Understanding the Challenges of Managing Mental Health in the Workplace With a Focus on ADHD

Transcription

1 Understanding the Challenges of Managing Mental Health in the Workplace With a Focus on ADHD Dr. Don Duncan Clinical Director BC Interior ADHD Clinic Kelowna, BC Mental Health Summit Vancouver, BC December 8 th, 2015

2 DISCLOSURE Grants/Research Support, Speakers Bureau/Honoraria, Consulting Fees, Bureau/Honoraria, or Licensing Agreements: Purdue Shire Eli Lilly Janssen Western Psychological Services This program sponsored by: Janssen

3 OVERVIEW OF ADHD Neurobiological Highly genetic 1/23 Adults; 1/17 children/youth Usually unrecognized Inattention +/- Hyperactivity/Impulsivity

4 Goals IMPACT OF ADHD ON WORKPLACE To explore the professional challenges faced by ADHD sufferers To determine the time and productivity cost of employee ADHD, and to examine how workplaces accommodate ADHD sufferers Fielded Completion Time From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100 April May 2013 Via online survey 8 minutes Survey Audience Canadian Adults with ADHD Nationally representative sample N=100 respondents

5 Many co-morbid conditions are experienced by ADHD sufferers; those unemployed are more likely to experience problems 63% experienced depression 58% reported anxiety 75% Of Currently Employed 95% Of Currently Unemployed 22% had suffered drug or alcohol addiction 16% had bipolar disorder Suffer from at least 1 other condition From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100

6 With few exceptions, ADHD symptoms negatively affect performance While suffering symptoms of ADHD, the average respondent feels they work at 2/3 of their full capacity. Only 5% say they are able to function at full capacity. 78% said they were mentally exhausted at the end of the day 76% said that they put off projects that they knew require substantial amounts of thought 66% had trouble wrapping up the final details of a project after the challenging parts were complete 28% said they were unable to multitask successfully From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100

7 2 in 5 have quit a job or scholastic program due to difficulty 38% Quit a job / school due to difficulty 30% Reported having taken sick days 29% Said they had left their work area for an extended period of time during the workday/school day As a result of their ADD/ADHD. 26% 27% Reported having lost a job as a result of their condition Have quit a job/school due to need for new challenges 25% Reported having reduced their work/study hours From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100

8 Days Lost Performance LOST WORKPLACE PERFORMANCE DUE TO ADHD Reduced Quantity Reduced Quality Absenteeism n=139 ; age de Graff R et al, Occup Environ Med (2008) 65(12):

9 Days Lost Performance LOST WORKPLACE PERFORMANCE DUE TO ADHD 0 ABSENTEEISM PRESENTEEISM TOTAL Professional Service n=3198 ; age White Collar Tech Blue Collar Kessler R et al, Occup Environ Med (2005) 47(6): 565

10 MEDICATION MAKES A DIFFERENCE Compared to those not on medication, those taking medication to manage their ADHD miss less time at work/school tend to perform better on the job feel a greater sense of job security From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100

11 Only half believe their school or employer accommodates their ADHD, while only a third indicate that all of the medication they require is covered on their benefits plan 48% of respondents indicated that their employer or school accommodates their needs that result from their ADD/ADHD Only 32% indicated that all of the medication they need is covered by their benefits plan 17% responded that a portion of the medication they need is covered by their benefits plan From the Benefits Canada 2013 ADD/ADHD in the Workplace study, made possible by Janssen, n=100

12 ADHD MEDICATIONS IN CANADA 12+ Hour Products 8-10 Hour Products Short Acting Untested Methylphenidate (MPH) Concerta Biphentin Ritalin Generics Stimulants Dextroamphetamine (DEX) Vyvanse Adderall Dexedrine Non- Stimulants Strattera Intuniv XR

