scholarly journals Rise, and pronounced regional variation, in methylphenidate, amphetamine, and lisdexamfetamine distribution in the United States

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12619
Author(s):  
Sneha M. Vaddadi ◽  
Nicholas J. Czelatka ◽  
Belsy D. Gutierrez ◽  
Bhumika C. Maddineni ◽  
Kenneth L. McCall ◽  
...  
Keyword(s):  
United States ◽  
Adult Adhd ◽  
Regional Analysis ◽  
The United States ◽  
The West ◽  
Prescription Stimulants ◽  
Drug Enforcement ◽  
Hyperactivity Disorder ◽  
Sympathomimetic Drugs ◽  
Usage Patterns

Background The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine are sympathomimetic drugs with therapeutic use. They are designated in the United States as Schedule II substances, defined by the 1970 Controlled Substances Act as having a “high potential for abuse”. Changing criteria for the diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and the approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. This report compared the pharmacoepidemiology of these stimulants in the United States from 2010–2017. Methods Distribution of amphetamine, methylphenidate, lisdexamfetamine were examined via weights extracted from the Drug Enforcement Administration’s (DEA) Automated Reports and Consolidated Ordering System (ARCOS). Median stimulant Daily Dosage per patient was determined for a regional analysis. The percent of cost and prescriptions attributable to each stimulant and atomoxetine in Medicaid from the “Drug Utilization 2018 - National Total” from the Centers for Medicare and Medicaid was determined. Results There was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) from 2010–2017. The change in methylphenidate (−3.0%) was modest. Persons/day stimulant usage was lower in the West than in other US regions from 2014-2017. There was a negative correlation (r(48) = −0.43 to −0.65, p < .05) between the percent Hispanic population per state and the Daily Dosage/population per stimulant. Methylphenidate formulations accounted for over half (51.7%) of the $3.8 billion reimbursed by Medicaid and the plurality (45.4%) of the 22.0 million prescriptions. Amphetamine was responsible for less than one-fifth (18.4%) of cost but one-third of prescriptions (33.6%). Lisdexamfetamine’s cost (26.0%) exceeded prescriptions (16.3%). Conclusion The rising amphetamine and lisdexamfetamine distribution may correspond with a rise in adult ADHD diagnoses. Regional analysis indicates that stimulant distribution in the West may be distinct from that in other regions. The lower stimulant distribution in areas with greater Hispanic populations may warrant further study.

scholarly journals Rise and Regional Variations in Schedule II Stimulant Use in the United States

2020 ◽  
Author(s):  
Sneha M. Vaddadi ◽  
Nicholas J. Czelatka ◽  
Belsy D. Gutierrez ◽  
Bhumika C. Maddineni ◽  
Carlos D. Torres-Teran ◽  
...  
Keyword(s):  
United States ◽  
Adult Adhd ◽  
Regional Analysis ◽  
The United States ◽  
Hispanic Population ◽  
The West ◽  
Stimulant Use ◽  
Daily Dose ◽  
Recent Trends ◽  
Ordering Systems

AbstractObjectiveThere is a need to better understand recent trends in stimulant usage. This report compares the pharmacoepidemiology of three Schedule II stimulants in the United States from 2010 – 2017.MethodsDrug weights were extracted from the Automated Reports and Consolidated Ordering Systems (ARCOS) for amphetamine, methylphenidate, and lisdexamfetamine. Total grams per drug were averaged across all states and compared from 2010–2017. Median stimulant daily dosage per patient user was determined from electronic medical records for a regional analysis.ResultsThere was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) use from 2010–2017. The change in methylphenidate (−3.0%) was modest. Regional analysis indicated that persons/day usage of stimulants in the west was lower than that of other US regions from 2014–2017. There was a negative correlation (r(48) = −0.43 to −0.65, p < .05) between the percent Hispanic population per state and the daily dose/population per stimulant.ConclusionThe increasing amphetamine and lisdexamfetamine, but not methylphenidate, use may be explained by a rise in adult ADHD diagnoses and treatment. Regional analysis indicates that the use of stimulants in the west may be distinct from that in other regions. The lower stimulant use in areas with greater Hispanic population may reflect socioeconomic factors. Further research is needed on social factors impacting stimulant use and reasons for the pronounced regional variance.

