Massive variation in Ritalin prescribing

There is a 23-fold difference in the rate at which children in different parts of England are prescribed Ritalin to control their behaviour, figures seen by HSJ reveal.

The highest rate was in the Wirral, where pharmacists dispensed one prescription for methylphenidate hydrochloride - popularly known as Ritalin - for every seven children under 16 in 2007. This is equivalent to 144 prescriptions for every 1,000 children for which Wirral primary care trust is responsible (see below).

Stoke on Trent had the lowest rate, on average one prescription for every 159 children. Across England the average is one prescription for every 23 children under 16.

Methylphenidate is an amphetamine used to treat child attention deficit hyperactivity disorder, but its growing use has led to concern.

"The PCT is aware of high levels of Ritalin prescribing. There is an action programme in place including a current, ongoing review by a consultant paediatrician"


County Durham PCT director of public health Tricia Cresswell

PCT figures for the number of prescriptions dispensed since 2003 placed in the Commons library this week showed 461,000 items of the drug were prescribed to children in 2007, up from 199,000 in 2003.

Wirral PCT acknowledged "the apparent high prescribing rates of ADHD drugs in comparison to other PCTs".

County Durham PCT had the fourth highest rate at one prescription for every 10.3 children. Director of public health Tricia Cresswell said: "The PCT is aware of high levels of Ritalin prescribing. There is an action programme in place including a current, ongoing review by a consultant paediatrician of children and young people who have previously been prescribed Ritalin."

She said she expected the rate to fall in subsequent months.

A spokesman for Isle of Wight PCT, which had the second highest rate (one for every 9.3 children, or 107 for every 1,000 children), said he was not aware of any reason for this but added that the island's small population could skew the figures.

A Department of Health spokesperson said: "It is important to note these figures are dispensing levels, and not the number of children taking the drug [and] could include repeat prescriptions for the same child."

Methylphenidate (Ritalin) prescriptions per 1,000

0-15 year olds 2007

PCT                                            

Prescriptions dispensed per 1,000 children

Wirral

144

Isle of Wight

107

Great Yarmouth and Waveney

100

County Durham

97

Medway

85

PCT average

43

Source: Commons library/ONS


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Reader Response

It is also important to note that many GPs are reluctant to prescribe Ritalin , and therefore in some PCTs the use of Ritalin will not appear in the usual prescribing data. In these cases the prescriptions are sometimes supplied by the acute or mental health services.

If the data used to collect this information is purely PPA originated PCT data, then the results will be skewed by the different prescribing and supply arrangements for this drug in different areas. In some areas GPs are involved in shared care agreements and prescribe for their own patients, in some supply is made via hospital FP10 prescriptions, in some supply is made from secondary care, and in others the clinics may have FP10 pads with PCT codes on.
Further detail needed before the relevance of this report can be established.

I don't always agree with the Department of Health, but surely these figures - 'dispensed items' - must be treated with real caution. An 'item' can be for a supply of anything between 1 week and three months, I guess. Before any comparisons can be made between PCTs, we need to know the SDDs (standard daily dose units) prescribed, or at least, the average number of weeks supply for these prescriptions. Otherwise, completely meaningless.

John Gilby