Quinn Patrick D, Chang Zheng, Hur Kwan, Gibbons Robert D, Lahey Benjamin B, Rickert Martin E, Sjölander Arvid, Lichtenstein Paul, Larsson Henrik, D'Onofrio Brian M
From the Department of Psychological and Brain Sciences, Indiana University, Bloomington; the Center for Health Statistics and the Departments of Medicine and of Public Health Sciences, University of Chicago, Chicago; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; and the School of Medical Sciences, Örebro University, Örebro, Sweden.
Am J Psychiatry. 2017 Sep 1;174(9):877-885. doi: 10.1176/appi.ajp.2017.16060686. Epub 2017 Jun 29.
Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events.
The authors analyzed 2005-2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not.
In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64-0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67-0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78-0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82-0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women.
These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.
物质使用障碍是导致注意缺陷多动障碍（ADHD）患者超额死亡率的主要因素，但ADHD药物治疗与物质相关问题之间的关联仍不明确。本研究调查了ADHD药物治疗与物质相关事件之间的同时期及长期关联。
作者分析了2993887名（47.2%为女性）青少年及成年ADHD患者在2005年至2014年期间的商业医疗保健索赔记录。个体内分析比较了患者接受处方兴奋剂药物或托莫西汀治疗的月份中与物质使用障碍相关的急诊就诊等物质相关事件的风险，与未接受治疗月份的风险。
在调整后的个体内比较中，与未接受ADHD药物治疗的时期相比，男性患者在接受药物治疗时同时期发生物质相关事件的几率降低了35%（优势比=0.65，95%置信区间=0.64 - 0.67），女性患者同时期发生物质相关事件的几率降低了31%（优势比=0.69，95%置信区间=0.67 - 0.71）。此外，男性患者在药物治疗期结束2年后发生物质相关事件的几率降低了19%（优势比=0.81，95%置信区间=0.78 - 0.85），女性患者在药物治疗期结束2年后发生物质相关事件的几率降低了14%（优势比=0.86，95%置信区间=0.82 - 0.91）。敏感性分析支持了大多数研究结果，但女性长期关联方面的一致性较差。
这些结果表明，在青少年或成年期接受ADHD药物治疗不太可能与物质相关问题的更高风险相关。相反，药物治疗与同时期较低的物质相关事件风险相关，并且至少在男性中，与未来物质相关事件的长期风险较低相关。
