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Barriers in dispensing ADHD medications to children persist

In South Africa, children diagnosed with ADHD are required to visit a physician monthly to obtain their medication, imposing financial and time burdens, particularly on families living in rural areas or lacking medical coverage.

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Barriers hindering swift access to ADHD medications for children
Barriers hindering swift access to ADHD medications for children

Barriers in dispensing ADHD medications to children persist

Revised Article:

Attention deficit and hyperactivity disorder (ADHD) is a common issue, affecting between 5% and 7% of school-aged kids in South Africa. But because doctors can only prescribe ADHD meds for a month at a time, many children miss out on consistent treatment, especially those from lower-income families who can't afford regular doctor visits.

Enter methylphenidate, a central nervous system stimulant that can significantly reduce symptoms in about 70% of users with ADHD. The World Health Organization recommends this drug for treating ADHD, and it's known as the gold standard for ADHD treatment. Methylphenidate helps people with ADHD focus better and reduces impulsivity and hyperactivity.

Research shows that when methylphenidate is used correctly, children's school grades improve, and they are better equipped to develop social skills. Essentially, effective ADHD treatment doesn't just help kids stay still and pay attention in class - it supports them in learning and socializing, which sets the foundation for a productive adulthood.

However, methylphenidate is classified as a schedule 6 drug in South Africa. This means pharmacies can only dispense the medicine with a doctor's prescription, and doctors can only prescribe 30 days' worth of treatment at a time. So, patients need to visit the doctor each month for a new prescription, adding to the cost of medication and the time spent seeking treatment, especially for those struggling with ADHD's more severe symptoms, like executive dysfunction, forgetfulness, and inattention.

This scheduling presents numerous administrative and financial challenges for patients and caregivers seeking treatment. As someone working in both the public and private healthcare sectors, I've witnessed firsthand the toll that untreated ADHD takes on children, adults, and families. It's a reality that affects employment, depression, addiction, and even suicide.

But one of the biggest obstacles keeping people from life-changing treatment is our own healthcare policies, which haven't changed in years.

A 2024 qualitative study with 23 South African stakeholders, including healthcare professionals, pharmacists, regulators, patients, and caregivers, found that the current scheduling of methylphenidate doesn't effectively prevent misuse and illegal use. Instead, participants said that classifying methylphenidate as a schedule 6 drug "negatively impacts treatment adherence."

The South African Health Products Regulatory Authority (Sahpra) must urgently review the scheduling of methylphenidate to consider reclassifying it as a schedule 5 drug. Schedule 5 medicines have a low to moderate potential for abuse or dependence, meaning doctors could provide six-monthly prescriptions. Here are four reasons why:

  1. Improved Treatment Access and Coverage: ADHD affects approximately 7.6% of children aged 3-12 and 5.6% of teens aged 12-18, with many cases persisting into adulthood. Currently, as a schedule 6 drug, methylphenidate requires monthly doctor visits for prescriptions, creating a major barrier to consistent treatment. By reclassifying it to schedule 5, doctors could provide longer prescriptions, making it easier for people with ADHD to get and maintain treatment.
  2. Enhanced Treatment Adherence and Outcomes: The monthly prescription requirement presents practical and financial challenges that contribute to poor adherence. Improved adherence reduces the risks associated with untreated ADHD, such as the development of comorbid psychiatric conditions and poor academic and occupational outcomes.
  3. Consideration of Comparative Precedents and Low to Moderate Abuse Potential: Schedule 5 drugs are defined as having low to moderate abuse or dependence potential. Research and clinical experience suggest that methylphenidate’s abuse potential is manageable under proper medical supervision. Reclassification would align with South Africa's approach to other psychiatric medications, making it easier for more people to access treatment, especially in resource-limited settings.
  4. System Efficiency: South Africa's public health system relies heavily on nurses, who often have limited doctor availability. By allowing longer prescription durations for methylphenidate, we could optimize workforce use, reduce waiting times, and make treatment more accessible for patients and providers.

In summary, reclassifying methylphenidate as a schedule 5 drug acknowledges its moderate abuse potential, while making it easier for people with ADHD to get consistent treatment and improve their overall quality of life.

  1. Science plays a crucial role in managing health conditions, like attention deficit and hyperactivity disorder (ADHD).
  2. Medications, such as methylphenidate, can significantly improve symptoms in individuals with ADHD.
  3. Methylphenidate is a central nervous system stimulant, recommended by the World Health Organization for treating ADHD.
  4. Effective treatment of ADHD not only helps children focus better, but also supports their learning and social skills development.
  5. Chronic diseases, like ADHD, require consistent treatment, but current policies in South Africa limit prescriptions to 30 days.
  6. This scheduling of methylphenidate as a schedule 6 drug creates administrative and financial challenges for patients and caregivers.
  7. Untreated ADHD can have severe consequences, affecting employment, depression, addiction, and even suicide.
  8. A 2024 study found that the current scheduling of methylphenidate negatively impacts treatment adherence.
  9. The South African Health Products Regulatory Authority (Sahpra) should consider reclassifying methylphenidate as a schedule 5 drug.
  10. Reclassification would facilitate improved treatment access and coverage for various chronic illnesses.
  11. Longer prescription durations could enhance treatment adherence and subsequent outcomes for patients with ADHD.
  12. This reclassification would align South Africa's approach to methylphenidate with its approach to other psychiatric medications.
  13. Optimizing workforce use, reducing waiting times, and increasing accessibility are all potential benefits of reclassifying methylphenidate to schedule 5.
  14. By acknowledging the moderate abuse potential of methylphenidate, reclassification would improve the overall quality of life for people living with ADHD.

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