One courageous cardiologist, Dr. Evan Levine, is calling out this malpractice. He is especially worried about the increasing practice of prescribing Adderall to those who aren’t formally diagnosed with ADHD. This trend, he asserts, compromises both physical health and mental well-being, particularly as many seek the drug to enhance focus and performance. With telehealth services making Adderall more accessible, the current landscape presents several challenges, including the legitimacy of ADHD diagnoses and the implications for heart health.
Adderall, a stimulant medication primarily prescribed for ADHD, has seen an increase in use among people in the general population who do not have the disorder. Dr. Levine, who practices in Scarsdale, New York, points out one very positive trend. Today, only 1 in 9 children in the United States are prescribed Adderall, yet just 1 in 17 adults have ever been formally diagnosed with ADHD. This mismatch leads to questions about whether these prescriptions are warranted.
The Risks of Misuse
Dr. Levine explains why it can be dangerous to take Adderall without being properly diagnosed. He points to studies showing a sixfold increase in cardiovascular risks for young, healthy adults taking these medications.
“In April 2024, they find that when you follow them up for eight years, young healthy people aged 20 to 40, they have a 57% higher risk than young healthy people not on these meds,” – Dr. Evan Levine
Our cardiologist’s point that fewer than 5 percent of patients treated with Adderall even have significant cardiac pathology. This may be one reason that careful diagnosis and monitoring are critical.
“It ends up that 1/500 of these patients were diagnosed with a cardiomyopathy.” – Dr. Evan Levine
Dr. Levine’s worries address the long-term effects of the normalization of Adderall usage to young adults. As he describes the situation, many of these young kids were on these medications since they were children. This increased exposure might lead to more serious health outcomes as they age.
“The numbers of young adults on this since childhood can be significant,” – Dr. Evan Levine
The Role of Telehealth Services
With telehealth booming, it’s easier than ever for people to obtain prescriptions for Adderall. Now, most are able to avoid the comprehensive mental health assessments that used to be required. Echoing concerns from the AMA, Dr. Levine blasted this trend as eroding appropriate levels of psychiatric care and raising the risk of diversion and abuse.
“With better behavioral health, available psychiatric evaluation and alternatives like non-stimulants, of course the amount of prescriptions for these drugs will diminish,” – Dr. Evan Levine
He is most worried about people who will pretend to have ADHD symptoms to get access to the drug. The cutthroat environment of all areas—most notably high stakes competitive sports—encourages those looking to optimize performance by whatever means possible.
“One can only guess there are some that claim a diagnosis to improve their ability and concentration in a sport,” – Dr. Evan Levine
In non-Olympic sports, athletes should only have to provide medical documentation of an ADHD diagnosis. This is important to prevent disqualification when they are on stimulant medications such as Adderall.
Questions Surrounding ADHD Diagnoses
Critics have long probed the legitimacy of some ADHD diagnoses. Dr. Levine feels this is a missed opportunity that has serious implications for public health in general. He takes the FDA to task for doing nothing when it comes to regulating how Adderall has been used and prescribed.
“The FDA never did their job,” – Dr. Evan Levine
He points to longitudinal studies that the FDA has conducted in the past. These two studies showed no elevated risk of cardiovascular events among young and middle-aged adults using stimulant medications. He adds that these studies were limited.
“In 2011, the Food and Drug Administration used a study to confirm the safety of these stimulant medications and they concluded — among young and middle-aged adults — [that there is] no increase in cardiovascular events,” – Dr. Evan Levine
He thinks six seconds isn’t enough. This is short-sighted as it doesn’t address the chronic dangers associated with elevated norepinephrine in the bloodstream.
“But the study clearly states the average follow-up was only 1.3 years,” – Dr. Evan Levine
He argues that this short duration does not sufficiently address the long-term risks associated with elevated norepinephrine levels in the blood.
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