Estonia eases ADHD treatment access for children and teens

Estonia’s Ministry of Social Affairs is easing prescription rules for certain attention deficit hyperactivity disorder medicines for children aged 6 to 19, ERR reported. The requirement to consult a psychiatric treatment team before initially prescribing the medicines will be removed, and psychiatrists will be authorised to issue the first prescriptions.

Under a draft regulation prepared by the ministry, certain ADHD medicines covered at a 75% reimbursement rate will be subject to the revised rules. The medicines may be prescribed by either a psychiatrist or a psychiatrist with additional qualifications in treating children and adolescents.

“The requirement to consult the treatment team will disappear,” said Getter Hark, head of the Health Insurance Fund’s medicines reimbursement service.

The change concerns two active substances: methylphenidate, sold under brand names including Ritalin and Concerta, and atomoxetine, sold as Atominiex. They are first-line medicines for children aged 6 to 19.

Hark said the changes were prepared in close cooperation with the Estonian Psychiatric Association. Their aim is to bring prescription rules for children closer to those for adults, reduce differences between age groups and align treatment practices with clinical guidelines.

The changes will take effect on October 1.

The Estonian Psychiatric Association has described the existing requirement to consult a treatment team as an unnecessary waste of time that does not fit modern medical practice.

Anne Kleinberg, the association’s vice-president, said excessive regulation was not in the interests of patients or doctors because diagnosing ADHD and deciding on treatment were routine tasks for a psychiatrist.

“There is no need to add consultation with a treatment team, especially when that team may include a speech therapist, psychologist or mental health nurse, for whom prescribing medicines is neither their work nor their responsibility,” Kleinberg said.

Health Insurance Fund statistics show that over the past five years, the number of prescriptions for ADHD medicines containing methylphenidate and atomoxetine, as well as the number of patients aged 6 to 19 receiving them, has increased.

In the 6-to-10 age group, about 4,200 prescriptions were issued to approximately 950 people in 2021. This year, the same age group has received nearly 9,600 prescriptions for around 2,430 people.

Experts said the change to prescription rules would not affect the thorough decision-making process used to diagnose ADHD and determine treatment.

“There are certain rules we must follow for diagnosis. Those rules are not imposed through medicine prescription requirements; we follow clinical guidelines, which include diagnostic criteria. That is how doctors make a diagnosis,” Kleinberg said.