The effects of psychostimulant prescription on opioid use disorder among people with co-occurring ADHD

Importance

Attention-deficit/hyperactivity disorder (ADHD) is a condition often comorbid with substance use disorders. With the increase in opioid and stimulant overdoses, there remains concern regarding the appropriateness of psychostimulants for patients on maintenance therapy for opioid use disorder (OUD) with co-occurring ADHD.

Objectives

To assess the impact of psychostimulant use on outcomes of OUD maintenance therapy with buprenorphine based on rates of (1) treatment discontinuation and (2) opioid-related hospitalization.

Design, setting, and participants

This present investigation used a retrospective cohort study design consisting of a secondary analysis of data collected from IBM MarketScan Commercial claims from 2011 to 2021. Individuals were aged 12 to 64 with concurrent ADHD and OUD diagnosis receiving buprenorphine treatment.

Exposures

Presence of psychostimulant prescriptions.

Main outcomes and measures

Primary outcomes were buprenorphine discontinuation and opioid-related hospitalization.

Results

Study sample included 10,712 individuals with comorbid ADHD and OUD (mean age of 31.7 years, SD 10.9) who initiated buprenorphine maintenance therapy. 5190 individuals received psychostimulant prescriptions while 5522 individuals did not. Individuals who received psychostimulants demonstrated lower odds of buprenorphine discontinuation (OR = 0.669, 95 % CI = 0.610, 0.734) and hospitalization (OR = 0.493, 95 % CI = 0.418, 0.581). A one-unit increase in the psychostimulant fill count (IRR = 0.580, 95 % CI = 0.493, 0.683) was associated with a lower incidence rate of hospitalization.

Conclusions

In patients with a dual diagnosis of ADHD and OUD on buprenorphine therapy, treatment of ADHD with prescription psychostimulants is associated with improved adherence to buprenorphine and lower odds of opioid-related hospitalization.