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Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder.
JAMA Netw Open. 2018 08 03; 1(4):e181152.JN

Abstract

Importance

There exist limited data on the long-term concurrent use of stimulants and opioids among adults with attention-deficit/hyperactivity disorder (ADHD), a population at risk for prescription drug abuse.

Objective

To assess the prevalence and secular trends of and the factors associated with long-term concurrent use of stimulants and opioids among adults with ADHD.

Design, Setting, and Participants

This cross-sectional study assessed Medicaid Analytic eXtract data from 29 states between 1999 and 2010. Medicaid fee-for-service enrollees aged 20 to 64 years with ADHD who were continuously enrolled for more than 12 months after receiving an ADHD diagnosis were included. One 12-month continuous enrollment period was randomly selected as an observation unit for each enrollee. Multivariable regression models were used to determine secular trends in the prevalence of and the potential risk factors associated with long-term concurrent stimulant-opioid use. Analyses were conducted between January 1 and December 31, 2017.

Exposures

Risk factors measured during the first half of the 12-month observation unit.

Main Outcomes and Measures

Prevalence of long-term use of stimulants and opioids overlapping for at least 30 consecutive days was measured during the second half of the randomly selected 12-month observation unit.

Results

Of the 66 406 Medicaid-enrolled adults with ADHD who were identified as eligible, 35 670 (53.7%) were 20 to 30 years old, 37 155 (56.0%) were women, and 52 551 (79.1%) were non-Hispanic white individuals. Of these 66 406 adults with ADHD, 21 723 (32.7%) used stimulants, and 3590 (5.4%) were long-term users of stimulants and opioids. Long-term opioid use was more common among adults with ADHD who used stimulants (3590 of 21 723 [16.5%]) than among those with ADHD who did not use stimulants (5826 of 44 683 [13.0%]). Long-term concurrent stimulant-opioid use increased between 1999 and 2010 (adjusted prevalence relative ratio [PRR], 1.12; 95% CI, 1.10-1.14). Compared with patients aged 20 to 30 years, the prevalence of long-term concurrent stimulant-opioid use was higher among patients in their 30s (PRR, 1.07; 95% CI, 1.07-1.08) and was further increased among patients in their 40s (PRR, 1.14; 95% CI, 1.12-1.15) and 50s (PRR, 1.17; 95% CI, 1.16-1.19). Other strongly associated risk factors included being non-Hispanic white (black PRR, 0.93; 95% CI, 0.92-0.93; other PRR, 0.97; 95% CI, 0.97-0.98; vs white), living in the southern United States (Midwest PRR, 0.98; 95% CI, 0.97-0.98; Northeast PRR, 0.94; 95% CI, 0.93-0.94; West PRR, 0.95; 95% CI, 0.94-0.96; vs South), and receiving a diagnosis of substance abuse disorder (PRR, 1.04; 95% CI, 1.03-1.05), depression (PRR, 1.02; 95% CI, 1.01-1.03), anxiety disorder (PRR, 1.05; 95% CI, 1.04-1.07), chronic pain (PRR, 1.10; 95% CI, 1.07-1.13), chronic obstructive pulmonary disease (PRR, 1.05; 95% CI, 1.04-1.07), or cardiovascular disease (PRR, 1.02; 95% CI, 1.01-1.03).

Conclusions and Relevance

Long-term concurrent use of stimulants and opioids among adults with ADHD is common. This study suggests that clinical and research priorities should be made toward understanding the benefits and risks of long-term coadministration of stimulants and opioids in the management of ADHD and co-occurring pain conditions.

Authors+Show Affiliations

Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville.Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville.Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville. Now with Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland.Department of Psychiatry, College of Medicine, University of Florida, Gainesville.Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville. Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30646105

