my name is Jon Murphy, psychiatric nurse practitioner. I'm here with James Kennedy, psychiatric nurse practitioner, and this is Compass Point Institute. This is our first episode, and we're just gonna jump right into it. James, why don't you, take it from here.
So we're just recently a, a new article, I think it was published about a week or two ago in JAMA Psychiatry. Uh, actually the title of the, the paper was Increased prescribing of ADHD medication
I see. So it's the, the Telep psychiatry.
I don't think it's all just focused on telepsychiatry, just the, I mean it obviously aligns pretty well with the, the boom in telepsychiatry and the increase in diagnosis and prescribing, large study.
Covers I think 250,000 patients that take a ADHD medications, based in Sweden, one thing that always speaking to with my patients, especially when we're considering a stimulant, which as we know is the gold standard for a ADHD, but, you know, talking risks and benefits and, and informed consent and such, and about the risks that certainly come with medications. And I think
Well, yeah, it's the, the perceived risk, like the perception of risk.
I've always talked to my patients about, it's like, yes, of course, you know, there's definitely an increased cardiac risk. I think left ventricular hypertrophy and other cardiac risks, they're there for sure. But I think looking at things, especially through the nursing lens. So we know patients that are receiving treatment for ADHD medications all cause mortality is about 10 years less. So life expectancy is dramatically impacted by not taking medications.
What did this study say?
So biggest takeaways here, so protective benefits were demonstrated. Medication showed statistically significant reductions and serious outcomes across all time periods. There's a really significant improvement in self-harm. 15 to 23% reduction in self-harm behaviors. Unintentional injuries, seven to 13% reduction in traffic crashes.
16 to 27% reduction in criminal behaviors, I think it of speaks to what we have already known, but this, it with, with, a million people, um, in this current environment where there is just a lot of heat on increased prescribing and increased diagnosis.
Sorry to cut you off, but what was the, the, um, timeframe? Was it because it's longitudinal? Is it longitudinal?
I believe it was
15 years. Wow. It's a long time. And how was the data collected. And was it the same medicine or medication sort of regimen or,
They recruited 260,000 individuals. Follow somebody for that long, with ADHD no less, that I think is incredibly impressive. too, doesn't appear to be a drug study, you know, funded by big pharma.
You said it was published in jama, is it?
Psychiatry, it looks like it was June, June 25th, 2025.
I'd say that everything you've said mirrors the things that I see.
Real world risks that, that go with not actively treating your a ADHD.
I get most concerned for myself taking ADHD medication and having ADHD that makes me the most scared. Being with my family, being with my kids, going on vacation. I'd rather be at work 'cause that's routine. And um, you know, these sort of, I think the behavioralism that comes with consistency as well. You're more likely to. Be able to have habits that, are gonna help you out without medication if you're actually consistent with it for any period of time.
So there's a weird duality, a a sort of irony, but I wanted to ask you it's like an echo chamber. I know how you are and I know how I am. What can we do, the bias that is present not only in the patients, but in the providers and the institutions. What do we do about that?
I think for this one, I think this both applies to clinician and to patients. I think I see a lot of patients that do have a concern, like, am I gonna become addicted to this drug?
DA guidance recently, put stimulants in that conversation with opiates, you know, didn't say it overtly, but just a lot of concerns that this is the next new wave where, you know, the new opioid epidemic This is a very different situation where I think honestly, just leaning on this study, it, it just drives some, the fact that, individuals engaged in criminal behaviors, they didn't sit here and as a result of their medication have a reduction in criminal behavior.
That in of itself, especially from the DEA and a criminal justice
Right.
it's, that really drives me the point that this is not similar in, in any way but I think have that concern about addicted to these medications, being dependent on them. And there's still that stigma that's out there.
And I think for clinicians and patients leaning on studies like this, talking about real world outcomes and, and really look at things holistically, I think this is a great, you know, a great study to have, especially the, the breadth of it and, and you know, not just the, the length, but just the amount of patients that were followed. I mean, this is huge. Sometimes, especially the newer clinicians too, and, and myself, I think I kind of fell into that trap initially.
