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Opioid Use on the Rise Among Adults with ADHD Taking Stimulants

Long-term concurrent use of stimulant medications and opioids has become increasingly common in adults with ADHD, according to a new study using Medicaid data from 29 states between 1999 and 2010.



August 16, 2018

How common — and dangerous — is it for adults with attention deficit disorder (ADHD or ADD) to take both stimulant medications and opioids for more than a month?

This is a critical question, in part, because the Unites States does not restrict stimulant prescriptions for people with substance use disorder or for those receiving opioid treatment, despite the potential enhanced risk of drug dependence. And the answer is not good.

In a new study of Medicaid data from 29 states, researchers from the University of Florida, Gainesville found that long-term concurrent use of stimulants and opioids has become increasingly common in adults with ADHD.1 Results were recently published in JAMA Network Open.

In this cross-sectional study, Wei and colleagues evaluated data from adults enrolled in Medicaid fee-for-service plan who were aged 20-64 years with at least 1 inpatient or 2 outpatient visits coded with an ADHD diagnosis between 1999 and 2010. They selected a random 12-month continuous enrollment period for each patient. A minimum of 30 days was deemed long-term concurrent use of stimulants and opioids.

Of the 66,406 adults with ADHD, 32.7% (21,723) used stimulants and 5.4% (3,590) used stimulants and opioids for at least 30 days. Long-term opioid use was more common among adults who used stimulants than it was among those who did not use stimulants (16.5% vs. 13%).

Between 1999 and 2010, there was a significant 12% increase in long-term concurrent stimulant-opioid use, and older patients were more likely than younger ones to use both substances. Compared with adults in their 20s, those in their 30s had a higher prevalence (adjusted prevalence relative ratio [aPRR] 1.07); in their 40s and 50s this increased to aPRR 1.14 and aPRR 1.17, respectively.

Concurrent stimulant-opioid use was most common among non-Hispanic whites living in the southern United States. With the exception of schizophrenia, the following mental health comorbidities were also significantly associated with concurrent drug use: depression (aPRR 1.02), substance abuse disorder (aPRR 1.04), and anxiety disorder (1.05). Physical health comorbidities significantly associated with long-term concurrent stimulant-opioid use were cardiovascular disease (aPRR 1.02) and chronic obstructive pulmonary disease (aPRR 1.05).

Since the data used in the study only captured medications filled and reimbursed by Medicaid, people who paid for prescriptions with cash or through illicit means were not counted. Additionally, this study does not reflect current clinical opioid prescribing practice; several initiatives were implemented after 2010 to educate physicians to reduce unsafe opioid prescribing.

“Our study contributes to the understanding of the potential risk factors associated with long-term concurrent stimulant-opioid use among adults with ADHD,” noted the authors. “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,” they concluded.


1Wei Y-JJ, Zhu Y, Liu W, Bussing R, Winterstein AG. Prevalence of 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. doi:10.1001/jamanetworkopen.2018.1152

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  1. The psychiatrist I am seeing was very very reticent to let me go back into Ritalin after I told him I had a problem with opiates in the past. He said doctors are certainly discouraged from prescribing stimulants to people with addiction issues, and face penalties if things go badly. I think he finally allowed it because it was clear I don’t even like taking stimulants, there just aren’t many effective options for people with severe inattentive ADHD.

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