Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder

Wei, Yu‐Jung; Zhu, Yanmin; Liu, Wei; Bussing, Regina; Winterstein, Almut G.

doi:10.1001/jamanetworkopen.2018.1152

Cited by 24 publications

(16 citation statements)

References 43 publications

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“…This is consistent with prior clinical trials, where dextroamphetamine has been shown to reduce cravings and use of cocaine, and to improve ADHD symptoms when prescribed to people with concurrent ADHD and cocaine use disorder [21]. Given the high rates of ADHD among people with stimulant use disorder [22,23], and the indication of dextroamphetamine for the treatment of ADHD, ADHD screening could be incorporated into assessments for patients seeking treatment for stimulant use disorder with potential for dual bene ts.…”

Section: Discussionsupporting

confidence: 76%

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

Palis

Marchand

Peachey

et al. 2021

Preprint

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Background: A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients.Methods: Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n=20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results: Participants reported a range of stimulant use types, including cocaine (n=8), methamphetamine (n=8), or both (n=4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic).Conclusion: In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

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Section: Discussionsupporting

confidence: 76%

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

Palis

Marchand

Peachey

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…These data confirm, and extend to more recent years, results of previous studies indicating increasing diagnosis and drug treatment of adults for ADHD covering time periods from 1999 to 2016. [21][22][23][24] One study of adults with ADHD in a large integrated health system also reported high rates of comorbid depression and anxiety. 21 Another study of ADHD diagnosis and treatment based on office visit data in an earlier 5-year period (2008-2009 to 2012-2013) reported a 36.4% increase.…”

Section: Discussionmentioning

confidence: 99%

Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study

et al. 2021

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ObjectiveTo assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their medical and/or neurological conditions.DesignCross-sectional study.SettingAnnual US Medical Expenditure Panel Survey, a stratified random sample of approximately 30 000 persons designed to produce national population estimates. It focuses on reported medical spending, medical services used, health status and prescription medications.ParticipantsAdults age 19 years and older who reported obtaining one or more prescriptions for amphetamine or methylphenidate products during two survey years, 2013 and 2018.Main outcomes measuresPrescriptions obtained, the specific stimulant product and annual treatment days of drug supplied.ResultsIn 2018, an estimated 4.1 million US adults (95% CI 3.4 million to 4.8 million) reported prescriptions for CNS stimulants, having filled a mean of 7.3 (95% CI 6.8 to 7.8) prescriptions with a mean of 226 (95% CI 210 to 242) days’ supply. Compared with 2013, the estimated number of adults reporting using CNS stimulants in 2018 increased by 1.8 million (95% CI 1.0 million to 2.7 million) or 79.8%. Most 2018 adult stimulant users reported taking psychoactive medication for one or more mental, behavioural or neurodevelopment disorders. Overall, 77.8% (95% CI 72.6% to 83.0%) reported some medication for adult attention deficit disorder, 26.8% (95% CI 22.2% to 31.5%) took medication for anxiety, 25.1% (95% CI 19.9% to 30.3%) for depression and 15.3% (95% CI 9.8% to 20.8%) indicated drug treatment for other mental or neurological disorders. Adult CNS stimulant use was higher in females, in younger age cohorts and among individuals of white race/ethnicity.ConclusionsAdult medical use of prescription stimulants increased markedly in 5 years and occurred in a population often reporting multiple mental or neurological disorders. Further action is needed to understand and manage this new resurgence in drugs with high risks of dependence.

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“…All these ADHD outcomes are also risk factors for CAD (34) and hence may act additively as mediators of the observed effect of genetic liability for ADHD on CAD. There are some reports of observational associations between ADHD and cardio-vascular diseases (41, 42), although such studies are difficult to conduct due to the latency between exposure and outcome. Here we report evidence supporting a causal effect of genetic liability for ADHD on CAD but not on other cardiovascular risks (such as hypertension).…”

Section: Discussionmentioning

confidence: 99%

ADHD genetic liability and physical health outcomes - A two-sample Mendelian randomization study

Leppert

Riglin

Dardani

et al. 2019

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Objective: Attention-deficit/hyperactivity disorder (ADHD) has been associated with a broad range of physical health problems, including cardiometabolic, neurological and immunological conditions. Determining whether ADHD plays a causal role in these associations is of great importance for treatment and prevention but also because comorbid health problems further increase the serious social and economic impacts of ADHD on individuals and their families. Methods:We used a two-sample Mendelian randomization (MR) approach to examine the causal relationships between genetic liability for ADHD and previously implicated physical health conditions. 11 genetic variants associated with ADHD were obtained from the latest summary statistics. Consistent effects obtained from IVW, weighted median and MR Egger methods were taken forward for sensitivity analysis, including bidirectional MR and multivariable MR (MVMR). Results:We found evidence of a causal effect of genetic liability for ADHD on childhood obesity (OR:1.29 (95% CI:1.02,1.63)) and coronary artery disease (CAD) (OR:1.11 (95% CI:1.03,1.19)) with consistent results across different MR approaches. There was further evidence for a bidirectional relationship between genetic liability for ADHD and childhood obesity. The effect of genetic liability for ADHD on CAD was independent of smoking heaviness but was attenuated when simultaneously controlling for childhood obesity. There was little evidence for a causal effect on other cardiometabolic, immunological, neurological disorders and lung cancer. Conclusion:Our findings strengthen the argument for early treatment and support for children with ADHD and their families and especially promoting physical activity and providing them with dietary advice to reduce future risk for developing CAD.3 Key Message• Epidemiological studies have reported observational associations between ADHD and adult onset physical health outcomes.• Mendelian Randomization can be used to assess causal associations for ADHD on health outcomes that would traditionally require long term follow-up and may suffer confounding • We found that genetic liability for ADHD was associated with coronary artery disease and there was evidence for a bidirectional association between genetic liability for ADHD and childhood obesity• Multivariable mendelian randomization suggests that the link between genetic liability and coronary artery disease might partially act through childhood obesity but was independent of smoking heaviness• There was little evidence of a causal of ADHD on other cardiometabolic and immunological diseases.

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Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder

Abstract: This cross-sectional analysis of US Medicaid files from 29 states investigates the prevalence of and risk factors associated with concurrent stimulant and opioid use among Medicaid-enrolled adults with attention-deficit/hyperactivity disorder.

Cited by 24 publications

References 43 publications

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study

ADHD genetic liability and physical health outcomes - A two-sample Mendelian randomization study

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