Schepis Ty S, Werner Kennedy S, Figueroa Olivia, McCabe Vita V, Schulenberg John E, Veliz Phil T, Wilens Timothy E, McCabe Sean Esteban
Department of Psychology, Texas State University, San Marcos, TX, USA.
Department of Health Behavior and Biological Sciences, Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), School of Nursing, University of Michigan, Ann Arbor, MI, USA.
EClinicalMedicine. 2023 Mar 16;58:101902. doi: 10.1016/j.eclinm.2023.101902. eCollection 2023 Apr.
Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stimulant and non-stimulant pharmacotherapy improve adolescent ADHD, but their associations with prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear. Using 2005-2020 US Monitoring the Future data, we investigated relationships between ADHD pharmacotherapy history and PSM, cocaine, or methamphetamine use.
Secondary students (13-19 years) provided data on pharmacotherapy history (N = 199,560; 86.3% of total sample) between January 1, 2005 and May 31, 2020 in a cross-sectional multi-cohort study; weights assured a nationally representative sample. Participants were grouped by ADHD pharmacotherapy history: none (88.7%; principally non-ADHD controls); stimulant-only (5.8%); non-stimulant-only (3.3%); both stimulant and non-stimulant (2.1%). Outcomes were past-year PSM, cocaine, and methamphetamine use. Logistic regressions examined relationships between pharmacotherapy history and outcomes, controlling for sociodemographics, recent substance use, and stimulant treatment cessation.
Past-year outcome rates were lowest in adolescents with no pharmacotherapy history: 4.7% for PSM [8310/174,561], 1.6% for cocaine [2858/174,688], and 0.7% for methamphetamine [1036/148,378]. A history of both stimulant and non-stimulant treatment was associated with the highest rates: 22.3% for PSM [940/4098], 10.4% for cocaine [450/4110], and 7.8% for methamphetamine [275/3427]. Adolescents who received monotherapy (stimulant- or non-stimulant-only) had intermediate rates, with no differences between monotherapy groups.
While elevated PSM and illicit stimulant use rates are likely influenced by ADHD, our findings suggested adolescents with a history of both stimulant and non-stimulant pharmacotherapy are at highest risk for these stimulant outcomes. Adolescents receiving ADHD pharmacotherapy should be monitored for PSM and illicit stimulant use.
National Institute on Drug Abuse/National Institutes of Health (USA) and Food and Drug Administration (USA).
注意力缺陷多动障碍（ADHD）与更高的物质使用率相关。兴奋剂和非兴奋剂药物治疗可改善青少年ADHD，但它们与处方兴奋剂滥用（PSM）、可卡因和甲基苯丙胺使用之间的关联尚不清楚。利用2005 - 2020年美国未来监测数据，我们调查了ADHD药物治疗史与PSM、可卡因或甲基苯丙胺使用之间的关系。
在一项横断面多队列研究中，中学生（13 - 19岁）提供了2005年1月1日至2020年5月31日期间药物治疗史的数据（N = 199,560；占总样本的86.3%）；权重确保了全国代表性样本。参与者按ADHD药物治疗史分组：无（88.7%；主要为非ADHD对照）；仅使用兴奋剂（5.8%）；仅使用非兴奋剂（3.3%）；同时使用兴奋剂和非兴奋剂（2.1%）。结局为过去一年的PSM、可卡因和甲基苯丙胺使用情况。逻辑回归分析了药物治疗史与结局之间的关系，并控制了社会人口统计学、近期物质使用情况和兴奋剂治疗停药情况。
过去一年中，无药物治疗史的青少年结局发生率最低：PSM为4.7%[8310/174,561]，可卡因为1.6%[2858/174,688]，甲基苯丙胺为0.7%[1036/148,378]。同时使用兴奋剂和非兴奋剂治疗的历史与最高发生率相关：PSM为22.3%[940/4098]，可卡因为10.4%[450/4110]，甲基苯丙胺为7.8%[275/3427]。接受单一疗法（仅使用兴奋剂或仅使用非兴奋剂）的青少年发生率处于中等水平，单一疗法组之间无差异。
虽然PSM和非法兴奋剂使用率升高可能受ADHD影响，但我们的研究结果表明，有兴奋剂和非兴奋剂药物治疗史的青少年出现这些兴奋剂相关结局的风险最高。接受ADHD药物治疗的青少年应监测PSM和非法兴奋剂使用情况。
美国国立药物滥用研究所/美国国立卫生研究院和美国食品药品监督管理局。
