which is the chemical "generic" name for Ritalin brand, get upset stomaches. Sometimes it subsides, but sometimes it doesn't. The same patient who had intolerable side effects from let's say the Ritalin example above, could quite possibly benefit and have minimal to zero side effects while taking a dextroamphetamine derivative instead of a methylinphenidate derivitative.

Like all other drugs, sometimes it is abused by those who do not have ADHD (or narcolepsy for that matter). Sometimes, a child busts into a pill collection and takes them because they think they are candy. When I was a child, and this was in the 1980's before the safety lids on pill bottles, I thought the candy coated tylenol was REALLY good tasting. It ended in a trip to the ER and a nice stomach lavage at age 4. Drug companies no longer make candy coated medication due to this.

Thankfully, most of the time ADHD patients who are taking the drugs do a good job of safeguarding and managing their pills so this doesn't happen. Safety bottles help of course. It's always worth trying cognitive-behavioral therapy in conjunction with medication, which they say is the most effacious. You have to learn to RE-LEARN when you have ADHD... when you have the right dose and the right medication, it only gets better as time goes on, because now your short term memory allows you to learn from your mistakes.

I've never been able to get high off of the medication I take, thankfully. When you don't have ADHD, you don't have the same chemical makeup, and of course getting high off of stimulants is easier for a non-ADHDer. I feel sorry for those who think it's a fun pill, but the facts remain that most patients with ADHD who are medicated are LESS LIKELY to become a drug addict or abuse drugs of any kind. A lot of the time, the problems with the stimulants are that the "coming down" phase is torturous for a couple of hours in that the efficacy has worn off, but to some degree the drugs are still working, perhaps by keeping you awake, but unable to sleep. The right combo needs to be achieved for every ADHDer.