• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Adderall and Death: It’s Team FDA versus Team Canada!

Adderall and Death: It’s Team FDA versus Team Canada!

April 1, 2005
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.

On February 9, 2005, Health Canada (HC) announced that it was suspending sales of Adderall XR in Canada because of concerns that it might lead to sudden death and stroke. The FDA, however, has begged to differ.

Both agencies claim to have analyzed the same data, yet according to their respective health advisories, their numbers look different. HC reported 20 sudden unexplained deaths (“SUDs”) linked to Adderall from 1999-2003, while the FDA reported only 12. What gives?

We called both agencies for answers, but only the FDA responded. According to FDA spokeswoman Crystal Rice, six of HC’s deaths were in adults, which the FDA ommitted from its analysis because of the high baseline rate of SUDs in adults. Of HC’s 14 remaining pediatric SUDs, the FDA claims that one was a duplicate case, and that another should not be included because it involved a child who was found with cocaine “on his lap” at death.

All right, so the number of pediatric Adderall-related deaths is actually 12. But is this greater than the rate associated with other stimulants?

Unclear. According to Dr. Robert Peterson, director general of the therapeutic products directorate at HC, the death risk from Adderall was “two or three times” higher than that of Ritalin or Concerta (NYT, Feb 11, 2005). However, in the same article, Dr. Robert Temple, director of the FDA’s Office of Medical Affairs, said that seven cases of sudden death occurred in patients taking Ritalin and Concerta vs. 12 deaths for Adderall from 1999-2003, an insignificant difference, according to Temple.

We asked the FDA for the raw data, but they told us that this data is “considered proprietary.” However, we did find some relevant information on the DEA’s (Drug Enforcement Administration) website, which reported that in 1999, 11 million methylphenidate scripts were written vs. 6 million amphetamine scripts (they reported no data beyond 1999). Since the FDA’s Health Advisory reported that 30 million Adderall prescriptions had been written over the 5 years, we assumed that the DEA’s number was accurate (6 million per year x 5 years = 30 million). We did this same math with DEA’s methylphenidate number (11 million x 5 = 55 million). (Granted, it seems unlikely that the same number of prescriptions were written in each year, but unless the FDA releases its data, this is the best we can come up with.) Dividing deaths by prescriptions, we discovered that the death rate per million methylphenidate scripts is 7/55= 0.13, while the death rate per million amphetamine scripts is 12/30=0.3. Thus, amphetamines appear to be about 2.3 times more likely than methylphenidate to lead to sudden death.

We emailed our calculations to the FDA, who pointed out that since Adderall is newer and more intensively marketed than Ritalin, the higher Adderall numbers may be due to excess reporting rather than an actual difference in death rates. Furthermore, the baseline rate of sudden unexplained death (so-called “SUD”) in children is substantial. While the Adderall death rate may be 0.3/million, a recent study of SUD in the U.K. reported a rate of about 2 deaths/million/ year in kids older than 2 years old (Heart 2000; 83:410-413), meaning that the background risk may be 10 times higher than the supposed Adderall risk.

Ultimately, TCR has to side with the FDA in this inter-agency skirmish. Any connection between Adderall and death is probably spurious. After a series of high profile embarrassments, it appears that Team FDA has finally gotten its numbers right.

TCR VERDICT: Adderall and death? No connection.
General Psychiatry
    Carlat 150x150
    Daniel Carlat, MD

    Medication Fact Book for Psychiatric Practice, Seventh Edition (2024)

    More from this author
    www.thecarlatreport.com
    Issue Date: April 1, 2005
    SUBSCRIBE NOW
    Table Of Contents
    The Dark Side of Stimulants
    Lawrence H. Diller, MD, on The Use of Stimulants in ADHD
    Adderall and Death: It’s Team FDA versus Team Canada!
    Therapy vs. Meds for ADHD: Lessons from the MTA Study
    Psychostimulants and Strattera Explained
    The Official TCR ADHD Medication Comparison Chart
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.