Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Abstract

IMPORTANCEMotor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear.OBJECTIVE To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD. DESIGN, SETTING, AND PARTICIPANTS For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication.EXPOSURES Dispensed prescription of ADHD medications. MAIN OUTCOMES AND MEASURES Emergency department visits for MVCs.RESULTS Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up.CONCLUSIONS AND RELEVANCE Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.

Previously undiagnosed attention-deficit/hyperactivity disorder associated with poor metabolic control in adolescents with type 1 diabetes

“…It has been shown that stimulant medication reduces health risk behavior, such as alcohol and drug abuse and vehicle accidents among patients with ADHD. Similarly, medical treatment of ADHD among patients with type 1 diabetes might result in better metabolic control.…”

“…We concluded that the diabetes care should target the specific needs of these patients in order to ensure their quality of life and metabolic control and thus prevent long-term complications 30. It has been shown that stimulant medication reduces health risk behavior, such as alcohol and drug abuse31 and vehicle accidents32…”

Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

“…Pharmacotherapy has been shown to improve executive function, reduce risk-seeking behavior, and decrease rates of criminality in individuals with ADHD. 53,54,[57][58][59] ADHD treatment has also been shown to decrease trauma rates with dramatic reduction in motor vehicle trauma, 42,60 and it can decrease the risk of substance use-related disorders. 59,61 A 2012 meta-analysis of long-term outcomes of ADHD treatment found 50% to 100% improvement in driving, obesity, self-esteem, social functioning, academics, drug use/addiction, antisocial behaviors, and use of services for treated vs untreated patients.…”

“…Adolescents may not adhere to or may discontinue their medication 110,142 even though it helps prevent risky behaviors and increases academic performance. 60,139,143,144 In adolescence, we may also begin to see patients diverting (swapping with or selling to peers) or misusing their short-acting stimulants. Engaging the adolescent patient and parents in shared decision making about ADHD treatment and monitoring for signs of diversion and misuse can help improve medication adherence and enhance outcomes.…”

Risk of Major Congenital Malformations Associated With the Use of Methylphenidate or Amphetamines in Pregnancy

“…2 Treatment of adult ADHD improves functioning 3,4 and quality of life 5 and reduces the risk of adverse outcomes such as accidents 6 and problems related to substance abuse. 7 Women on treatment for ADHD may therefore wish to continue their medications during pregnancy in order to continue to experience the benefits of treatment.…”