Stimulant Medication and Substance Use Outcomes A Meta-analysis

IMPORTANCE Psychostimulant medication is an efficacious treatment for childhood attention-deficit/hyperactivity disorder, yet controversy remains regarding potential iatrogenic effects of stimulant medication, particularly with respect to increasing susceptibility to later substance use disorders. However, stimulant treatment was previously reported to reduce the risk of substance problems. OBJECTIVE To meta-analyze the longitudinal association between treatment with stimulant medication during childhood and later substance outcomes (ie, lifetime substance use and substance abuse or dependence). DATA SOURCES Studies published between January 1980 and February 2012 were identified using review articles, PubMed, and pertinent listservs. STUDY SELECTION Studies with longitudinal designs in which medication treatment preceded the measurement of substance outcomes. DATA EXTRACTION AND SYNTHESIS Odds ratios were extracted or provided by the study authors. Odds ratios were obtained for lifetime use (ever used) and abuse or dependence status for alcohol, cocaine, marijuana, nicotine, and nonspecific drugs for 2565 participants from 15 different studies. MAIN OUTCOMES AND MEASURES Random-effects models estimated the overall association, and potential study moderators were examined. RESULTS Separate random-effects analyses were conducted for each substance outcome, with the number of studies ranging from 3 to 11 for each outcome. Results suggested comparable outcomes between children with and without medication treatment history for any substance use and abuse or dependence outcome across all substance types. CONCLUSIONS These results provide an important update and suggest that treatment of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders.