Adults With ADHD More Often Using Both Opioids and Stimulants

By David Douglas

NEW YORK (Reuters Health) - Concurrent use of stimulants and opioids appears to be on the rise in adults with attention-deficit/hyperactivity disorder (ADHD), according to a new U.S. study.

"While this may not be surprising in light of the opioid epidemic, it is particularly concerning because stimulants bear risk for abuse themselves and ADHD has been linked to a higher prevalence of substance use disorder," Dr. Jenny Wei of the University of Florida, in Gainesville, told Reuters Health by email.

In a paper online August 10 in JAMA Network Open, Dr. Wei and colleagues note that as prescriptions for these agents have risen sharply in recent years, "concerns have intensified regarding increased risk for misuse or abuse of these medications, alone or together, and the sequelae."

In addition, they note, "The prevalence of ADHD diagnosis and treatment has dramatically increased in the past decade among adults, especially among those insured by Medicaid."

To investigate, the researchers examined Medicaid data from 29 states spanning the years 1999 to 2010. They identified more than 66,000 patients aged 20 to 64 years who were continuously enrolled for more than 12 months after receiving an ADHD diagnosis. One 12-month continuous enrollment period was randomly selected as an observation unit for each enrollee.

Overall, 32.7% used stimulants and 5.4% were long-term users of stimulants and opioids. Long-term opioid use was more common in those using stimulants (16.5%) than among those who did not (13.0%).

Compared with patients aged 20 to 30 years, the adjusted prevalence relative ratio (PRR) of long-term concurrent stimulant-opioid use was significantly higher among patients in their 30s (1.07), their 40s (1.14) and their 50s (1.17).

Compared with non-Hispanic whites, blacks were at significantly reduced risk (PRR, 0.93) as were those classified as "other" (PRR, 0.97). People living in the Southern U.S. and having a pain or anxiety disorder diagnosis were at significantly higher risk.

Dr. Wei concluded, "The observed pattern in our study, especially long-term concomitant use of stimulants and opioids, is certainly a concern and requires more clinical and scientific attention."

Dr. Stephen V. Faraone of The State University of New York Upstate Medical University, in Syracuse, told Reuters Health by email, "This article is the first to document that adults with ADHD treated with stimulant medications are also more likely to have had long-term treatment with opioids for some other condition."

"More research is needed to determine if this combined treatment is necessary or if it increases the risk for substance abuse among adults with ADHD who are already at high risk for addictions," said Dr. Faraone, a professor of psychiatry and of neuroscience & physiology, who was not involved in the study.

SOURCE: https://bit.ly/2MhmDRJ

JAMA Network Open 2018.

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