A new study finds that there has been an alarming increase in the number of ADHD medication errors among U.S. teens over the past 22 years, with most occurring at home. The researchers say their findings highlight the need for increased patient and caregiver education to avoid these preventable errors.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurodevelopmental disorders. An estimated 9.4% of children in the United States were diagnosed with ADHD in 2019, and 5 in 100 children were prescribed medications to treat it.
Stimulants are commonly prescribed medications to treat ADHD and include methylphenidate (Ritalin, Concorda), amphetamines (Adderall), lisproide (Vyvanse, Elvanse), and modafinil (Provigil). However, non-stimulant medications such as atomoxetine (Struttera), guanfacine (Tenex, Intuniv), and lonidine (Kapvay) are also prescription drugs. As with any medication, there is the potential for errors when given in children and adolescents, resulting in adverse effects.
Researchers at Nationwide Children's Hospital studied the incidence of out-of-hospital ADHD medication errors reported to U.S. poison centers in adolescents younger than 20 between 2000 and 2021 and found some concerning statistics.
The National Poison Data System (NPDS) defines a treatment error as "an unintentional deviation from the correct treatment regimen that results in the wrong dose, route, recipient, or substance," and poison centers receive calls through the National Poison Helpline.
In the current study, the researchers retrospectively analyzed NPDS data from 2000 to 2021. Participants are divided into age groups: under 6 years old, 6 to 12 years old, and 13 to 19 years old. Exposure location was classified as residence (home or other), school, other (public place, workplace, restaurant), or unknown. ADHD medications are classified as amphetamines and related compounds, methylphenidate, guanfacine, lonidine, modafinil, or atomoxetine.
Researchers found that between 2000 and 2021, U.S. poison centers received 124,383 reports of ADHD drug-related treatment errors, a 299% increase in annual frequency. During the study period, there were 87,691 medication error cases involving adolescents under 20 who were taking ADHD medications as their primary medication, an average of 3,985 per year.
In 2021 alone, 5,235 medication errors were reported, equivalent to one child making a medication error every 100 minutes. Males accounted for a disproportionate number of these medication errors, at 76%, and children aged 6 to 12 accounted for 67%. Most exposures (93%) occurred at home. Amphetamines and related compounds were the number one drug, accounting for 50.5% of medication errors, followed by guanfacine (23.1%) and methylphenidate (14.7%). The most common situations where errors occurred were "accidentally taking/administering medication twice" (53.9%), "accidentally taking/administering medication to others" (13.4%) and "taking/administering the wrong medication" (12.9%).
83% of cases did not require treatment, but 2.3% required admission to a medical facility, of which 0.8% required admission to an intensive care unit. In addition, serious medical consequences occurred in 4.2% of cases, with some children experiencing agitation, tremors, convulsions and changes in mental status. Compared with children aged 13 to 19, children under 6 are twice as likely to experience serious medical consequences and more than three times as likely to be admitted to a medical facility.
Natalie Rine, one of the study's co-authors, said: "The increase in the number of reported medication errors is consistent with other studies reporting that ADHD diagnoses have increased in U.S. children over the past two decades, which is likely related to increased use of ADHD medications."
The researchers say their findings highlight the need for better education about ADHD medications and perhaps changes in how they are administered.
Gary Smith, corresponding author of the study, said: "Because ADHD medication errors are preventable, greater emphasis should be placed on educating patients and caregivers and developing better dispensing and tracking systems for drug-resistant medications in children. Another strategy might be to transition from pill bottles to unit-dose packaging, such as blister packs, which may help remember whether the medication has been taken or administered."
The study was published in the journal Pediatrics.