Impairment Associated with Adult ADHD

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S12) ◽  
pp. 9-11 ◽  
Author(s):  
Mark A. Stein
Keyword(s):  
United States ◽  
Attention Deficit Hyperactivity Disorder ◽  
Treatment Outcomes ◽  
Adult Adhd ◽  
The United States ◽  
The Body ◽  
Marital Problems ◽  
Hyperactivity Disorder ◽  
Body Of Knowledge ◽  
Co Morbidity

Attention-deficit/hyperactivity disorder (ADHD) is present in 4% to 6% of adults in the United States. In the National Co-morbidity Survey Replication, a diagnosis of ADHD was associated with greater marital problems, unemployment, difficulties in the workplace, and frequent workplace absence. Despite these findings, the body of knowledge regarding impairment in adult ADHD is far from complete. Building upon our knowledge of impairment in adults with ADHD will result in a broader range of treatment outcomes which may be measured and targeted.

Mafias on the Move

2011 ◽  
Author(s):  
Federico Varese
Keyword(s):  
United States ◽  
New York ◽  
Organized Crime ◽  
The United States ◽  
The West ◽  
Market Expansion ◽  
The North ◽  
Economic Transformations ◽  
At Will

Organized crime is spreading like a global virus as mobs take advantage of open borders to establish local franchises at will. That at least is the fear, inspired by stories of Russian mobsters in New York, Chinese triads in London, and Italian mafias throughout the West. As this book explains, the truth is more complicated. The author has spent years researching mafia groups in Italy, Russia, the United States, and China, and argues that mafiosi often find themselves abroad against their will, rather than through a strategic plan to colonize new territories. Once there, they do not always succeed in establishing themselves. The book spells out the conditions that lead to their long-term success, namely sudden market expansion that is neither exploited by local rivals nor blocked by authorities. Ultimately the inability of the state to govern economic transformations gives mafias their opportunity. In a series of matched comparisons, the book charts the attempts of the Calabrese 'Ndrangheta to move to the north of Italy, and shows how the Sicilian mafia expanded to early twentieth-century New York, but failed around the same time to find a niche in Argentina. The book explains why the Russian mafia failed to penetrate Rome but succeeded in Hungary. A pioneering chapter on China examines the challenges that triads from Taiwan and Hong Kong find in branching out to the mainland. This book is both a compelling read and a sober assessment of the risks posed by globalization and immigration for the spread of mafias.

The Rise and Fall of Great Powers

2017 ◽  
Author(s):  
Geir Lundestad
Keyword(s):  
United States ◽  
International Relations ◽  
Nuclear Weapons ◽  
The United States ◽  
Great Powers ◽  
Foreseeable Future ◽  
The West ◽  
Economic Modernization

There are no laws in history. Realists, liberals, and others are both right and wrong. Although no one can be certain that military incidents may not happen, for the foreseeable future China and the United States are unlikely to favor major war. They have cooperated well for almost four decades now. China is likely to continue to focus on its economic modernization. It has far to go to measure up to the West. The American-Chinese economies are still complementary. A conflict with the United States or even with China’s neighbors would have damaging repercussions for China’s economic goals. The United States is so strong that it would make little sense for China to take it on militarily. There are also other deterrents against war, from nuclear weapons to emerging norms about international relations. It is anybody’s guess what will happen after the next few decades. History indicates anything is possible.

The Proximity of Other Skins

2019 ◽  
Author(s):  
Celine Parreñas Shimizu
Keyword(s):  
United States ◽  
South Korea ◽  
The United States ◽  
The Philippines ◽  
The Other ◽  
The West ◽  
Pain And Suffering ◽  
The Spectator ◽  
Existing Frames ◽  
The Voice

Transnational films representing intimacy and inequality disrupt and disgust Western spectators. When wounded bodies within poverty entangle with healthy wealthy bodies in sex, romance and care, fear and hatred combine with desire and fetishism. Works from the Philippines, South Korea, and independents from the United States and France may not be made for the West and may not make use of Hollywood traditions. Rather, they demand recognition for the knowledge they produce beyond our existing frames. They challenge us to go beyond passive consumption, or introspection of ourselves as spectators, for they represent new ways of world-making we cannot unsee, unhear, or unfeel. The spectator is redirected to go beyond the rapture of consuming the other to the rupture that arises from witnessing pain and suffering. Self-displacement is what proximity to intimate inequality in cinema ultimately compels and demands so as to establish an ethical way of relating to others. In undoing the spectator, the voice of the transnational filmmaker emerges. Not only do we need to listen to filmmakers from outside Hollywood who unflinchingly engage the inexpressibility of difference, we need to make room for critics and theorists who prioritize the subjectivities of others. When the demographics of filmmakers and film scholars are not as diverse as its spectators, films narrow our worldviews. To recognize our culpability in the denigration of others unleashes the power of cinema. The unbearability of stories we don’t want to watch and don’t want to feel must be borne.

scholarly journals Environmental justice, settler colonialism, and more-than-humans in the occupied West Bank: An introduction

