ADHD News & Research

Study: Prescription Stimulants Do Not Increase the Risk of Illicit Drug Use in Adolescents

High school seniors who took prescription stimulants for ADHD were no more likely to use cocaine or methamphetamine than their neurotypical peers; however, those who misused stimulants were 2.5 times likelier to use the illicit drugs as young adults.

July 15, 2023

Prescription stimulant medication use for the treatment of ADHD does not increase adolescents’ risk for illicit drug use as young adults; however, adolescents who divert and/or misuse stimulants are 2.5 times more likely to use cocaine or methamphetamine during young adulthood, according to a new study published in the journal JAMA Open Network.1

The University of Michigan study of 5,034 U.S. high school seniors found that adolescents with ADHD who used stimulant therapy were no more likely to use cocaine and methamphetamine at ages 19 to 24 than their neurotypical peers. However, the study found that 20% to 34% of teens who misused prescription stimulants during high school later used cocaine or methamphetamine as young adults. Researchers also reported associations between baseline marijuana use and later cocaine and methamphetamine use.

Timothy Wilens, M.D., a co-author of the study, shared similar findings during the ADDitude webinar “Substance Use Disorder and ADHD: Safe, Effective Treatment Options:” “Early treatment of ADHD and its continued treatment across the lifespan reduce the risk for substance use and substance use disorders,” he said.2 “Stimulant treatment for ADHD before age 9 seems to be associated with the biggest reduction in the risk for later SUD. One study showed that children who started stimulant treatment after this age were at greater risk for substance use during adolescence than were children who started earlier. The same study also showed that early onset stimulant treatment of ADHD does not increase the risk for using cocaine or methamphetamine — both stimulants.”3

Prescription Stimulant Misuse

“Prescription stimulants are one of the most commonly misused controlled substances during adolescence,” the researchers wrote.

A cross-sectional study published in April 2023 by the same research team reported that up to one in four middle and high school students has abused prescription stimulant medications used to treat ADHD. In addition, non-medical use of prescription stimulants among teens remains more prevalent than misuse of other prescription drugs, including opioids and benzodiazepines, the research found.4

Such misuse could lead to dire consequences. According to the Centers for Disease Control and Prevention (CDC), one in five overdose deaths in 2019 involved cocaine. Stimulant-related overdose deaths have increased tenfold in the past decade.5

Stimulants for ADHD Curbs Risk of SUD

ADHD can be a risk factor for substance use disorders (SUD)6; however, the University of Michigan research team said that the study’s results suggest that prescription stimulants for ADHD provide a “potential protective effect.”

“These findings should be comforting to parents who have teenagers taking stimulants for ADHD, who worry that these medications may lead to the use of illicit stimulants like cocaine or methamphetamine as their children enter young adulthood and become more independent,” said lead researcher Sean Esteban McCabe, University of Michigan professor of nursing and director of the Center for the Study of Drugs, Alcohol, Smoking, and Health.

For the study, researchers analyzed data collected between 2005-2017 from Monitoring the Future, a National Institute of Drug Abuse (NIDA) multi-cohort survey that measures drug and alcohol use among adolescents nationwide, and follow-up surveys administered to the study participants from 2011-2021.

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1McCabe, S.E., Schulenberg, J.E., Wilens, T.E., Schepis, T.S., McCabe, V.V., Veliz, P.T. (2023). Cocaine or Methamphetamine Use During Young Adulthood Following Stimulant Use for Attention-Deficit/Hyperactivity Disorder During Adolescence. JAMA Netw Open. 6(7):e2322650.

2Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V., & Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. The Journal of nervous and mental disease.185(8), 475–482.

3S.E., Dickinson, K., West, B.T., & Wilens, T.E. (2016). Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study. Journal of the American Academy of Child and Adolescent Psychiatry. 55(6), 479–486.>/a>

4McCabe, S.E., Schulenberg, J.E., Wilens, T.E., Schepis, T.S., McCabe, V.V., and Veliz, P.T. (2023). Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020. JAMA Netw Open.(4):e238707.

5Ahmad, F.B., Rossen, L.M., Sutton, P. Provisional Drug Overdose Death Counts. National Center for Health Statistics. Reviewed May 17, 2023.

6Zulauf, C.A., Sprich, S.E., Safren, S.A., Wilens, T.E. (2014). The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders. Curr Psychiatry Rep. 16(3):436.