High Use Of Stimulants On Cape Cod, Researchers Report

In a novel study examining geographic variations in the use of "mental health" drugs — stimulants, antidepressants and antipsychotics — researchers from Yale identified clear regional "clusters" where use of these types of medications was elevated. Notably, "in a large area of the South centered on Tennessee, use of... [these drugs] is 40% higher than in the rest of the United States," researchers found.

Also notable (if you have a New England bias) is what's going on at the Eastern tip of the Bay State: Cape Cod, the researchers found, "had the highest use of stimulants at 16% of residents, compared to a mean of 2.6% of the population nationally."

So what's happening on the Cape that might be driving higher-than-average use of drugs such as Ritalin, Adderall, Focalin, Strattera, Vyvanse and other medications used to treat ADHD? Is it the fried clams? The hypnotic lull of the tides? The tough winters?

Authors found extremes in other locales as well:

Antidepressant use was highest in Alexandria, Virginia where two in five residents received an antidepressant, compared to a mean of 10.4% nationally. Gainesville, Florida had the highest use of antipsychotics at a rate of 4.6% of residents, compared to a mean of 0.8% nationally.

This study doesn't provide clear answers on why particular regions appear to be super-users of certain meds. Still, the authors suggest several factors:

“Access to clinical care and pharmaceutical marketing explains some of the geographic variation we observed,"

lead author Marissa King, assistant professor of organizational behavior at the Yale School of Management, said in an interview. "As far as the stimulant use, there is some association with underlying prevalence and with doctors preferences for how they treat disorders like ADHD.

The paper is online journal Health & Place. Here's more from the news release:

The study analyzed geographic differences in the use of these three classes of mental health medications using data that covers 60% of prescriptions written in the U.S. in 2008. It is the first study to examine local and regional patterns of use, which the authors mapped based on the three-digit zip code of the prescribing physician.

“We identified clear regional clusters where the use of antidepressants, antipsychotics, and stimulants was elevated,” said author Marissa King... “The geography of the cluster for each class of medication was different, but they overlapped each other, with Tennessee as the center point.”

People living within one these clusters were 77% more likely to fill a stimulant prescription, 46% more likely to fill an antidepressant prescription, and 42% more likely to fill an antipsychotic prescription than residents outside of the cluster.

King and co-author Connor Essick, a graduate of the Yale School of Public Health, found that the use of mental health medications varied considerably at the local level.

For all three classes of medications, use was lowest in the western part of the country. Stimulant use, in particular, had very little penetration in the west...

Much of the geographic variation in medication use can be explained by access to healthcare and pharmaceutical marketing efforts, according to the authors’ analysis. For all three classes of medications, use rates were significantly associated with local access to healthcare as measured by the density per capita of physicians in the area, and with the amount of pharmaceutical marketing dollars paid to physicians. Stimulants were the only class of medication for which use rates were explained by the underlying prevalence, with use associated with ADHD prevalence at the state level.