Concurrent stimulant and opioid use ‘common’ in adult ADHD

A significant number of adults with attention-deficit/hyperactivity disorder are concurrently using stimulants and opioids, highlighting a need for research into the risks and benefits of long-term coadministration of these medications.

Researchers reported the results of a cross-sectional study using Medicaid Analytic eXtract data from 66,406 adults with ADHD across 29 states.

Overall, 32.7% used stimulants, and 5.4% had used both stimulants and opioids long term, defined as at least 30 consecutive days of use. Long-term opioid use was more common among adults who used stimulants, compared with those who did not use stimulants (16.5% vs. 13%), wrote Yu-Jung “Jenny” Wei, PhD, and her associates. The report was published in JAMA Network Open.

Most of the adults who used both stimulants and opioids concurrently long term were using short-acting opioids (81.8%) rather than long-acting (20.6%). However, nearly one-quarter (23.2%) had prescriptions for both long- and short-acting opioids.

The researchers noted a significant 12% increase in the prevalence of concurrent use of stimulants and opioids from 1999 to 2010.

“Our findings suggest that long-term concurrent use of stimulants and opioids has become an increasingly common practice among adult patients with ADHD,” wrote Dr. Wei, of the College of Pharmacy at the University of Florida, Gainesville, and her associates.

The researchers also found an increase in these trends with age: Adults in their 30s showed a 7% higher prevalence of long-term concurrent use, compared with adults in their 20s. In addition, those aged 41-50 years had a 14% higher prevalence, and those aged 51-64 years had a 17% higher prevalence.

Adults with pain had a 10% higher prevalence of concurrent use, while other factors associated with concurrent use included non-Hispanic white ethnicity, living in the southern United States, depression, anxiety disorder, substance use disorder, or cardiovascular disease. People with schizophrenia appeared to have a 5% lower incidence of concurrent use.

“Although the concurrent use of stimulants and opioids may initially have been prompted by ADHD symptoms and comorbid chronic pain, continued use of opioids alone or combined with central nervous system stimulants may result in drug dependence and other adverse effects (e.g., overdose) because of the high potential for abuse and misuse,” the authors wrote. “Identifying these high-risk patients allows for early intervention and may reduce the number of adverse events associated with the long-term use of these medications.”

Among the limitations cited is that only prescription medications filled and reimbursed by Medicaid were included in the analysis. “Considering that opioid prescription fills are commonly paid out of pocket, our reported prevalence of concurrent stimulant-opioid use may be too low,” they wrote.

The authors reported no conflicts of interest. One author was supported by an award from the National Institute on Aging.

SOURCE: Wei Y-J et al. JAMA Network Open. 2018. Aug 10. doi: 10.1001/jamanetworkopen.2018.1152.

A significant number of adults with attention-deficit/hyperactivity disorder are concurrently using stimulants and opioids, highlighting a need for research into the risks and benefits of long-term coadministration of these medications.

Researchers reported the results of a cross-sectional study using Medicaid Analytic eXtract data from 66,406 adults with ADHD across 29 states.

Overall, 32.7% used stimulants, and 5.4% had used both stimulants and opioids long term, defined as at least 30 consecutive days of use. Long-term opioid use was more common among adults who used stimulants, compared with those who did not use stimulants (16.5% vs. 13%), wrote Yu-Jung “Jenny” Wei, PhD, and her associates. The report was published in JAMA Network Open.

Most of the adults who used both stimulants and opioids concurrently long term were using short-acting opioids (81.8%) rather than long-acting (20.6%). However, nearly one-quarter (23.2%) had prescriptions for both long- and short-acting opioids.

The researchers noted a significant 12% increase in the prevalence of concurrent use of stimulants and opioids from 1999 to 2010.

“Our findings suggest that long-term concurrent use of stimulants and opioids has become an increasingly common practice among adult patients with ADHD,” wrote Dr. Wei, of the College of Pharmacy at the University of Florida, Gainesville, and her associates.

