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Kathleen Gannon Longo is a Contributing Editor.
How pharmacists can help students get the treatments they need.
As the summer winds down, pharmacists need to gear up for students returning to school in September. Ensuring that children have the right medications for attention deficit hyperactivity disorder (ADHD) is a top priority.
More than 5 million children have an ADHD diagnosis, according to the 2016 National Survey of Children’s Health, a parent-focused survey conducted by the U.S. Census Bureau on behalf of HHS. Included in the total are 2.2 million children aged 6 to 11 and 2.9 million adolescents aged 12 to 17. Two out of three of children who are diagnosed take a medication (62%), and nearly one out of three receive a combination of medication and behavioral treatment (32%).
Many families don’t notice ADHD symptoms as much in the summer, when children are very active, and they will often lapse on medications, says Jake Olson, PharmD, owner of Skywalk Children’s Pharmacy in Milwaukee. This shifts as parents “restart their child’s therapies as the child heads back to school.”
Agreeing with Olson, Jim Cox, director of pharmacy at Coborn’s Inc., a 38-store regional grocery/pharmacy chain in Minnesota, says ADHD is the primary area in which those pharmacies see an increase in prescriptions as students return to school. ADHD becomes more evident as summer sports and activities wind down, he says. “In many cases, we’ll dispense more than one bottle, one for the child to have with him in school and one to keep at home,” he said.
Tracy Bayer, PharmD, a pharmacist at Hillcrest Pharmacy in Vernon, TX, says she sometimes needs to order extra supplies of drug products for ADHD as the demand increases in September.
Common prescription drugs for the treatment of ADHD, according to Christopher Nadeau, PharmD, a fourth-generation pharmacist at Bedard Pharmacy in Lewiston, ME, are a combination of stimulant drugs, which are also Schedule II drugs, and nonstimulant drugs (See Fig. 1). These drugs can be supplemented with over-the-counter items.
In addition to prescription drugs, Olson says Skywalk recommends nutritional supplements and vitamins for ADHD. Since ADHD therapies can have the side effect of a reduced appetite, the pharmacists may recommend an appetite stimulant, he says. Additionally, melatonin may be recommended to help with sleep problems, another side effect.
In Maine, Nadeau has a different approach. “I generally don’t recommend OTC products as much as I do lifestyle changes,” says Nadeau. “I usually suggest that the patient gets ample time for physical activity and develops good sleep habits. This has helped a few of my patients lower their dose, or get off the medication altogether.”
Bayer says Hillcrest Pharmacy doesn’t dispense many OTC products for ADHD. It is generally more cost-effective for parents to request a prescription drug, which can be covered by insurance, she says.
Nadeau says that, from what he has seen in his pharmacy, providers may be seeking alternative treatments before writing a prescription for an ADHD drug; he has seen an overall decrease in the number of prescriptions written. “Many ADHD medications are Schedule II narcotics, which have been scrutinized extensively over the last few years,” he says. He also points out that there are now more resources for families, such as counseling.
The pharmacist can serve as a catalyst in ensuring that a child is properly diagnosed with ADHD. Cox says parents may reach out to pharmacists based on symptoms they’ve seen in their child. Pharmacists can then encourage parents to take their children to a physician for diagnosis. Olson notes that a child’s teacher may often be involved in helping to secure a diagnosis as well.
Nadeau says that he refers students and families to resources in the community, when applicable.