2021 ◽  
Vol 4 (1) ◽  
pp. 3-27
Author(s):  
Irus Braverman
Keyword(s):  
United States ◽  
Environmental Justice ◽  
West Bank ◽  
Settler Colonialism ◽  
The United States ◽  
Special Issue ◽  
The West ◽  
The Core ◽  
Waste Concrete

Our special issue provides a first-of-its kind attempt to examine environmental injustices in the occupied West Bank through interdisciplinary perspectives, pointing to the broader settler colonial and neoliberal contexts within which they occur and to their more-than-human implications. Specifically, we seek to understand what environmental justice—a movement originating from, and rooted in, the United States—means in the context of Palestine/Israel. Moving beyond the settler-native dialectic, we draw attention to the more-than-human flows that occur in the region—which include water, air, waste, cement, trees, donkeys, watermelons, and insects—to consider the dynamic, and often gradational, meanings of frontier, enclosure, and Indigeneity in the West Bank, challenging the all-too-binary assumptions at the core of settler colonialism. Against the backdrop of the settler colonial project of territorial dispossession and elimination, we illuminate the infrastructural connections and disruptions among lives and matter in the West Bank, interpreting these through the lens of environmental justice. We finally ask what forms of ecological decolonization might emerge from this landscape of accumulating waste, concrete, and ruin. Such alternative visions that move beyond the single axis of settler-native enable the emergence of more nuanced, and even hopeful, ecological imaginaries that focus on sumud, dignity, and recognition.

scholarly journals A Cross-Sectional Study of 0.6 Million Children with Attention-Deficit/Hyperactivity Disorder in the United States

2020 ◽  
Vol 10 (01) ◽  
pp. e97-e103
Author(s):  
Irene Rethemiotaki
Keyword(s):  
United States ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Family Income ◽  
Neurodevelopmental Disorder ◽  
Multiple Logistic Regression Analysis ◽  
The United States ◽  
Cross Sectional ◽  
Children With Adhd ◽  
Hyperactivity Disorder

AbstractAttention-deficit hyperactivity disorder (ADHD) is an increasingly recognized chronic neurodevelopmental disorder. This work aims at studying the prevalence and clinical characteristics of children with ADHD in the United States in the period between 2009 and 2018. Data from the National Health Interview Survey were analyzed by univariate and multivariate statistics to assess the role of socioeconomic factors in the development of ADHD. It has been studied 615,608 children, 51.2% male and 48.7% female. The prevalence of ADHD was 9.13%, with males predominating over females. The number of children with ADHD increased from 2009 to 2018 by 14.8%. As specified by multiple logistic regression analysis, males (odds ratio [OR] 2.38) who have neither mother nor father (OR 1.76) are twice as likely to have ADHD compared with their peers. In addition, family income (OR 1.40) and parent's education (OR 1.12) were significantly associated with ADHD. It has been highlighted the significance of deprivation of both family and financial comfort as primary indicators for ADHD in children. Moreover, children with ADHD were more likely to be males in the age group of 12 to 17.

scholarly journals EPIDEMIOLOGY OF PEDIATRIC CARTILAGE RESTORATION PROCEDURES IN THE UNITED STATES: INSURANCE AND GEOGRAPHY PLAY A ROLE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Tyler B. Hall ◽  
Max J. Hyman ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Statistical Significance ◽  
Private Insurance ◽  
Univariate Analysis ◽  
The United States ◽  
National Database ◽  
The West ◽  
Cartilage Restoration ◽  
Common Diagnosis

Background: A number of surgical options are available for sizeable articular cartilage lesions of the knee. These include osteochondral autograft (OAU) or allograft (OAL) transfer, or autologous chondrocyte implantation (ACI). In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another, which may lead to variation in preferred practice. Hypothesis/Purpose: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing OAU, OAL, and ACI in the United States, with attention to variation along the lines of demographic and geographic factors. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing OAU, OAL, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically into regions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 809 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (48.6%) underwent OAL, 339 (41.9%) underwent OAU, and 77 (9.5%) underwent ACI. The most common diagnosis at the time of surgery was osteochondritis dissecans in 360 patients (44.5%) followed by an associated cruciate ligament injury in 126 (15.6%) and patellar instability in 98 (12.1%). After adjusting for confounders in a multivariate model, ACI was more 3.4 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.5-7.5, p=0.002). Furthermore, a patient in this Northeast was 29.3 times more likely to undergo ACI than in the West (95% CI 4.0-217.4, p=0.001). OAU was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p<0.001). Univariate analysis also revealed differences along the lines of race, but these findings did not maintain statistical significance in multivariate analysis. Conclusion: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast. OAU is the most commonly performed procedure in the West and Midwest.

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