| THE | VACCINE AND PREVENTION SPECIAL
14 MARCH 2025
The country ’ s leading independent medical publication
| THE | VACCINE AND PREVENTION SPECIAL
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Will ADHD role haunt GPs ?
The pressure to prescribe stimulants should worry us , says top GP .
Rachel Carter “ A NON-MEDICAL colleague contacted me recently to ask whether his son , who was doing a school exam , could have a Ritalin prescription ,” Professor Simon Willcock says .
“ His son had tried a mate ’ s prescription and it helped him focus .
“ That is a classical presentation to general practice in 2025 .”
The respected GP says this example highlights the heavy expecta- general practice and primary care at Sydney ’ s Macquarie University wants GPs to keep asking themselves : “ Why are we doing this ?”
He says balancing the risks and benefits of routine pharmacological treatment for ADHD is vital but complex , especially for adults .
“ For younger children , nobody disputes the importance of the medication . Where it becomes harder is the ongoing use in older children and then adults .
“ You can ask the question : If it ’ s not a harmful drug , does it really matter ?”
But there is “ not good literature ” to show that long-term use for adults is useful , or for that matter , whether
‘ The challenge for GPs is recognising the boundary between normal variance and pathology .’
Elon Musk ’ s X factor and the tinfoil hats
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tions around stimulant prescribing for ADHD amid growing patient demand for a diagnosis .
The WA Government has promised to expand the scope of GPs by letting them diagnose ADHD and initiate treatment for adults and teens . Other states are likely to take similar steps .
It is something Professor Willcock supports .
“ We ’ ve totally abused the workforce resource in this … Psychiatrists and paediatricians were overwhelmed by the rush of people wanting a diagnosis ,” he says .
“ But quite frankly , I think a lot of psychiatrists have given up [ on ] any ethical claim . Some are charging $ 1200 and doing this online based on a questionnaire . “ We GPs can do better .” But the honorary professor of
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there are safety risks , he says . Some studies have drawn a link between long-term exposure and an increased risk of CVD , which Professor Willcock says is “ not surprising ” given the drugs are cardiovascularly active . Others have suggested no neuropsychological problems result from long-term use .
“ But if you consider the context of past medication use and other drugs that have been used legally and illegally , there are plenty of reasons to be concerned ,” Professor Willcock says .
“ If you saw your doctor in the 1950s saying you had an anxiety disorder , it was quite likely you would be prescribed cigarettes because we knew that nicotine was calming .
“ In the 1970s , it was a prescription for the new wonder drug diazepam .
“ And as a society , particularly in
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Australia , we ’ ve always used alcohol as an anxiolytic .”
Professor Willcock worries that widespread stimulant prescribing could end with doctors looking back in 20 years asking , “ Why were we so non-selective and unbalanced in our recommendations ?”
Another example he points to is
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Professor Simon Willcock .
Benzedrine , the first brand of commercially available amphetamine .
“ That took off hugely in the 1930s and ’ 40s and became one of the most used medications in the US .”
As famously detailed in the Jack Kerouac novel On the Road , the drug was clearly “ being abused and causing all sorts of problems in the PAGE 3
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Genomics and the GP THERAPY UPDATE , PAGE 46
Influenza HOW TO TREAT , PAGE 25
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Receptionist who poisoned GPs has sentence cut
Heather Saxena A WOMAN who poisoned two GPs and their child by adding an antipsychotic to a mushroom dish at a family dinner has had her nine-year sentence reduced on appeal .
Sharon Lee had worked as a medical receptionist in a Perth practice owned by her younger sister .
Five weeks before the dinner , she had been fired for repeatedly asking patients the same question — such as their name — as a result of her obsessive compulsive disorder .
While the GPs continued to pay her a salary , complicating the case was that her sister had become her treating doctor , with both GPs prescribing her olanzapine for anorexia nervosa .
At the dinner in 2021 , Ms Lee served a mushroom and runner bean dish , and a dessert tart , which she had laced with the antipsychotic . The Supreme Court of WA was told she left shortly after her brother-in-law began to experience nausea and chest tightness .
The other GP then began to feel “ intoxicated ”.
The attack was revenge after being sacked .
“ During the night , [ she ] had a shower and collapsed multiple times , striking her head on the bathroom floor ,” the Supreme Court heard .
Subsequent blood tests suggested the GPs and their 10-year-old daughter had consumed about 200mg of the anti psychotic — 10 times the recommended dose — with levels 0.13 and 0.14mg / L .
Ms Lee then returned early the next morning with a 2kg dumbbell and struck her brother-in-law several times . He was hospitalised with a Glasgow Coma Scale score of 8 .
Although the GP recovered , his injuries included a left orbital wall fracture , severe concussion and intracranial bleeding .
Ms Lee originally pleaded guilty in a district court to three counts of intentionally endangering “ life health and safety ” and one count of assault .
The court said she was motivated by revenge , jealousy or animus .
But the appeal court ruled the sentence for the assault was “ unreasonable or plainly unjust ” given her mental health and no previous criminal history .
Ms Lee will be eligible for parole after serving 6.5 years in custody .