The prescription process
KRISTIN DE DECKER
Ritalin and Concerta both require prescriptions in order to be purchased from a pharmacy, owing to their schedule six classification. In an interview with PDBY, Dr Johan Momberg and Dr Erwin Lingenfelder weighed in on this process of acquiring Concerta and Ritalin prescriptions. Both doctors are general practitioners who obtained their qualifications from the University of Pretoria and are currently based at Hatmed, the practice they helped found in 1995.
ADHD is the attention disorder alleviated by Concerta and Ritalin, and subsequently, is required to be present for a legitimate prescription to be granted to a patient. Accordingly, both doctors illuminate that this condition of ADHD can be assessed by an Adult Self Report Scale whereby patients use the set of eighteen questions to rank their symptoms from never to very often. Some of these include the inability to finish tasks, hyperactivity and fidgeting, poor memory and being easily distracted. Dr Momberg explains that the questionnaire will then be discussed and “a general conversation with the patient” will be had, entailing their marks, previous problems and overall academic performance. Additionally, Dr Momberg notes that younger patients are usually “referred to [doctors] by educational psychologists” that deal with career guidance or academic problems. Overall, if the patient’s answers or reference appears satisfactory and the qualifying symptoms are met, then the doctor will approve the prescription. Such prescriptions can be dispensed by “any medical doctor”, according to Dr Lingenfelder.
It appears that a self-reported checklist could easily be exploited and misused by dishonest patients. This would be an alarming loophole in the medical prescription process. Yet, Dr Lingenfelder maintains that this can be combatted by “the doctor’s common sense” and critical analysis skills. Interestingly, a study done by the Annals of Clinical Psychiatry concluded that this “Adult ADHD Self-Report Scale symptom checklist is a reliable and valid scale for evaluating ADHD [in] adults”. This seems to be encouraging regarding the validity and regulation of Ritalin and Concerta prescriptions, despite illegal trade among students.
Dr Lingenfelder attributes the strict regulation of Concerta and Ritalin to a “historical legacy”. He suggests that, the conditions of ADD and ADHD were not known twenty-five years ago and were rarely diagnosed. These drugs have thus “always [been] in that schedule six group” as “both contain a chemical called methylphenidate”. Dr Lingenfelder equally highlights that schedule six also contains “serious painkillers” such as morphine and pethlidine, which are highly addictive. The regulation and classification of both Ritalin and Concerta can, be linked to their chemical composition, possibility of addiction and past categorisation. Despite such strict regulation, in 2016, the South African Journal of Psychiatry found that 41.7% of university students used methylphenidate based medication to enhance concentration and while 26.4% used such medication to “improve study habits”, regardless of not being diagnosed with a condition.
The possible increase in ADHD diagnoses and consequent spike in the need for concentration medication is another relevant topic of discussion. Dr Momberg suggests that in contemporary society “there has been more of an awareness” raised whereas in the past children were often physically hit or punished if they did not concentrate. He also highlights the fact that attention disorders “often [run] in families”. Parents that were not diagnosed therefore often displayed the same symptoms as their children diagnosed with ADD/ADHD as these disorders were “definitely underdiagnosed”. Additionally, it was highlighted that doctors who do not follow proper diagnostic procedures and unethically give patients illegal prescriptions would face serious consequences. Dr Momberg notes that the doctor can be “reported to the Health Professionals Council” and Dr Lingenfelder adds that the doctor can be repudiated. This process will begin with an initial warning if it is found that “random prescriptions” were given with no medical basis. If the infringement occurs again then the doctor can “be scrapped from the role for a period of time”. Moreover, it is significant to acknowledge the issue of the “oversupply of medical practices” that Dr Lingenfelder brought to attention. As South Africa is saturated with medical practices, some are not as ethical as they should be and essentially ‘sell’ prescriptions and sick certificates for around R300 in order to survive.
Despite the demand for methylphenidatebased medication, Hatmed appears relatively unaffected. Dr Momberg opines that Hatmed does not see an excessive number of students trying to get prescriptions for Concerta or Ritalin, but there are a few. Both Dr Momberg and Dr Lingenfelder indicate that they do not think anything could be done to influence how patients utilise or sell their prescriptions. It is “outside [the doctor’s] control” how the patient decides to use the “thirty tablets” each prescription covers. Dr Lingenfelder further highlights that doctors cannot prevent serious dealers from obtaining multiple, illegal prescriptions and selling them to university students. The responsibility of the doctor is weighted in ethically prescribing Ritalin or Concerta for those that truly need it, not monitoring how the needed medication is potentially sold. Finally, Dr Lingenfelder expressed his sympathy towards “students in desperate positions” who use the medication under dire academic circumstances.
Photo: Kristin De Decker