Citation

Wei, Yu-Jung Jenny, et al. "Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder." JAMA Network Open, vol. 1, no. 4, 2018, pp. e181152.
Wei YJ, Zhu Y, Liu W, et al. Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open. 2018;1(4):e181152.
Wei, Y. J., Zhu, Y., Liu, W., Bussing, R., & Winterstein, A. G. (2018). Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Network Open, 1(4), e181152. https://doi.org/10.1001/jamanetworkopen.2018.1152
Wei YJ, et al. Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open. 2018 08 3;1(4):e181152. PubMed PMID: 30646105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of and Factors Associated With Long-term Concurrent Use of Stimulants and Opioids Among Adults With Attention-Deficit/Hyperactivity Disorder. AU - Wei,Yu-Jung Jenny, AU - Zhu,Yanmin, AU - Liu,Wei, AU - Bussing,Regina, AU - Winterstein,Almut G, Y1 - 2018/08/03/ PY - 2019/1/16/entrez PY - 2019/1/16/pubmed PY - 2019/9/27/medline SP - e181152 EP - e181152 JF - JAMA network open JO - JAMA Netw Open VL - 1 IS - 4 N2 - Importance: There exist limited data on the long-term concurrent use of stimulants and opioids among adults with attention-deficit/hyperactivity disorder (ADHD), a population at risk for prescription drug abuse. Objective: To assess the prevalence and secular trends of and the factors associated with long-term concurrent use of stimulants and opioids among adults with ADHD. Design, Setting, and Participants: This cross-sectional study assessed Medicaid Analytic eXtract data from 29 states between 1999 and 2010. Medicaid fee-for-service enrollees aged 20 to 64 years with ADHD who were continuously enrolled for more than 12 months after receiving an ADHD diagnosis were included. One 12-month continuous enrollment period was randomly selected as an observation unit for each enrollee. Multivariable regression models were used to determine secular trends in the prevalence of and the potential risk factors associated with long-term concurrent stimulant-opioid use. Analyses were conducted between January 1 and December 31, 2017. Exposures: Risk factors measured during the first half of the 12-month observation unit. Main Outcomes and Measures: Prevalence of long-term use of stimulants and opioids overlapping for at least 30 consecutive days was measured during the second half of the randomly selected 12-month observation unit. Results: Of the 66 406 Medicaid-enrolled adults with ADHD who were identified as eligible, 35 670 (53.7%) were 20 to 30 years old, 37 155 (56.0%) were women, and 52 551 (79.1%) were non-Hispanic white individuals. Of these 66 406 adults with ADHD, 21 723 (32.7%) used stimulants, and 3590 (5.4%) were long-term users of stimulants and opioids. Long-term opioid use was more common among adults with ADHD who used stimulants (3590 of 21 723 [16.5%]) than among those with ADHD who did not use stimulants (5826 of 44 683 [13.0%]). Long-term concurrent stimulant-opioid use increased between 1999 and 2010 (adjusted prevalence relative ratio [PRR], 1.12; 95% CI, 1.10-1.14). Compared with patients aged 20 to 30 years, the prevalence of long-term concurrent stimulant-opioid use was higher among patients in their 30s (PRR, 1.07; 95% CI, 1.07-1.08) and was further increased among patients in their 40s (PRR, 1.14; 95% CI, 1.12-1.15) and 50s (PRR, 1.17; 95% CI, 1.16-1.19). Other strongly associated risk factors included being non-Hispanic white (black PRR, 0.93; 95% CI, 0.92-0.93; other PRR, 0.97; 95% CI, 0.97-0.98; vs white), living in the southern United States (Midwest PRR, 0.98; 95% CI, 0.97-0.98; Northeast PRR, 0.94; 95% CI, 0.93-0.94; West PRR, 0.95; 95% CI, 0.94-0.96; vs South), and receiving a diagnosis of substance abuse disorder (PRR, 1.04; 95% CI, 1.03-1.05), depression (PRR, 1.02; 95% CI, 1.01-1.03), anxiety disorder (PRR, 1.05; 95% CI, 1.04-1.07), chronic pain (PRR, 1.10; 95% CI, 1.07-1.13), chronic obstructive pulmonary disease (PRR, 1.05; 95% CI, 1.04-1.07), or cardiovascular disease (PRR, 1.02; 95% CI, 1.01-1.03). Conclusions and Relevance: Long-term concurrent use of stimulants and opioids among adults with ADHD is common. This study suggests that clinical and research priorities should be made toward understanding the benefits and risks of long-term coadministration of stimulants and opioids in the management of ADHD and co-occurring pain conditions. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/30646105/Prevalence_of_and_Factors_Associated_With_Long_term_Concurrent_Use_of_Stimulants_and_Opioids_Among_Adults_With_Attention_Deficit/Hyperactivity_Disorder_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1152 DB - PRIME DP - Unbound Medicine ER -