More adults are taking medication for ADHD. Physicians say trend is a double-edged sword

For decades, David Martin struggled with time management and procrastination, but he wasn't sure why.

In university, he noticed his grades were better during shorter semester-long courses rather than year-long classes. And by his 40s, he even let his household bills pile up for months — not because he couldn't afford them, but because he simply didn't pay them on time.

Then close to a decade ago, when he was 46-years-old, the Toronto resident was diagnosed with attention-deficit/hyperactivity disorder, ADHD, and started taking medication that he now says changed his life.

Soon, Martin, who is now 57, began keeping track of bills, remembering important dates, and was able to finally manage his time.

"Different aspects of my life changed," he said. "Because I wasn't procrastinating."

ADHD is often identified in someone's childhood — when parents or teachers notice issues such as inattention, hyperactivity, or impulsive behaviour — but Canadian physicians and mental health professionals say more and more adults are now being diagnosed as well, sometimes as late as their 40s, 50s, and beyond.

New data provided to CBC News out of British Columbia suggests the rate of ADHD medication usage among adults has also gone up dramatically.

The figures show total ADHD medication use among B.C. adults has increased by an annual compounded rate of 17 per cent since 2004, from one user per 1,000 adults to 16.5 users per 1000 adults by 2022.

Obtained from the B.C. Ministry of Health, the data were released on Tuesday by the University of British Columbia's Therapeutics Initiative, an organization which provides Canadian physicians, nurse practitioners, pharmacists and other health professionals with independent, evidence-based information on healthcare interventions.

Medical experts who spoke to CBC News say the trend countrywide is likely similar, and one that could be improving the lives of many Canadians. Others, however, warn it's a double-edged sword.

Commonly diagnosed condition

ADHD is known as one of the most common neurodevelopmental disorders, impacting millions of people across North America. One 2022 review of Canadian research suggests roughly three per cent of adults may have ADHD, with a higher prevalence among children.

The condition is often treated through medication, therapy, behavioural changes, or a combination.

Megan Rafuse, a registered social worker, psychotherapist and CEO of online therapy practice Shift Collab, said she struggled to finish tasks, concentrate in class and finish projects during university. But she wasn't diagnosed with ADHD until she was in her early 20s.

Rafuse began taking medication as part of her treatment plan. She now credits it with helping her build habits that allowed her to pursue a career in psychotherapy.

"If we need eyeglasses to make us see, we wear the eyeglasses," she said. "Medication works the same way, we take medication to improve our brain functioning so that we can go out and be our best productive selves in the world."

While many patients experience success stories, Victoria-based family physician Dr. Josh Levin said there's a dark side to higher rates of adult ADHD medication usage that isn't always talked about.

"I worry a little bit that … we might be over-diagnosing ADHD and that could be unnecessarily medicalizing people," he told CBC News. "And then we end up treating them with medications that they may not derive a lot of benefit from, and in fact, they may be getting harmed from side effects that we could expect from medications."

ADHD medication risks

In his own practice, Levin said he's treated patients who have developed heart conditions triggered by ADHD medications, some of which fall under the drug category of stimulants — including amphetamines and methylphenidate — which are known for speeding up the body's systems.

Common brand name stimulant drugs used for ADHD include Concerta, Ritalin, and Vyvanse, and websites for each all outline the potential risks of these medications.

Vyvanse, for instance — one of the newer options for treating ADHD — may cause serious side effects such as psychiatric issues, heart-related problems including sudden death, heart attack or stroke. Its website notes it also has a "high chance for abuse" and "may cause physical and psychological dependence."

Dr. Elia Abi-Jaoude, a researcher and assistant professor in the University of Toronto's department of psychiatry, said stimulant medications can also suppress someone's appetite or interfere with sleep, which can actually make ADHD harder to manage.

He stressed that the worst side effects linked to these medications remain quite rare — and can be more challenging to study — but "when we're talking about increased use of these drugs at a population level, then these things become especially salient."

The symptoms of ADHD fall along a spectrum, said Levin, adding there's growing acceptance of that range among the psychiatric community. But he also questioned where physicians should draw the line.

"As clinicians, we should be making a diagnosis based solely on what we see on a patient in front of us," Levin said. "But of course, we're human beings, so we're subject to bias."

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Private clinics focusing on ADHD

Levin pointed to the rise of private psychology-focused clinics, an emerging trend where patients can pay for assessments specifically to see if they have ADHD.

"When we're in a clinic where we're being paid by the patient to look for something, I think that does change our thinking a little bit, and we're more likely to see what the patient is looking for," he said. "And this sort of raises the concern about shopping for diagnoses."

Some clinics focus solely on ADHD, while others offer assessments for various psychological issues, charging patients several hundred to several thousand dollars for services, and often boasting minimal or nonexistent wait times.

One such clinic, the Adult ADHD Centre, operates across Canada. It charges $300 for assessments and says its team has conducted more than 20,000 to date. According to the centre's website, they are "very similar" to those normally performed under the public system.

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Dr. Gurdeep Parhar, the centre's medical director, told CBC News there was a cross-country need for a focused practice like his.

"We sort of learned that there were not a lot of places that adults with ADHD could go for an assessment," he said. "Children could go to pediatricians and family doctors, but adults just didn't have places to go. And partly it's because there weren't a lot of physicians and people aware that adults could get ADHD."

He also noted a "good percentage" of those being assessed by his team don't end up actually diagnosed with ADHD.

Given long wait times for psychiatric care in Canada, and limited access to family physicians, private ADHD clinics may be filling a void. (Nova Scotia, for instance, is even paying private-practice psychologists to perform autism and ADHD assessments to address its provincial backlog among kids.)

But multiple medical experts who spoke to CBC News also questioned why there appears to be such a high level of demand for ADHD assessments at all.

Growing awareness through social media

Growing awareness, fuelled in part by social media, could be contributing to more interest in the condition among the public. ADHD-related videos, quizzes, and advocacy posts, for instance, are now regularly found on platforms such as Instagram and TikTok.

Rafuse, a psychotherapist, said the increased awareness of neurodiversity — the term increasingly used to describe all the different ways people's brains work — can be beneficial.

"Suddenly, as a society, we're being more open around our struggles, what symptoms look like and how they show up," she said.

But others warn the trend could be leading to unnecessary diagnoses, misinformation about how ADHD actually presents in people, and more interest in medications that not everyone necessarily needs.

In one study published in 2022, a research team led by Abi-Jaoude analyzed the 100 most popular videos about ADHD uploaded onto TikTok — and found a little more than half were misleading. Notably, none of the videos told viewers to seek out an actual medical, psychiatric, or psychological assessment before attributing their symptoms to ADHD.

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While the full picture behind rising rates of adult ADHD medication use remain unclear, some stress the stories of patients whose lives have been changed for the better shouldn't be clouded by concerns over certain meds.

'Quite effective and quite safe'

"ADHD medications shouldn't be ostracized for any reason," Parhar said. "They're quite effective and quite safe."

Martin, the Toronto resident who was diagnosed with ADHD at 46, currently takes Vyvanse once a day to manage his condition.

His only regret now is not getting a diagnosis sooner. A failed math course in university, for instance, held him back from pursuing his goal of a career in computer science.

"Had I been diagnosed earlier, I maybe wouldn't have that regret," he said.

"I think [medication] is giving people a chance to live the life that maybe they wanted."