More frequent long-term opioid use was seen among adults with attention-deficit/hyperactivity disorder (ADHD) if they were taking stimulants, an observational study of Medicaid prescription data found.
Opioid use (≥30 days) was seen among 16.5% of those who used stimulants, compared with 13% of those who did not, reported Yu-Jung Jenny Wei, PhD, of the University of Florida in Gainesville, and colleagues.
The probability of concurrently using both drugs also increased over time. From 1999 to 2010, long-term opioid use in patients taking long-term stimulants jumped by 12% (adjusted prevalence relative ratio [aPRR] 1.12, 95% CI 1.10-1.14), the authors wrote in .
"A lot of effort has been put on patients who have chronic pain, trauma pain, and a whole gamut of pain indications. This is another population who have a psychological disorder associated with substance abuse issues and we see the opioid pattern as well," co-author Almut Winterstein, PhD, also of the University of Florida, told 鶹ý.
"To me research should not only focus on pain management," she said. "This is a population that should be looked at and deserves attention."
With the exception of schizophrenic patients, who demonstrated less frequent long-term dual use (aPRR 0.95), those with mental health disorders more commonly used both drugs concurrently. Researchers measured several comorbid conditions and reported a slightly but significantly higher frequency of use among patients with:
- Depression (aPRR 1.02)
- Anxiety (aPRR 1.05)
- Substance abuse disorder (aPRR 1.04)
As did patients with cardiovascular disease and chronic obstructive pulmonary disease (aPRR 1.02 and aPRR 1.05, respectively).
According to the study, the use of opioids may be enhanced by the presence of stimulants, and lead to euphoric effects, which could increase the . The U.S. allows the pairing of the two substances for individuals diagnosed with substance abuse disorder, though this practice is , for example, the authors noted.
The study collected data from the Medicaid Analytic eXtract (MAX) files of 29 states from 1999 to 2010 to conduct their analysis. Adults ages 20 to 64 years who had at least one inpatient visit or two outpatient visits coded with an ADHD diagnosis qualified.
For each patient, researchers used data from a randomly selected 12-month period in which the patient was continuously enrolled in Medicaid. The first 6 months established baseline characteristics to which the latter 6 months were compared in order to determine the patient's long-term concurrent stimulant-opioid use.
Of the 66,406 adults with ADHD, 56% were women, 79.1% were non-Hispanic white, and 70.8% were non-rural residents; 57.5% qualified for Medicaid due to disability.
Long-term stimulant-opioid use was significantly higher in white patients (aPRR 0.93 for black patients, aPRR 0.97 for "other" patients), as well as in those residing in the South (aPRR 0.98 for the Midwest, aPRR 0.94 for the Northeast, aPRR 0.95 for the West).
Concomitant use increased with age. Compared with those ages 20-30, patients 31-40 years of age used both types of drugs more frequently (aPRR 1.07). Patients ages 41-50 and 51-64 exhibited even higher rates (aPRR 1.14 and aPRR 1.17, respectively).
"Our study contributes to the understanding of the potential risk factors associated with long-term concurrent stimulant-opioid use among adults with ADHD," 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."
The authors reported several limitations. First, the MAX data excluded patients paying for prescriptions with cash or illicitly, as well as ADHD patients who did not seek medical care. Second, the data did not provide context on whether or not ADHD patients were using opioids for their intended use, which may lead to underestimated results. Lastly, since the study's conclusion in 2010, several efforts have been made to educate physicians and reduce opioid prescriptions, changes that would not be reflected in this data set.
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Disclosures
No disclosures were reported.
Primary Source
JAMA Network Open
Wei YJ, et al "Prevalence and factors associated with long-term concurrent use of stimulants and opioids among adults with attention-deficit/hyperactivity disorder" JAMA Network Open 2018; 1(4): e181152.