It's like, okay, well great, if you can take the weekends off, gonna buy us more time for tolerance to build. And I think
Uh, the myth of tolerance. Right, exactly. Yeah. And that, well, that cuts to, I think, a very practical and obvious solution to the provider bias, which is updated pharmacology or, or recommendations and, um, guidance for effective and optimal pharmacotherapy. I think that's huge problem that you can just fill that in and then we have. Things that are a lot better, but to play devil's advocate, culturally we have, you know, caffeine, right?
We're in New England, Dunkies, Dunkin' Donuts, America runs on Dunkin'. The distinction here is certainly not similarity in the drug effects of the, of the medicine. It's, it couldn't be more different. You got an upper and a downer, so, with opioids, you have a physical physiological dependency in addiction, whereas with stimulants it's what's called a psychological addiction. They should not be Schedule II to, uh, but that, you know, that's a, maybe a conversation for a different day.
for Stimulants might be, you know, a bit high. Especially where benzos are, are, you know, lower than stimulants. And we know that the effects of benzo withdrawal are, are potentially life threatening and especially Xanax is, is as much as it's prevalent out there.
Xanax is the one med that I've like, kind of had the worst experience with. Cautiously prescribing it, as I do with all benzodiazepines, because I know that they're not a great tool long term, but they can and should be used in certain situations in acute situations. But when you have the options that you have when you go to Xanax, it seems that observationally, it's just more addictive. And I've had people go from polite and nice to sort of really angry and wanting more, you know.
a Xanax prescription. For flights, you know, I'm like, okay, that's, you know, I don't necessarily have an issue with that, but as far as if I'm the initiating provider, I, there's never, never been a Xanax prescription that I've initiated. I, I tend to prefer Ativan and, but again, judiciously,
clonazepam too. I use either Ativan or Clonazepam.
both have really, really solid and, and benefits. But again, I think hit the nail on the head. It's short term. It's like this is
Exactly.
through the roof stressor, especially if we're just in initiating an SSRI and we need something to kind of buy us some time. Yeah, I think it's, flights, it's like how many people want to do exposure therapy, um, for have twice a year? Um, you couple, but most people prefer, okay, I'll take, take an Ativan, you know, take the nerves away. It's opioids and stimulants. They're, they're very different medications.
Looking at a study like this too, at these real world outcomes that are tremendously impacted positively by medications rather than vilifying and, and continuing to propagate like the of, stimulant medications. which.
Practicing in four states. When I think about the DEA is a federal body, the issues that I've had relative to what state I'm in. I know you and I went to a talk a couple years ago and you heard these sort of statements made by clinicians. Stimulants can be and are used for performance enhancement. If someone needs a cup of coffee, that's performance enhancement.
But we're distinguishing a difference here between someone that if you add medication, their life is better, not someone that reached for a cup of coffee we gotta think of these things in two different ways. So for the individual that is making those statements, maybe for you it's performance enhancement, but for others it's being able to actually show up. Let's put it this way. So, so there's a drug, okay. That can be used for, we're talking about pharmacotherapy for a very specific purpose.
We're not talking about the implications of amphetamine or methylphenidate. You know, these are drugs. But when we say a ADHD treatment, we're talking about pharmacotherapy. If there is a medicine, it's for a particular person. So when I talk to someone that is asking about the medicines, I'm like, you know, to be honest with you, it's not really the medicine. It's who gets what.
James and I just want to talk to the clinicians out there, the people that are interested in helping others, whether it's nursing or mental health in general. We want to give some advice that we could have had when we got started. So if anyone out there wants to hear us talk about anything, please reach out, let us know.
to analyzing what's out there and, and providing our windows of insights that we've gathered over the years. and There's, there's a lot of complexity out there, and we're here to kind of help you sort through it and, and really get to your best outcomes through your patients and feel clinically in a good spot, feel comfortable with your decision making and making sure that it's sound and, and based on good data and a good perspective.
Awesome. Yeah, and I, I'm excited to talk about everything, neurodivergence Autism Spectrum Disorder, trauma, anything that could, you know, befall someone in, in life, anything that falls under the category of mental health, I think is on the table. I'm Jon Murphy, psychiatric nurse practitioner.
I'm James Kennedy, psychiatric nurse practitioner. This has been an episode of Compass Point Institute. Stay tuned.