The researchers also found an increase in these trends with age: Adults in their 30s showed a 7% higher prevalence of long-term concurrent use, compared with adults in their 20s. In addition, those aged 41-50 years had a 14% higher prevalence, and those aged 51-64 years had a 17% higher prevalence.

Adults with pain had a 10% higher prevalence of concurrent use, while other factors associated with concurrent use included non-Hispanic white ethnicity, living in the southern United States, depression, anxiety disorder, substance use disorder, or cardiovascular disease. People with schizophrenia appeared to have a 5% lower incidence of concurrent use.

“Although the concurrent use of stimulants and opioids may initially have been prompted by ADHD symptoms and comorbid chronic pain, continued use of opioids alone or combined with central nervous system stimulants may result in drug dependence and other adverse effects (e.g., overdose) because of the high potential for abuse and misuse,” the authors wrote. “Identifying these high-risk patients allows for early intervention and may reduce the number of adverse events associated with the long-term use of these medications.”

Among the limitations cited is that only prescription medications filled and reimbursed by Medicaid were included in the analysis. “Considering that opioid prescription fills are commonly paid out of pocket, our reported prevalence of concurrent stimulant-opioid use may be too low,” they wrote.

The authors reported no conflicts of interest. One author was supported by an award from the National Institute on Aging.

SOURCE: Wei Y-J et al. JAMA Network Open. 2018. Aug 10. doi: 10.1001/jamanetworkopen.2018.1152.

A significant number of adults with attention-deficit/hyperactivity disorder are concurrently using stimulants and opioids, highlighting a need for research into the risks and benefits of long-term coadministration of these medications.

Researchers reported the results of a cross-sectional study using Medicaid Analytic eXtract data from 66,406 adults with ADHD across 29 states.

Overall, 32.7% used stimulants, and 5.4% had used both stimulants and opioids long term, defined as at least 30 consecutive days of use. Long-term opioid use was more common among adults who used stimulants, compared with those who did not use stimulants (16.5% vs. 13%), wrote Yu-Jung “Jenny” Wei, PhD, and her associates. The report was published in JAMA Network Open.

Most of the adults who used both stimulants and opioids concurrently long term were using short-acting opioids (81.8%) rather than long-acting (20.6%). However, nearly one-quarter (23.2%) had prescriptions for both long- and short-acting opioids.

The researchers noted a significant 12% increase in the prevalence of concurrent use of stimulants and opioids from 1999 to 2010.

“Our findings suggest that long-term concurrent use of stimulants and opioids has become an increasingly common practice among adult patients with ADHD,” wrote Dr. Wei, of the College of Pharmacy at the University of Florida, Gainesville, and her associates.

The researchers also found an increase in these trends with age: Adults in their 30s showed a 7% higher prevalence of long-term concurrent use, compared with adults in their 20s. In addition, those aged 41-50 years had a 14% higher prevalence, and those aged 51-64 years had a 17% higher prevalence.

Adults with pain had a 10% higher prevalence of concurrent use, while other factors associated with concurrent use included non-Hispanic white ethnicity, living in the southern United States, depression, anxiety disorder, substance use disorder, or cardiovascular disease. People with schizophrenia appeared to have a 5% lower incidence of concurrent use.

“Although the concurrent use of stimulants and opioids may initially have been prompted by ADHD symptoms and comorbid chronic pain, continued use of opioids alone or combined with central nervous system stimulants may result in drug dependence and other adverse effects (e.g., overdose) because of the high potential for abuse and misuse,” the authors wrote. “Identifying these high-risk patients allows for early intervention and may reduce the number of adverse events associated with the long-term use of these medications.”

Among the limitations cited is that only prescription medications filled and reimbursed by Medicaid were included in the analysis. “Considering that opioid prescription fills are commonly paid out of pocket, our reported prevalence of concurrent stimulant-opioid use may be too low,” they wrote.

The authors reported no conflicts of interest. One author was supported by an award from the National Institute on Aging.

SOURCE: Wei Y-J et al. JAMA Network Open. 2018. Aug 10. doi: 10.1001/jamanetworkopen.2018.1152.