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

Background Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stim-ulant 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 stim-ulant 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. Copyright (c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 2023;58: Published 2023 https://doi.org/10. 1016/j.eclinm.2023. 101902

Automated summary

Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. The associations between ADHD pharmacotherapy and prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear.