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Thursday, April 17, 2014
Attention Deficit Hyperactivity Disorder
Admitting That you Take ADHD Meds
I was diagnosed with adult ADHD about 30 years ago; since starting medication (ritalin 40mg/day) my symptoms have been eliminated and life has been great. I always concealed my diagnosis fearing that people might react negatively even though I`m a successful professional with a great family etc. I recently had surgery scheduled and was reluctant to tell the anesthesia folks that I take ritalin (I have been careful to keep this out of my medical records and all doctor visits and Rx`s have never gone thru insurance). The surgeon suggested a general anesthetic so I just went off the ritalin for 5 days beforehand, that way the drug and any of it`s effects would be long gone and I could keep my ritalin use a secret. The anesthesiologist who did the preop interview happened to be an friend from college and I asked her (off the record) if I should admit that I take ritalin for ADHD. I had expected her to criticise me for being less than honest about my medical history, but she surprized me when she suggested that I not mention my 30 years of ritalin use; as long as I have been off of it for 5 days before surgery, that was fine. She told me that a friend of hers (an anesthesia resident) was labeled as a "drug user" and treated like a leper because she had been taking stimulants for ADHD and that the medical establishment didn`t approve...same for several patients that she followed, it didn`t matter that they lead perfectly normal lives on stimulants, they were basically labeled as drug abusers and treated like crap...basically lumped into the same catagory as cocaine users. I have never been so proud of keeping my ritalin use a secret! Does stimulant use really carry that much of a stigma even in patients who have done great for most of their lives?
This question taps into wider issues: privacy of personal health information, drug interactions, data base for treatment, and stigma of illness. Although mental disorders, including substance use disorders, currently seem to carry the most stigma, it has not always been so. We have come a way since lepers had to ring a bell and yell "unclean," to warn off other people.
However, HIV currently seems to come close, possibly partly because of its association with illicit drug injection and another stigmatized activity. Even without stigmatization, some people prefer to keep their illness (e.g., irritable bowel, reproductive disorder, STD) and/or treatment confidential. That is why we have the HIPAA rules. On the other hand, it handicaps a physician not to have a complete data base (e.g., if a patient drinks heavily or smokes, it would be very relevant for the anesthesiologist to know that).
Even unintentional withholding of information from a physician may be risky (e.g., some people do not think to mention herbs when asked about medications, overlooking the fact that herbs are essentially crude drugs that could have interactions with prescription medication).
In this case it appears to have been safe to withhold information about Ritalin use because it had washed out for about 30 half-lives before anesthesia and its only interaction is to inhibit enzymes that break down some other drugs (this long of a washout should prevent interaction with anesthetics). However, it takes a good bit of medical knowledge to know when it is safe to withhold such information. Anyone who wishes to refrain from sharing all concomitant medication with a new physician (such as anesthesiologist) should discuss it with the original prescriber. Withholding medical information is not without risk.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University