A new study has found a staggering rise in the number of ADHD medication errors among US youth over the last 22 years, most of which occurred at home. The researchers say their findings highlight the need for greater patient and caregiver education to avoid these preventable errors.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurodevelopmental disorders. In the US in 2019, an estimated 9.4% of children were diagnosed with ADHD, with around five out of every 100 children prescribed medication for the condition.
Stimulants are commonly prescribed for ADHD, including methylphenidate (Ritalin, Concerta), amphetamine (Adderall), lisdexamfetamine (Vyvanse, Elvanse), and modafinil (Provigil). However, non-stimulant drugs like atomoxetine (Strattera), guanfacine (Tenex, Intuniv), and clonidine (Kapvay) are also prescribed. As with any medication, errors can be made, which, in children and young people, have the potential to cause adverse effects.
A study by researchers at the Nationwide Children’s Hospital examined the incidence of out-of-hospital ADHD medication errors in youth under 20 that had been reported to US poison centers between 2000 and 2021, revealing some worrying statistics.
A therapeutic error is defined by the National Poison Data System (NPDS) as “an unintentional deviation from a proper therapeutic regimen that results in the wrong dose, incorrect route of administration, administration to the wrong person, or administration of the wrong substance.” Poison centers receive phone calls through the national Poison Help Line.
In the current study, the researchers retrospectively analyzed NPDS data from 2000 to 2021. Participants were grouped by age: under six, six-to-12 years, and 13-to-19 years. The exposure site was categorized as a residence (own or other), school, other (public area, workplace, restaurant), or unknown. ADHD medications were grouped into amphetamines and related compounds, methylphenidate, guanfacine, clonidine, and modafinil or atomoxetine.
The researchers found that 124,383 ADHD medication-related therapeutic errors were reported to US poison centers between 2000 and 2021, with the annual frequency increasing by 299%. During the study period, there were 87,691 medication error cases involving ADHD medication as the primary substance among under-20s, an average of 3,985 individuals a year.
In 2021 alone, 5,235 medication errors were reported, equating to one child every 100 minutes. Males were overrepresented, accounting for 76% of the medication errors, as were six-to-12-year-olds, who accounted for 67%. The majority of exposures (93%) occurred in the home. Amphetamines and related compounds, as the first-ranked substance, accounted for 50.5% of medication errors, followed by guanfacine (23.1%) and methylphenidate (14.7%). The most common scenarios in which errors occurred were “inadvertently taken/given medication twice” (53.9%), “inadvertently taken/given someone else’s medication” (13.4%), and “wrong medication taken/given” (12.9%).
In 83% of cases, medical treatment was not required, but 2.3% of cases resulted in admission to a healthcare facility, including 0.8% to a critical care unit. In addition, 4.2% of cases were associated with a serious medical outcome, with some children experiencing agitation, tremors, seizures, and changes in mental status. Compared to 13-to-19-year-olds, children under six were found to be twice as likely to experience a serious medical outcome and more than three times as likely to be admitted to a healthcare facility.
“The increase in the reported number of medication errors is consistent with the findings of other studies reporting an increase in the diagnosis of ADHD among US children during the past two decades, which is likely associated with an increase in the use of ADHD medications,” said Natalie Rine, one of the study’s co-authors.
The researchers say their findings highlight the need for better education about administering ADHD medications and perhaps a change in delivery methods.
“Because ADHD medication errors are preventable, more attention should be given to patient and caregiver education and development of improved child-resistant medication dispensing and tracking systems,” said Gary Smith, the study’s corresponding author. “Another strategy may be a transition from pill bottles to unit-dose packaging, like blister packs, which may aid in remembering whether a medication has already been taken or given.”
The study was published in the journal Pediatrics.
Source: Nationwide Children’s Hospital