More than one in five adolescents take psychostimulants in Quebec to treat attention deficit disorder with or without hyperactivity (ADHD), a record ratio which places it far ahead of other provinces, reveals a recent report.
Published at 5:00 a.m.
Multinational health analytics company IQVIA screened 80% of all prescriptions processed in pharmacies nationwide. In Quebec, 5% of the population was prescribed psychostimulants in 2023, a marked increase compared to 2019 (3.9%) and a ratio almost twice as high as in Ontario (2.7% in 2023 ).
However, it is among boys aged 12 to 17 that Quebec stands out the most. The consumption rate of psychostimulants in this age and sex category was 22.3% last year, compared to an average of 12.1% in Canada, according to the statistical report published on November 15.
With a prescription prevalence of 13.7% among adolescents, the Atlantic provinces occupy second place. Ontario ranks last (7.9%).
These new statistics should fuel social reflection, believes Benoît Hammarrenger, neuropsychologist and founder of the Cognitive Evaluation and Rehabilitation Clinic (CERC).
PHOTO MARCO CAMPANOZZI, LA PRESSE
Neuropsychologist Benoît Hammarrenger, from the Cognitive Assessment and Rehabilitation Clinic
Among young people, approximately three times more are prescribed in Quebec than in Ontario. However, we should not be so different from our neighbors; the education system and the standard of living are similar.
Benoît Hammarrenger, neuropsychologist
The Quebec exception is also observed among adolescent girls: 13.6% of Quebec women aged 12 to 17 have used psychostimulants in 2023, compared to 4.5% of Ontarian women of the same age.
In Quebec, “since the 2000s, the annual prevalence of ADHD and the prescription rate of medications specific to ADHD have constantly increased among young people aged 24 and under,” notes the National Institute of Excellence in Health and Services. (INESSS) in a notice published on November 11.
Both the Institute and the Quebec Health and Social Services Commission emphasize the need to improve access to services, promote psychosocial interventions and a multimodal approach.
An alert from 2019
Already in 2019, a group of 48 pediatricians and researchers warned against the strong growth in the consumption of drugs to treat young Quebecers. The medication rate was then 14.5% among 13-17 year olds. The whole of society “too easily turns towards one pill to treat all ills”, they worried.
This release inspired parliamentary work on the increase in the consumption of psychostimulants among children and adolescents. During the consultations, several experts expressed concern about the trivialization of the diagnosis of ADHD, including Dr.r Hammer cleaners.
“How come we got here despite what was raised five years ago? », he asks himself today.
Should we note that in Quebec, we have made the conscious or unconscious choice to medicate not only a disorder, but also success and performance?
Benoît Hammarrenger, neuropsychologist
Medicating a disorder allows an “inattentive, distracted, impulsive, hyperactive” child to have access to learning, he notes. “It’s a bit like installing a ramp for a student in a wheelchair. We eliminate functional limits. »
Medicinating success is more about boosting a young person’s potential. “It’s saying to yourself: ‘My child has 70% at school, but we find that this is not very high compared to the average of 78%, and he tells us that he has difficulty to focus.” With a drug, we think we can obtain a result of 78% or even 80%. »
However, “there is added value to a young person who is having difficulty at school and who is learning to log,” believes Benoît Hammarrenger. “No one wants their child to live in poverty, that’s normal. But there is an element of learning when overcoming obstacles. »
Against the tide
Last Wednesday, The Press highlighted rapid ADHD diagnoses offered by a single professional on private telehealth platforms1a phenomenon that contributes to overmedication, according to many experts.
Some private platforms offer an evaluation in just 60 minutes.
One of them, Medfuture, justified its practice by claiming that the result was a “diagnostic impression” rather than a real diagnosis. On this basis, the practitioner then evaluates “the patient’s response to pharmacological treatment”, explained a manager. “If the symptoms improve or disappear, this confirms our impression. »
However, in its November 18 update on care, INESSS clearly states that “pharmacological treatment should not be initiated without an established diagnosis.”
“I am worried when I read that medication is prescribed following a hypothesis of ADHD,” reacts Annick Héon, director of the Philippe Laprise Foundation, which raises awareness among Quebecers of the issues linked to the disorder.
According to her, assessments “which are not subject to a rigorous approach and whose reliability leaves something to be desired” partly create the phenomenon of overdiagnosis. “Added to this is self-diagnosis,” she points out. Many people claim to have ADHD without ever having approached a health professional. »
However, solutions exist, continues, Mme Héon, citing the resources and tools of organizations such as the Philippe Laprise Foundation.
For his part, neuropsychologist Benoît Hammarrenger is campaigning for Quebec’s professional orders to adopt uniform guidelines for making a diagnosis of ADHD, regardless of the field of practice. “We could avoid a loss of control over assessments and medication. »
Although the use of psychostimulants is more moderate elsewhere in Canada, the trend is increasing across the country. Nearly 1.5 million Canadians used psychostimulants in 2023, compared to fewer than 900,000 in 2019, a jump of around 70%.
IQVIA Canada analyzed databases that cover 80% of all prescriptions processed in Canadian pharmacies from 2019 to 2023, she specifies. The company used an algorithm to estimate the occurrence in the 20% of unaccounted transactions. The psychostimulants that were considered in the analysis are amphetamine (Adderall XR), atomoxetine (Strattera), dextroamphetamine (Dexedrine), guanfacine (Intuniv Ritalin).
1. Read the file “Telemedicine: 60 minutes for an ADHD diagnosis”
A national concern
In 2017, the National Institute of Excellence in Health and Social Services (INESSS) revealed that around 14% of Quebecers aged 10 to 17 consumed psychostimulants specific to ADHD. The ratio among Quebecers under 25 was then 6.4%, compared to 2.4% among other young Canadians. The Health and Social Services Commission has been given the mandate to look into the increase in the consumption of psychostimulants among children and young people. Among the possible explanations formulated in the report: differences between public drug insurance programs in Quebec and the rest of Canada, diagnoses made too quickly, insufficient medical follow-up and a lack of resources. “People showing symptoms related to ADHD have difficulty accessing services,” we noted. This is why pharmacological interventions are often the only treatment offered and within reach. »
