Pencils, pens, meds

Back-to-school season is in full swing. Time to pick out a backpack, sneakers and a stimulant medication for attention-deficit hyperactivity disorder.

Nearly 2 million children in the United States are diagnosed with ADHD, which is marked by poor concentration, lack of self-control and/or hyperactivity. Besides time off from school, many kids with ADHD get a summer “vacation” from the prescription medications that help them focus in class.

So August has become a prime time to market the idea that a change in drug for the new school year (Concerta to Adderall?) might help the kids focus better, keep them going longer or have fewer side effects. Direct-to-parent marketing of ADHD drugs -- most of which are stimulants -- has grown pervasive over the last few years, despite a United Nations treaty banning most of it. Use of such medications increased by more than 60% from 2001 to 2005, according to the International Narcotics Control Board.

This month’s homemaker-targeted magazines, such as Family Circle, Woman’s Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.'s new entry in the growing stable of ADHD medications. The ads show “Consistent Kevin through the day, even through homework,” picturing a well-groomed boy smiling as he wields his pencil through a work sheet, and “Consistent Sarah,” who even at 6 p.m. contentedly pecks away at the piano keys.

ADDitude magazine, published for people with ADHD, has ads for four medications. One ad touts a flavored, chewable form of methylphenidate with the slogan, “Give me the grape.” (Methylphenidate is best known under the trade name Ritalin, which is not among those drugs advertised.)

Ads for candy-flavored methylphenidate are a far cry from the vision set forth in 1971 by the Convention on Psychotropic Substances. So far, 159 countries, including the U.S., have agreed to ban consumer-targeted marketing of psychotropic medications -- which all these ADHD drugs are -- that carry the potential for addiction or dependency. For decades, pharmaceutical companies abided by its provisions.

But in 2001, one company began buying ads in the September issue of women’s magazines in the U.S. to draw attention to Metadate CD, a long-acting form of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration, lawyers for the drug companies vowed to defend themselves under the umbrella of 1st Amendment speech rights. According to former DEA officials, the Department of Justice was unwilling to test this one in court.

Six years later, the results are dramatic. Doctors and therapists increasingly see parents seeking to change their child’s medication or coming in with their own diagnosis of ADHD and suggestions for medications they have seen advertised. Many of the companies offer coupons for a free trial supply.

Children in the U.S. are 10 times more likely to take a stimulant medication for ADHD than are kids in Europe. In fairness, children in Europe are also somewhat less likely to be diagnosed with ADHD because of a stricter set of criteria. But that doesn’t nearly account for the difference in prescription rates. The U.S., the only nation to violate the U.N. treaty, consumes about 85% of the stimulants manufactured for ADHD.

Though the drugs do not appear to be habit-forming in children with ADHD, there’s a rising black market for methylphenidate and similar drugs. A report last year by the National Institute on Drug Abuse found that teenage abuse of prescription stimulants was rising.

Drug companies would argue that increased production and use of ADHD drugs are the result of better diagnosis and treatment. But the International Narcotics Control Board holds advertising responsible. In a report earlier this year, the board noted that from 2001 -- when the ads first appeared -- to 2005, medical consumption of methylphenidate increased by 64%.

“That large increase was mainly a result of developments in the United States, where the substance is advertised in the media, directly to potential customers,” according to the report.

The Food and Drug Administration should move forward with rules to bring the U.S. into compliance -- in conjunction with the Justice Department. There’s legitimate debate about Americans’ rush to diagnose and medicate children who fall problematically outside the norm. In some cases, the drugs are the only thing that keeps a child from being expelled for aggressive behavior, or falling into the foster-care system, or believing that he is an impossibly bad or stupid kid. Yet other countries are making do with far less of the medications.

Powerful psychotropic medications should be an option of last resort and uninfluenced deliberation, not another brand-name product to add to the back-to-school shopping list.