ADHD Medication and Substance-Related Problems.
Level 3 - non-randomized controlled study
Retrospective within-individual longitudinal cohort study using healthcare claims data
PubMed 28659039 · doi:10.1176/appi.ajp.2017.16060686
What was done
Researchers analyzed 2005–2014 commercial healthcare claims from 2,993,887 adolescent and adult ADHD patients (47.2% female). Using within-individual analyses, they compared the risk of substance-related events (emergency department visits related to substance use disorders) during months when patients received prescribed stimulant medication or atomoxetine relative to months when they did not, as well as 2 years after medication periods.
What was found
In adjusted within-individual comparisons, male patients had 35% lower odds of concurrent substance-related events during medication periods compared to non-medication periods (odds ratio = 0.65, 95% CI: 0.64–0.67), and female patients had 31% lower odds (odds ratio = 0.69, 95% CI: 0.67–0.71). Two years post-medication, male patients had 19% lower odds of substance-related events (odds ratio = 0.81, 95% CI: 0.78–0.85) and female patients had 14% lower odds (odds ratio = 0.86, 95% CI: 0.82–0.91). Sensitivity analyses were less consistent for 2-year associations among women.
Why it matters
This large study provides evidence that ADHD pharmacotherapy is not associated with an increased risk of substance use problems in adolescents and adults, but rather with concurrent and long-term reductions in acute substance-related events.
Limits
As an observational claims-based study, residual time-varying confounding (such as lifestyle or severity changes influencing both medication adherence and substance use) cannot be excluded. The outcome was limited to emergency department visits, missing substance misuse managed elsewhere or unmanaged. The sample was restricted to commercially insured individuals.
Cited by
- supports Treating ADHD with medication reduces the risk of subsequent substance abuse compared to leaving ADHD untreated.