Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study

Ty S Schepis; Kennedy S Werner; Olivia Figueroa; Vita V McCabe; John E Schulenberg; Phil T Veliz; Timothy E Wilens; Sean Esteban McCabe

doi:10.1016/j.eclinm.2023.101902

Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study

EClinicalMedicine. 2023 Mar 16:58:101902. doi: 10.1016/j.eclinm.2023.101902. eCollection 2023 Apr.

Authors

Ty S Schepis^{1

2}, Kennedy S Werner^{2

3}, Olivia Figueroa², Vita V McCabe^{2

4}, John E Schulenberg^{2

5

6}, Phil T Veliz^{2

6

7

8}, Timothy E Wilens^{2

9

10}, Sean Esteban McCabe^{2

6

7

8}

Affiliations

¹ Department of Psychology, Texas State University, San Marcos, TX, USA.
² Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA.
³ School of Medicine, Wayne State University, Detroit, MI, USA.
⁴ Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
⁶ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
⁷ Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA.
⁸ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁹ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Harvard Medical School, Harvard University, Boston, MA, USA.

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stimulant and non-stimulant pharmacotherapy improve adolescent ADHD, but their associations with prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear. Using 2005-2020 US Monitoring the Future data, we investigated relationships between ADHD pharmacotherapy history and PSM, cocaine, or methamphetamine use.

Methods: Secondary students (13-19 years) provided data on pharmacotherapy history (N = 199,560; 86.3% of total sample) between January 1, 2005 and May 31, 2020 in a cross-sectional multi-cohort study; weights assured a nationally representative sample. Participants were grouped by ADHD pharmacotherapy history: none (88.7%; principally non-ADHD controls); stimulant-only (5.8%); non-stimulant-only (3.3%); both stimulant and non-stimulant (2.1%). Outcomes were past-year PSM, cocaine, and methamphetamine use. Logistic regressions examined relationships between pharmacotherapy history and outcomes, controlling for sociodemographics, recent substance use, and stimulant treatment cessation.

Findings: Past-year outcome rates were lowest in adolescents with no pharmacotherapy history: 4.7% for PSM [8310/174,561], 1.6% for cocaine [2858/174,688], and 0.7% for methamphetamine [1036/148,378]. A history of both stimulant and non-stimulant treatment was associated with the highest rates: 22.3% for PSM [940/4098], 10.4% for cocaine [450/4110], and 7.8% for methamphetamine [275/3427]. Adolescents who received monotherapy (stimulant- or non-stimulant-only) had intermediate rates, with no differences between monotherapy groups.

Interpretation: While elevated PSM and illicit stimulant use rates are likely influenced by ADHD, our findings suggested adolescents with a history of both stimulant and non-stimulant pharmacotherapy are at highest risk for these stimulant outcomes. Adolescents receiving ADHD pharmacotherapy should be monitored for PSM and illicit stimulant use.

Funding: National Institute on Drug Abuse/National Institutes of Health (USA) and Food and Drug Administration (USA).

Keywords: Attention-deficit/hyperactivity disorder; Non-stimulant therapy; Onset; Prescription; Stimulant.

Grants and funding

R01 DA001411/DA/NIDA NIH HHS/United States