Pill bottles

South Carolina has one of the highest rates of ADHD diagnosis in the country.

A new report claims that the controversial drugs used to treat attention deficit disorders are prescribed more often than any other medications in South Carolina, even as some experts said last week they aren’t sure why these potentially addictive drugs are so prevalent here. Other researchers chose not to speculate about the trend at all.

A researcher with the online publication GoodRx released a report last month showing clinicians in South Carolina and Delaware prescribed the “amphetamine salt combo,” the generic form of Adderall, more than any other drug. In other states, the most-prescribed drug was Synthroid, used to treat thyroid hormone deficiencies, followed by opioid painkillers and drugs used to treat high cholesterol or blood pressure.

The reasons behind the prescribing trends in South Carolina are opaque. Some experts pointed to poverty levels and poor maternal health, while others wouldn’t discuss the issue.

“These are important medications,” said Dr. Kevin Gray, a researcher in the Medical University of South Carolina’s Department of Psychiatry and Behavioral Sciences. “But they ought to be used carefully and after the appropriate diagnosis.”

The state has one of the highest rates of ADHD diagnoses in the country, according to 2011 information from the CDC. More recent information is difficult to come by. Sixteen percent of South Carolina kids and teens have had an ADHD diagnosis sometime in their life.

A spokeswoman for the state’s Medicaid agency, which covers more than half of children and teenagers under 18, confirmed that the S.C. Department of Health and Human Services reimburses providers for a generic ADHD drug more than any other prescription medication.

BlueCross BlueShield of South Carolina, the largest private insurer in the state, would not provide data regarding prescription trends, but information from the federal Centers for Disease Control and Prevention validates the GoodRx report, showing that South Carolina has a higher rate of ADHD diagnoses than most other states.

A spokesman for the S.C. Department of Health and Environmental Control said the state agency does not keep tabs on the topic. A spokeswoman with the Department of Mental Health said the majority of ADHD and ADD diagnoses are made by family doctors and pediatricians, not by an agent of a state department.

Some researchers The Post and Courier reached out to declined to discuss the findings in GoodRx’s article because they were unsure of the methodology. The researcher who published the study wrote that he culled the information from insurers and pharmacies, but he did not respond to questions about how he conducted his study.

Brian Sullivan, a psychologist at the local Lifeworks Charleston, said he has seen people’s lives transformed because of the positive effects of the drug. Suddenly they are able to perform at work and be attentive partners in their relationships.

He also acknowledged that the stimulants commonly used to treat ADHD have significant potential for abuse.

“The problem is, it’s also a very effective drug for people who don’t have the disorder,” he said.

Sullivan said he took part in research at the College of Charleston that evaluated students who complained at the college’s health center of symptoms of ADHD.

He said the research found nearly 48 percent of students demonstrated they were exaggerating or even fabricating their symptoms.

This creates a problem for people who genuinely struggle with the disorder, Sullivan said, because they’re often met with skepticism from peers and pharmacies that are short on the drug.

Adderall is not the only drug prescribed for ADHD, said Gray, the MUSC researcher. As a first-line treatment, doctors may consider one of several amphetamine- and methylphenidate-based drugs, known as stimulants.

He explained there is a perception that ADHD is diagnosed too often, but a good clinician will follow careful guidelines before offering a diagnosis.

Sullivan, the Lifeworks Charleston psychologist, said some patients who are concerned they have ADHD actually wind up with an anxiety disorder diagnosis. Anxiety can be distracting, he pointed out.

The world is also becoming more distracting in general, he said.

“There is a lot of evidence suggesting it is becoming more and more difficult for us to focus.”