Stimulant medications not associated with substance use later in life

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An association between stimulant medication and later substance use has long been debated, but new research has found that children with ADHD who take prescription stimulants are not at an increased risk for substance abuse as adolescents or young adults.

The study was conducted by researchers at the University of Pittsburgh School of Medicine and gives parents and clinicians important information that can help them decide if treatment with stimulants is the right choice. The data was published in JAMA Psychiatry.¹

“Stimulants are the first-line treatment recommended for most individuals with ADHD—the drug class is an evidence-based treatment with few side effects,” Brooke Molina, PhD, professor of psychiatry, psychology, and pediatrics at UPMC, said in a release.² “Because stimulant medications are classified by the Drug Enforcement Administration as schedule two substances with the potential for misuse, many people fear that harmful substance use could result.”

Investigators conducted a cohort study to assess the possible association between stimulant treatment of ADHD with subsequent substance use. Data was gathered from the Multimodal Treatment Study of ADHD (MTA), a 14-month multisite, randomized clinical trial of medication and behavior therapy for ADHD.

The MTA study was conducted at 6 sites in the United States and 1 in Canada. Participants were recruited between 1994 and 1996, and were assessed on demographic, clinical, and treatment variables. The study cohort included 579 children aged 7 to 9 years with a DSM-IV diagnosis of combined-type ADHD.

The study eventually transitioned to a longitudinal observational study where participants were repeatedly assessed until a mean age of 25 years. Data analysis took place between April 2018 and February 2023.

Main study outcomes included frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use as confidentially self-reported with a standardized substance use questionnaire.

Investigators found there was no evidence to suggest that current or prior stimulant treatment was associated with substance use later in life. Additionally, there was no evidence that more years of stimulant treatment or continued use of stimulants was associated with substance use in adulthood.

“Our study not only accounted for age, but also used a statistical method that adjusted over time for the many characteristics that may distinguish treated from non-treated individuals,” Traci Kennedy, PhD, a co-author on the study and an assistant professor of psychiatry at UPMC, said in a release.² “Considering these factors allowed us to more accurately test the relationship between stimulants and substance use.”

“We hope the results of this study will help educate providers and patients,” Molina said.² “By understanding that stimulant medication initially prescribed in childhood is not linked to harmful levels of substance use, I anticipate that parents’ and patients’ fears will be alleviated.”

References:

1. Molina BSG, Kennedy TM, Howard AL, et al. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry. Published online July 05, 2023. doi:10.1001/jamapsychiatry.2023.2157

2. Treating Childhood ADHD with Stimulant Meds Not Associated with Increased Substance Use Later in Life, Study Finds. News Release. University of Pittsburgh. July 5, 2023. Accessed July 11, 2023.

This article was initially published by our sister publication, Drug Topics®.