Necessity for research directed at stimulant type and treatment-onset age to access the impact of medication on drug abuse vulnerability in teenagers with ADHD

Kantak, Kathleen M.; Dwoskin, Linda P.

doi:10.1016/j.pbb.2016.03.009

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…Any concerns about risk of dependency on stimulant‐type drugs (Kantak & Dwoskin, ; Lambert & Hartsough, ) stand in stark contrast to our findings. Despite the vast majority of probands taking stimulants for varying lengths of time (Swanson et al., ), we did not find more adults in the ADHD group than the LNCG using stimulant‐type illicit drugs (e.g., cocaine) or misusing prescription stimulants (under 2% in both groups for both types of substances).…”

Section: Discussioncontrasting

confidence: 99%

Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the MTA longitudinal study

Molina

Barbaree

Swanson

et al. 2018

Child Psychology Psychiatry

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Section: Discussioncontrasting

confidence: 99%

Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the MTA longitudinal study

Molina

Barbaree

Swanson

et al. 2018

Child Psychology Psychiatry

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“…Some early research suggested a sensitization hypothesis , wherein exposure to stimulants might increase risk of substance-related problems (14). This possibility continues to be supported by some animal studies, particularly during adolescence (15). Further clinical studies, in contrast, have not found support for medication-induced increases in risk.…”

Section: Introductionmentioning

confidence: 61%

“…First, medication treatment in these data was mostly with stimulants. It will be valuable to examine non-stimulant treatments (including extended-release clonidine and guanfacine) and stimulant types more closely (15). Future studies should also consider dosage and polypharmacy effects.…”

Section: Discussionmentioning

confidence: 99%

ADHD Medication and Substance-Related Problems

Quinn

Chang

Hur

et al. 2017

AJP

143

106

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Objective Substance use disorders are major contributors to excess mortality among individuals with attention-deficit/hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. Method The authors analyzed 2005–2014 commercial healthcare claims from 2 993 887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., substance-use-disorder-related emergency-department visits) during months in which patients received prescribed stimulant medication or atomoxetine relative to that during months in which they did not. Results In adjusted within-individual comparisons, relative to periods in which they did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio [OR] = 0.65, 95% CI, 0.64–0.67), and female patients had 31% lower odds of concurrent substance-related events (OR = 0.69, 95% CI, 0.67–0.71). Moreover, male patients had 19% lower odds of substance-related events two years after medication periods (OR = 0.81, 95% CI, 0.78–0.85), and female patients had 14% lower odds of substance-related events two years after medication periods (OR = 0.86, 95% CI, 0.82–0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. Conclusions These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

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“…One particular important question regarding the long-term effects is whether early exposure to ADHD medication change the developmental trajectories of patients, for example development of substance use problem. Animal studies suggest that repeated exposure to stimulants during the sensitive adolescent period was associated with long-term risk of substance abuse (88). Clinical follow-up studies suggest that ADHD medication neither protects nor increases the risk of later substance use disorders (89,90), whereas pharmacoepidemiology studies based on prescription databases have found that ADHD medication was associated with lower risk of substance-related events up to three years later (64,66).…”

Section: Remaining Knowledge Gapsmentioning

confidence: 99%

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Chang

Ghirardi

Quinn³

et al. 2019

Biological Psychiatry

115

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ADHD medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry. However, major questions and concerns remain regarding the benefits and risks of ADHD medication, especially in real-world settings. We conducted a qualitative systematic review on studies that investigated the effects of ADHD medication on behavioral and neuropsychiatric outcomes using linked prescription databases from the last ten years, and identified 40 studies from Europe, North America, and Asia. Among them, 18 have used within-individual designs to account for confounding by indication. These studies suggested short-term beneficial effects of ADHD medication on several behavioral or neuropsychiatric outcomes (i.e., injuries, motor vehicle accidents, education, substance use disorder), with estimates suggesting relative risk reduction of 9-58% for these outcomes. The within-individuals studies found no evidence of increased risks for suicidality and seizures. Replications studies are needed for several other important outcomes (i.e., criminality, depression, mania, psychosis). The available evidence from pharmacoepidemiology studies on long-term effects of ADHD medication are less clear. We discussed time-varying confounding and other limitations which should be considered when interpreting results from

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Necessity for research directed at stimulant type and treatment-onset age to access the impact of medication on drug abuse vulnerability in teenagers with ADHD

Cited by 6 publications

References 37 publications

Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the MTA longitudinal study

Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the MTA longitudinal study

ADHD Medication and Substance-Related Problems

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

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