13 Methylphenidate (ng/ml) Pharmacokinetic Profiles for Ritalin SR and CONCERTA OROS CONCERTA OROS and Ritalin SR have similar AUC 0- and C max values Could be deemed bioequivalent despite very different PK profiles C max Ritalin SR 20 mg (Normalized to 18mg) CONCERTA 18mg (Reference) 3 2 AUC 0-1 T max Time (h) 2 CONCERTA (methylphenidate HCI) ER Tablets Citizen Petition. McNeil Consumer & Specialty Pharmaceuticals. 2004

14 PK Profile FDA Advisory Committee for Pharmaceutical Science and Clinical Pharmacology Meeting FDA Recommendations: April 13, 2010 FDA is recommending using additional bioequivalence metrics for any second entry MR-MPH* formulation to ensure therapeutic equivalence and interchangeability of these products. *Modified Release Methylphenidate

15 Goal MENTAL HEALTH SURVEY To better understand the risks of generic interchangeability in mental health products Fielded Completion Time Sept- Oct 2015 Via online survey 15 minutes Survey Audience* Canadian Patients and Caregivers suffering from various mental health conditions Nationally representative sample N=397 respondents *Patient Associations: CADDAC, Mood Disorders of Canada, Schizophrenia Society of Canada, Tourette Society

16 Primary Mental Health Condition

17 Drug Coverage of Respondents 26% Have public drug plan 13% Have no drug plan coverage 55% Have private drug plan coverage 6% Are unsure

18 Treatment Options/Accommodations Base: Total Respondents n=319 % Parent/caregiver receiving education on condition Person with condition receiving education on their condition Home accommodations School accommodations Workplace accommodations 4.39 Medication 79 Cognitive Behaviour Therapy Psychotherapy/Family therapy Coaching Tutoring Mindfulness None 4.39 Other % of respondents have NOT been able to access all treatments/accommodations that have been recommended 54% felt that the cost of non-medication treatment is prohibitive 15% have not been able to access the recommended medication

19 Mental Health Survey, cont d. Of 308 respondents, 59% have had experience with taking or being prescribed the generic version of a drug 37% of respondents stated that their physician has written No Sub on the prescription

20 Mental Health Survey, cont d. Reasons for Pharmacist Switching to a Generic:

21 Conclusions of Mental Health Survey 68.91% of respondents are not aware of how to know if they were switched to a generic, while 93.28% of respondents would like to know if they were switched to a generic: 22.95% reported intolerable changes in symptom control after being switched to the generic version 43.80% experienced changes in functioning when switched to the generic version 42.98% of respondents switched back to the brand after being switched to generic

22 Clinical Outcomes Teva-Methylphenidate ER-C does not appear to be clinically equivalent to CONCERTA 9 Pediatric Practice Retrospective Review to evaluate whether bioequivalence translates into clinical equivalence 162 patient study: 87% of patients switched from CONCERTA to Teva-Methylphenidate ER-C destabilized compared to only 26% of patients who remained on CONCERTA (defined as patient requiring a change in medication or dosage) Longer term follow up showed that 92.4% preferred CONCERTA in terms of clinical efficacy 30% of patients that destabilized when switched to Teva-Methylphenidate ER-C have not been able to re-stabilize their ADHD symptoms The generic appears to be less effective, to wear off faster and to have different side effects (dizziness, eating more, not sleeping well and anger) compared to CONCERTA 9. Van Stralen, Poster Presentation AACAP &CACAP Joint Annual Meeting, Toronto, October 2011; Submitted Paediatrics & Child Health

23 Adverse Drug Reactions The number of ADR s are considerably higher for Teva-Methylphenidate ER-C compared to CONCERTA 10 (headache, insomnia, reboundhyperactivity) ADR s per million treatment days for CONCERTA : ADR s per million treatment days for Teva- Methylphenidate ER-C: Health Canada Database

24 There are potential impacts on the workplace of being switched to a generic, including: Absenteeism Decreased productivity Presenteeism STD LTD

25 Tips for Employers For these tips and more, visit a new resource on Adult ADHD brought to you by Janssen