Use of medication for attention-deficit/hyperactivity disorder (ADHD) does not appear to increase the risk of substance-related problems in adolescent and adult patients with ADHD, and among males it may even be protective against later substance-related problems, according to a report in AJP in Advance.
“Our results cannot speak to the possibility of diversion or misuse of stimulants outside of treatment,” Patrick D. Quinn, Ph.D., of Indiana University and colleagues wrote. “However, they do join a growing evidence base of protective associations for patients receiving medication therapy. It may be useful to consider these associations in conjunction with other potential benefits and harms (such as growth delay) when making treatment decisions.”
Quinn, together with colleagues from American and Swedish institutions, used data from the Truven Health MarketScan Commercial Claims and Encounters (MarketScan) databases of de-identified inpatient, outpatient, and prescribed drug claims for commercially insured individuals. They identified 2,993,887 ADHD patients who received either an ADHD diagnosis or stimulant or atomoxetine ADHD medication treatment. Patients were followed from first inpatient or outpatient diagnosis or filled prescription until December 2014 (or the last month of enrollment in their health plan). A “substance-related event” was defined as at least one emergency department claim with “any non-tobacco-related substance use disorder diagnosis” during a month in which the individual was medicated for ADHD.
Relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication, and female patients, 31% lower odds. Moreover, ADHD medication predicted a 19% reduction in the odds of substance-related events two years later among male patients and a 14% reduction among female patients.
In comments to Psychiatric News, child psychiatrist and past APA Trustee David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont, noted that the authors appropriately considered and discussed alternative explanations for their findings, which cannot be definitively excluded due to the observational nature of the study. “However, I agree with their conclusion that the current results join a growing body of evidence supporting the protective factors associated with timely and appropriate treatment for ADHD in both adolescents and adults,” he said.
For related information, see the Psychiatric News article “Medicated ADHD Patients Have Reduced Risk of Motor Vehicle Crashes.”
Live Mentally Healthy,
Dr. Jennie Byrne