The changes to ADHD treatment rules, explained

The Spinoff

17 hours ago

Being diagnosed with and treated for ADHD in Aotearoa is set to get much easier. Here's what you need to know.
What's all this then?
Yesterday, government drug-funding agency Pharmac and medical regulatory body Medsafe announced changes to the rules relating to stimulant treatments for ADHD (attention deficit hyperactivity disorder). From February 1, 2026, general practitioners (GPs) and nurse practitioners (NPs) will be able to prescribe methylphenidate, dexamfetamine and lisdexamfetamine (often known by their brand names, including Ritalin, Rubifen, Concerta and Teva) to adults aged 18 and over. For those aged 17 and younger, nurse practitioners working in mental health services will also be able to prescribe them.
Who can prescribe these drugs currently?
Initially, only 'a medical practitioner with a vocational scope of practice of paediatrics or psychiatry'. That essentially means, for adults, a psychiatrist (clinical psychologists can diagnose ADHD but not prescribe medication). After diagnosing ADHD and getting the patient established on the correct meds at the correct dose, the psychiatrist can write a written recommendation to the patient's GP or NP, after which they too can prescribe the drugs. (People prescribed ADHD meds used to have to be reviewed by their psychiatrist every two years in order to keep getting them, but that onerous requirement was ditched in December last year.)
Interesting. But if GPs can already prescribe (eventually), and the two-year review is already goneburger, what's the problem?
It can be very difficult to secure that crucial appointment with a psychiatrist or clinical psychologist (for adults) or paediatrician (for kids) to get the diagnosis that is a prerequisite for being prescribed the medication. Nabbing a referral through the public system can be nigh on impossible in many regions, and even if you happen to be successful, the wait for an appointment is likely to be months. Even people who can afford to go privately or have health insurance – the cost for an assessment is usually upwards of $1,000 – might have to wait up to a year or longer for an appointment. Aside from the cost, which has led to inequities in treatment, there's the cruel irony of all this administrative hoop-jumping being particularly gruelling for the ADHD brain. It was this ' broken system ' that resulted in Auckland GP Tony Hanne, a leading ADHD specialist, being suspended and fined for flouting the rules and prescribing meds to his patients.
Not ideal then. Why such long waits for treatment?
A combination of the much-documented pressures on our health system (mental health is an area that's particularly stretched) and an increase in demand: between 2006 and 2022, the number of adults being prescribed ADHD medication in New Zealand rose tenfold as this neurodevelopmental disorder became better understood (the reality for ADHDers is far more complex than the old stereotype of the naughty little boy disrupting class). ADHD is still believed to be under-diagnosed, however: according to research published last year, 0.6% of the adult population was being treated for ADHD in 2022, but an estimated 2.6% have the condition.
Why are the prescribing rules so strict?
GPs lost the ability to prescribe the meds in 1999 due to fears they were being overprescribed, likely linked to a moral panic originating in the US around overmedicated kids. There were also concerns about misuse and 'diversion', ie when people prescribed the drugs give or sell them to others. ADHD drugs are safe and not addictive if used as prescribed, by people who actually have the condition – they amplify the release of dopamine, which has a calming and focusing effect. But they can be used recreationally – usually crushed and snorted at higher doses, or as a ' study drug ', and there were reportedly fears that gangs could use them to make methamphetamine.
Any evidence of that actually happening?
The gang thing, no, and there is no evidence that people prescribed ADHD meds are more likely to abuse substances either. There is, however, evidence of a link between undiagnosed and untreated ADHD and substance abuse. That's just one of many societal costs of untreated ADHD that have been identified, alongside, to name just a few, lost productivity, absenteeism, welfare and education costs and costs to the criminal justice system – various studies suggest people with ADHD are overwhelmingly overrepresented among the prison population worldwide.
Hmm. Surely the overprescribing thing is a valid concern though – how can an overworked GP be expected to provide an accurate diagnosis, especially if the patient has been influenced by all the ADHD content out there and is adamant they've got it?
Not all GPs and NPs will be offering ADHD diagnoses and treatment, and it won't be squeezed into a 15-minute appointment, say the decision-makers. 'It's important we ensure a high quality of ADHD assessment, and that people can expect to receive appropriate care and support,' said Medsafe group manager Chris James in the press release announcing the changes. 'We have been working closely with sector representatives to develop a clinical framework which will set out principles for diagnosing and treating ADHD, including the appropriate clinical care required of healthcare practitioners.'
But writing for Newsroom in February this year, when the proposal to change the rules was being consulted on, an associate professor in psychological medicine at the University of Otago said that the consequences were likely to be 'double-edged' if it was accepted. Ben Beaglehole, who led the recent research into the ADHD treatment gap referenced above, said that while the changes would give more people access to life-changing treatment, they were 'likely to cause inadvertent harm through less thorough assessments, poorly targeted treatment, and greater community misuse of stimulants'.
Oh. What do other people in the industry reckon?
The Royal New Zealand College of General Practitioners (RNZCGP), which has been at the forefront of the campaign for change, welcomed the news, with medical director Luke Bradford telling the Herald that GPs would be doing some serious upskilling and assessments would be thorough. 'It's not going to be, 'I'm going to the doctor about my sore knee, and by the way, I always thought I'm not very good at concentrating. Do you think I've got ADHD? Can I have some Ritalin?' That's not what is going to happen.'
Mental health nurse practitioner Anna Elders echoed this. 'I think there's going to be some misconceptions that GPs and nurse practitioners can diagnose within a 15- or a 30-minute consult, and that's not accurate,' she said, in comments made via the Science Media Centre. 'There are really firm guidelines from the working group, the ministry, and all of the colleges around what a really good, comprehensive assessment will look like. GPs are going to have to identify that they want to develop special skills and knowledge and undertake training in working with ADHD, just like they would if they developed a specialism in skin cancer, for example.'
Well, valid concerns aside, it's good to see these barriers to accessing treatment coming down. Anything else I should know about?
Oh yeah, there is the small problem of a global shortage of methylphenidate, the most commonly prescribed ADHD drug, which is why the start date for the changes has been pushed out till next year, in the hope that the situation will have improved by then. Currently, many ADHDers in New Zealand can't access their prescribed medication, and are instead receiving alternatives that may not be as effective. 'Pharmac is exploring several options to assist with the supply of methylphenidate,' said the agency when announcing the changes yesterday.