ADHD Medications: Risk, Bias, and Real Outcomes

Jon Murphy, PMHNP: 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.

J Kennedy, APRN, PMHNP-BC: 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

Jon Murphy, PMHNP: I see.

So it's the, the Telep psychiatry.

J Kennedy, APRN, PMHNP-BC: 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

Jon Murphy, PMHNP: Well, yeah,
it's the, the perceived risk,

like the perception of risk.

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP: What
did this study say?

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP: Sorry to cut you off,
but what was the, the, um, timeframe?

Was it because it's longitudinal?

Is it longitudinal?

J Kennedy, APRN, PMHNP-BC:
I believe it was

Jon Murphy, PMHNP: 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,

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP: You said it
was published in jama, is it?

J Kennedy, APRN, PMHNP-BC: Psychiatry, it
looks like it was June, June 25th, 2025.

Jon Murphy, PMHNP: I'd say that everything
you've said mirrors the things that I see.

J Kennedy, APRN, PMHNP-BC: Real
world risks that, that go with

not actively treating your a ADHD.

Jon Murphy, PMHNP: 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?

J Kennedy, APRN, PMHNP-BC: 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

Jon Murphy, PMHNP: Right.

J Kennedy, APRN, PMHNP-BC: 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

Jon Murphy, PMHNP: 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.

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP: 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.

J Kennedy, APRN, PMHNP-BC:
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,

Jon Murphy, PMHNP: clonazepam too.

I use either Ativan or Clonazepam.

J Kennedy, APRN, PMHNP-BC: 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

Jon Murphy, PMHNP: Exactly.

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP:
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.

J Kennedy, APRN, PMHNP-BC: 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.

Jon Murphy, PMHNP: 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.

J Kennedy, APRN, PMHNP-BC: I'm James
Kennedy, psychiatric nurse practitioner.

This has been an episode
of Compass Point Institute.

Stay tuned.