Canadian Safety Reporter

4 Canadian HR Reporter, a Thomson Reuters business 2015 been particularly notable among workers aged 25 to 45, according to the doctors interviewed. More and more adults are being prescribed with ADHD medications, according to a U.S. survey by Express Scripts. "Between 2008 and 2012, the number of Americans who use medication to treat ADHD rose 36 per cent, totalling more than 4.8 million privately insured in- dividuals in the U.S. in 2012," said Keith Widmer, senior clinical consultant at Express Scripts in St. Louis, Mo. "Separately, findings from our 2014 Drug Trend Report show that the year-over-year increase in spending on medications to treat attention disorders contin- ues to increase (14.2 per cent in 2012, four per cent in 2013 and 6.3 per cent in 2014)." The greatest increase in usage during the five-year study period was among adults, with the larg- est gains seen in women aged 26 to 34, climbing 85 per cent, said Widmer. Drug effects ADHD drugs are stimulant medications and the effects of a stimulant depend on the health of the individual using it, said Todd Essig, clinical psychologist in New York City. "For someone with ADHD, it stimulates cognitive function- ing to the point where they're able to focus and concentrate," he said. "For people who don't (have ADHD), it's like taking speed. Ad- derall is an amphetamine like any other, and it's a mixture of am- phetamine salts that was designed to optimally enhance cognitive functioning among children and adolescents with ADHD. "If you don't have ADHD, they're frequently referred to as 'smart drugs.' But I think that's a misnomer and much of the research that's coming out sug- gests that what they do is they enhance motivation and they help you kind of get through the boring, depressing parts of work. I refer to them as drive drugs, not smart drugs." These drugs give you the illu- sion of being able to get through the day, he said. "(But) there is no free lunch, and if you're kind of narrowing your focus and revving up your ability to get that spreadsheet done, you're taking away the ability to be creative, and even to be relaxed and enjoy your time." From campus to cubicle It's an open secret that ADHD drugs have been widely used across college campuses as a study aid for a number of years — students in fairly large num- bers are using these drugs, said Andrew Adesman, a New Hyde Park, N.Y.-based pediatrician and ADHD researcher. And it's not surprising ADHD drug use in the workplace is creeping up — there are a num- ber of likely factors behind the trend, he said. "One is that I think there's a greater acceptance of stimulants of being perceived as a safe and effective way to improve per- formance… there may be some greater mainstream legitimacy. So you have probably a shift in perceptions around the medica- tions and the safety," he said. "Number two, you have rela- tively newfound recognition that adult ADHD is a problem… It's really in the past 10 to 15 years that adult ADHD has been increasingly recognized. So you have a large number of individu- als who are presenting, getting diagnosed and provided with stimulants. Obviously, it's an im- perfect diagnostic approach." Thirdly, there are large num- bers of young adults graduating from college and entering the workforce who may already have access to and experience with these stimulants, he said. Entering the workforce, peo- ple tend to take with them the work habits they used in college, said Essig. "In my clinical practice in New York City, I see lots of people in their 20s and 30s who are in competitive industries, who take Adderall because that's how they've always worked. They're afraid not to," he said. "But there are some differenc- es between the workplace and college. If you take it during fi- nals week in college, you then get a semester break and you get a reset button with the new semes- ter starting fairly soon. But life is not finals week. In life, the pres- sure is constant and unremitting and you have to find a way to manage your performance over a long period of time." Risks, concerns Like any other prescription medication, there can be risks when ADHD drugs are not taken as directed, said David Juurlink, head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto. "From a medical perspec- tive… the harms really depend on the patient and the dose. So for most ADHD drugs at low doses, there aren't a lot of side effects. The dominant ones are insomnia and appetite suppres- sion. But as you go up on the dose, and certainly as you use them more chronically, there is concern about the mental health effects. So there is re- search emerging showing that these drugs can trigger psycho- sis in some people, and I've got concerns about the long-term cardiovascular safety," he said. "These drugs work in part by mimicking certain chemicals in the brain, and I think that in a very small subgroup of people who use these drugs long-term, high dose, they may be at risk for cardiovascular adverse effects — heart attacks or strokes." There are also some concerns around hypertension, increased heart rate, stunted growth in childhood, epilepsy and sei- zures, according to the 2011 peer-reviewed study European guidelines on managing adverse effects of medication for ADHD. There's also the issue of po- tential addictiveness or depen- dency, said Juurlink. "With most drugs that act on the central nervous system, there is the prospect of depen- dence… once you stop the drug, your body notices that it's not there anymore. So it's not purely a psychological thing, it's actu- ally a physical withdrawal syn- drome that can endure after you stop using these drugs," he said. "There also is the sort of psy- chological element. People who are used to taking a drug every day, whether it's a sleeping pill or an antidepressant or a stimulant of these sorts, or painkillers, they can develop the mindset that they need these drugs." Workplace pressure Perhaps one of the most sig- nificant risks is the workplace pressure such stimulant use can place on peers who would not otherwise be inclined to use a "productivity drug," said Essig. "The biggest safety risk is a kind of pharmacological arms race where other people who wouldn't be inclined to take a stimulant at work might decide they need to in order to keep up." That is just one of the reasons there must be greater awareness of stimulant misuse among em- ployers, he said. "Awareness of the problem among managers and employ- ers is crucial. I think they need to educate themselves that this is going on, especially among some of their younger employees, and begin to put programs in place to keep it from happening. I think a risk for managers is the belief that if it enhances performance, it's good for the company. But that misses that performance is something that takes place over a long period of time, and people who take Adderall frequently can function like a marathon runner who sprints as fast as they can, until they fall down ex- hausted," he said. "That person is not going to achieve as much as someone who's able to have a sustained pace over a long period of time." CSR |June 2015 | News ADHD < pg. 1 Greater awareness of stimulant misuse needed "People who take Adderall frequently can function like a marathon runner who sprints as fast as they can, until they fall down exhausted."

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