If you are a medical professional in BC prescribing ADHD medications, please sign this collective letter addressed to Minister Lake asking that the physician voice be part of the new PharmaCare review of ADHD medications. Deadline to sign is May 12th.

Medication treatment for ADHD is not a “one size fits all” scenario and individuals with ADHD have unique responses to different medications. It is essential that physicians can individualize treatment and prescribe as wide a group of medications as possible.

 

However, in British Columbia, short-acting medications are the only pharmacological treatments for ADHD fully covered by BC Pharmacare. Concerta is the only long-acting medication available on Pharmacare but is restricted to Special Authority Request (only for the paediatric population and only after failing on Ritalin or Dexedrine).

 

The Ministry of Health is currently conducting a review of ADHD treatment therapies. Despite numerous requests from BC physicians over the past months – spearheaded by CADDRA and ADHD patient organization CADDAC (Centre for ADHD Advocacy, Canada) for an opportunity to meet with Pharmacare officials and share their expertise, no appointment has been made to date. Letters sent by the physicians highlighted the poor access to ADHD medications in the province. A templated reply letter was sent to all of these physicians referencing the CDR “Do Not List” recommendation and stating that the ministry has to make tough decisions regarding health priorities.

 

There are many clinical treatment factors to consider when making a balanced patient-centered decision about coverage. As experts in this field and front line workers treating patients in this province every day, we believe that ADHD medical professionals should be a part of the conversation. We are requesting that a meeting be held with Minister Lake as soon as possible to discuss how experienced ADHD medical professionals will be an integral part in this review process.

 

If you are a medical professional in BC who is interested in this issue, we ask that you access this LINK to a collective letter addressed to Minister Lake and if you agree sign onto the letter through this site by May the 12th.

If the link does not work please cut and paste this into your browser https://www.surveymonkey.com/r/CADDRA-CADDAC-Letter-to-Minister

For additional information please read the document written by CADDRA board member and BC physician Dr. Don Duncan: Equal Access to ADHD Medication through PharmaCare

 

 

Table shows public plan listings by province for stimulants and non-stimulants for treatment of ADHD. Taken from Drugs Used in the Management of Attention-Deficit/Hyperactivity Disorder in Adults, Ontaro Drug Policy Research Network (ODPRN) Report, December 2015.

A new Ontario drug class review on medications used in the management of ADHD in adults was released today by the Ontario Drug Policy Research Network (ODPRN): Drugs Used in the Management of Attention-Deficit/Hyperactivity Disorder in Adults. The reviews are part of an initiative to modernize the public drug formulary in Ontario. CADDRA provided substantial feedback and commentary to the ODPRN at various stages of the report development, which began in Spring 2015.

Some of the main points in the report:

  • 17,482 adults were prescribed provincially-funded stimulant or atomoxetine medication in Ontario in 2014.
  • There has been an increase in the number of prescriptions and costs of ADHD medications for adults across Canada. Utilization has gone up 119% and cost 153% during the 5 year study period.
  • The transition from adolescent to adult can be a challenge when accessing mental health services for patients with ADHD, and can include breaks in coverage for medication through the ODB.
  • Coverage varies considerably from province to province. [Table showing public plan listings by province for stimulants and non-stimulants for treatment of ADHD]
  • A review of the literature indicates that misuse/abuse/ diversion occurs, and is especially prevalent in college-age students. However, the number of potentially inappropriate prescriptions in Canada is low (<0.3% in 2013/14) and more research is needed.
  • There were no published economic evaluations identified that examined the comparative cost-effectiveness of adult ADHD medications. However, findings from studies on the societal impact of adult ADHD on employment and criminality indicate an association between adult ADHD and increased unemployment and poorer work performance. In addition, pharmacological treatment of ADHD symptoms is associated with improved work performance and reduced likelihood of criminal behavior.

Report Recommendations:

  • Make atomoxetine available as "Limited Use" (for adults) instead of through the Exceptional Access Program (EAP);
  • No age restriction should be applied to stimulants or atomoxetine;
  • Monitor the cardiovascular health of those using the drugs, especially older adults with medical conditions;
  • Health care practitioners should remain vigilant about the potential for misuse/abuse/diversion of stimulant medications;
  • Remove the requirement in the current Therapeutic Notes for long-acting preparations for adults that patients must first be tried on methylphenidate immediate release or methylphenidate slow release or Dexedrine IR or Dexedrine SR before prescribing long-acting preparations.

