After the Defense Health Agency limited the maximum length of prescriptions for treating ADHD to 90 days, at least 65 military treatment facilities continued to dispense drugs for longer than recommended, according to an audit by the Department of Defense Inspector General.
Some prescriptions were filled for up to a year’s supply of Schedule II drugs that have a high potential for abuse and dependence.
“These MTFs dispensed Schedule II amphetamines to beneficiaries in a manner that was inconsistent with DHA policy and may have increased the risk of overdose and diversion from legal sources to the illicit market,” the audit report states.
The DHA instructed MTFs in December 2019 to limit prescriptions of Schedule II amphetamines for ADHD to 90-day supplies with no refills. Military departments were given until April 14, 2020 to implement the change.
The new guidance was intended to reduce the risk of addiction and overdose and ensure standardized practices across the force.
Schedule II amphetamines are typically prescribed to treat ADHD and narcolepsy. The Drug Enforcement Agency defines Schedule II drugs as having “a high potential for abuse, with use potentially leading to severe psychological or physical dependence.” Adderall, Ritalin and Vyvanse are all Schedule II amphetamines.
Using a military health database, DoDIG auditors found that between April 15 and Aug. 13, 2020, 96 percent of the 89,356 prescriptions filled for Schedule II amphetamines were in accordance with the new guidance.
However, 65 MTFs continued issuing prescriptions for 100-day supplies. During the period examined by the audit, these MTFs dispensed 2,967 100-day supplies. Of those prescriptions, 43 percent went to active duty servicemembers while 57 percent went to retired servicemembers and military family members.
According to a Congressional Research Service report in December 2020, there are 721 MTFs around the world, meaning about 9 percent of all MTFs failed to comply with the new DHA guidelines.
The DHA director disagreed with DoDIG’s conclusion that filling prescriptions for just 10 days longer than recommended could increase the risk of overdose.
The report shows that few regulations were being followed in running the pharmacies.
In addition to 100-day supplies, auditors found that MTFs dispensed 302 prescriptions for even longer periods of time, including five prescriptions supplying enough amphetamines for 301-365 days.
The MTFs at fault were mostly located on Navy and Air Force installations. According to the audit, the Navy failed to implement the new 90-day prescription guidance and continued to operate using existing 100-day limitations.
In a study conducted from January 2014 through December 2018, the military’s peer reviewed medical journal found that the prevalence of ADHD in the military decreased from 3.9 percent to 2.8 percent of active duty servicemembers.
Of those servicemembers with ADHD, approximately 60.2 percent were prescribed some sort of medication for their condition, with stimulants like amphetamines being the most common.
ADHD is a common barrier to entry into the military, but if an applicant has not taken medication for more than 24 cumulative months after the age of 14, a waiver is not necessary for their enlistment. In 2017, ADHD and disruptive disorders were the fifth most common medical disqualifier for first-time enlistees, according to the Medical Surveillance Monthly Report.
To address the problem of overprescribing amphetamines for ADHD, the DoDIG recommended that DHA officials ensure military pharmacies and healthcare providers adopt and enforce the 90-day limit.