Doctors in Georgia are prescribing ADHD medications to help low-income children struggling in elementary school, even when they do not have an , reports a front-page article in Tuesday鈥檚 .
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The story focused on Dr. Michael Anderson in Canton, Ga., who said he had little choice in the matter if he wanted to help students boost their academic performance in under-funded schools. 鈥淲e鈥檝e decided as a society that it鈥檚 too expensive to modify the kid鈥檚 environment. So we have to modify the kid,鈥 he told Times reporter Alan Schwarz. Dr. Anderson, Schwarz writes, is 鈥渙ne of the more outspoken proponents of an idea that is gaining interest among some physicians.鈥 听
Those extra prescriptions come at a to both the state and the federal government. One of the mothers profiled in the article notes that Medicaid pays for nearly every penny of her children鈥檚 prescription costs. And it鈥檚 not just stimulants like Adderall 鈥 all four children in the Rocafort family profiled in the story are on also on clonidine, a nightly sleep med that helps to counteract the effects of the other drugs.
Georgia鈥檚 Medicaid program did not respond to requests for cost data. But Melissa Carter, executive director of the at Emory University in Atlanta, says the program spends $28 million to $33 million annually on stimulants used to treat ADHD. 听
She points out that prescribing stimulants to kids without attention disorder is not necessarily a mainstream trend, but what is clear is that 鈥減arents, teachers, caregivers and even entire systems have a growing appetite to use drugs. There鈥檚 an avalanche leading towards meds as the only solution.鈥 听That may have something to do with the years of austerity cuts to education in Georgia, which have led to larger class size, shorter school days and furloughs for teachers, says Carter.
But she says that unlike investments in schools, which can give students lifelong skills for coping and adjusting, medications may offer 鈥渢he immediate satisfaction of behavioral control, but you have side effects, and you鈥檙e not giving the child any skills to help them function. Are these kids going to have to be medicated for life?鈥
Tim Sweeney, director of health policy for the , a nonprofit think tank in Atlanta, adds that Dr. Anderson鈥檚 dilemma is 鈥渁n indication of a big picture need for increased investment in secondary services around education, like tutors and counselors.鈥 To the extent that additional costs are 鈥渂eing born by Medicaid for prescriptions that are replacing those services, there is potentially a cost shift.鈥
Unlike education, however, which is paid for by mostly by the state, Medicaid costs are shared by the federal government.
鈥淭he Medicaid programs spends significant dollars on medications for , but I鈥檇 argue this is not the most cost-effective (or best) approach to treating these children,鈥 Shadi Houshyar, who works for the child advocacy organization , wrote in an e-mail.
Instead, she asks, 鈥渨hy don鈥檛 we attempt to address the poverty, lack of school funding and social barriers that contribute to the poor academic performance of these children, rather than medicate them?鈥
Experts and advocates did not know of any studies comparing the cost of medication versus investing in schools.