Physicians across British Columbia have begun advocacy effects aimed at convincing the BC Government to support a full range of treatments for ADHD in the province. Read the press release from CADDAC and CADDRA here. While treatment for ADHD should always be multimodal, medication can be an important component for individuals with ADHD. British Columbia is far behind the rest of Canada in regard to providing a full range of treatments for ADHD, and the province's inaction has wide-ranging social and financial impacts.

 

Take Action!

Healthcare professionals in BC are urged to write letters to Dr. Eric Lun (Executive Director, Drug Intelligence and Optimization Branch, Ministry of Health requesting that the province make access to long acting treatment options for ADHD more accessible. A letter writing guide can be found here. If possible, these letters should be sent by December 18, 2015.

Background information on the current situation is available here. This is written by CADDRA board member and BC physician, Dr. Don Duncan.

CADDRA has developed a new from to support the transfer of patients to new healthcare professionals, including pediatric patients to adult services. The CADDRA ADHD Transition Form can be downloaded here.

There is currently no standardized discharge of a patient from the care of a pediatric specialist once the patient becomes an adult. This is a time of great change for young adults and often coincides with them moving out of the family home and moving cities and/or provinces for work or further education. In many cases, these young adults then have to rely on walk-in clinics with no set continuity of care. A standardized document outlining previous care under a pediatric specialist will mitigate the risk of these patients been seen and labelled as a drug-seeker if no evidence of prior diagnosis and treatment can be provided.

This new concise and user-friendly document was developed with the assistance of a multi-disciplinary CADDRA committee (Dr. Karen Bamber, pediatrician, Langley, BC; Dr. Don Duncan, child and adolescent psychiatrist, Kelowna, BC; Dr. Matt Blackwood, family physician, Mission, BC and Dr. Lauri Alto, pediatrician, Winnipeg, MB). The form will support the continuity of care of young adults by providing a document that can be forwarded by the pediatric specialist to a physician (e.g. if the patient is transferred back to a family doctor) or be brought by the patient when registering in a new practice or attending a walk-in or university/college health clinic.

Letter from Ontario Physicians regarding Intuniv

Pediatricians and other physicians in Ontario are invited to add their signatures to a letter requesting the Ministry of Health and Long-Term Care to provide publically-funded access to Intuniv XR. The letter can be reviewed here.  Those who would like to sign the letter are requested to complete the survey at http://fluidsurveys.com/s/ADHD-letter-Ontario before November 8th 2015. The campaign is co-ordinated by Dr. H. Anne Richards, Assistant Professor, Department of Pediatrics, Univerity of Toronto and Dr. Judy van Stralen, Assistant Professor, Department of Pediatrics, Queen's University.

Parents, teachers and healthcare professionals are invited to a special CADDRA-sponsored presentation on child and adolescent ADHD - "Dispelling the Myths & Misinformation about ADHD".

Wednesday, October 28th at 10am or 1pm
Dr. Bruce Johnson Conference Room
Rouge Valley Centenary Hospital
2867 Ellesmere Road, Scarborough, Ontario.

Presenters: Dr. Ruben Gagarin (Shoniker Clinic) and Dr. Shirish Patel. Further information here.

Invitation to All Medical and Healthcare Professionals in BC

Whether it is long waiting lists, inequitable access to assessments, medication or ongoing support, patients with ADHD in BC are not getting the care they deserve.

We invite all interested medical and healthcare professionals to meet to discuss and formulate an action plan for submission to the BC Government.

BC ADHD Advocacy Meeting: A Call for Action!
Friday, 16 October, 5pm
Shaughnessy Salon
Vancouver Marriott Downtown Pinnacle Hotel

Preceding the 11th Annual CADDRA ADHD Conference. Registration at the conference is not required to attend this meeting.

Further information: This email address is being protected from spambots. You need JavaScript enabled to view it. / 416-637-8582
Register (free) or provide feedback for the Advocacy Meeting

Register Now

CADDRA's Response [PDF] to the Health Canada Announcement: “ADHD drugs may increase risk of suicidal thoughts and behaviours in some people; benefits still outweigh risks”

CADDRA's response [PDF] to the article “ADHD drugs suspected of hurting Canadian kids” sent to the Toronto Star on September, 26, 2012. A CADDRA Information Sheet for Healthcare Professionals [PDF]

CADDRA's response to a recent article in the National Post (reprinted from the New York Times) was printed in the National Post on Friday, February 3, 2012. Click here to see a PDF of the CADDRA rebuttal letter.

CADDRA information [PDF] on new American Academy of Pediatrics (AAP) Guidelines on diagnosing and managing ADHD in children, which recommend that doctors evaluate children between the ages of four and 18 years that show symptoms.