Use of Stimulant Medication in Childhood Not Associated with Increased Risk of Substance Use Disorders in Adulthood, Study Suggests

The treatment of attention-deficit/hyperactivity disorder (ADHD) with stimulant medication is not associated with either an increased or decreased risk of later substance use disorders, according to a meta-analysis published Online First by JAMA Psychiatry, a JAMA Network publication.

The use of medication, most often with stimulant medication (eg, methylphenidate and mixed amphetamine salts), is a well-established treatment for ADHD and constitutes the first-line ADHD treatment in many clinical settings. The use of stimulant medication to treat ADHD remains controversial given concerns about its potential for abuse and possible role in sensitizing patients to later substance problems, the authors write in the study background.

Kathryn L. Humphreys, M.A., Ed.M., of the University of California, Los Angeles, and colleagues examined the longitudinal association between treatment with stimulant medication during childhood for ADHD and later substance outcomes (i.e. lifetime substance use and substance abuse or dependence).

The meta-analysis included studies with longitudinal designs in which medication treatment preceded the measurement of substance outcomes and that were published between January 1980 and February 2012. Odds ratios were obtained for lifetime use (ever used) and abuse or dependence status for alcohol, cocaine, marijuana, nicotine, and nonspecific drugs for 2,565 participants from 15 different studies.

Separate random-effects analyses were conducted for each substance 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.

“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,” the study concludes.

(JAMA Psychiatry. Published online May 29, 2013. doi:10.1001/jamapsychiatry.2013.1273.