Adult ADHD
Evidence Based Answers
Stimulant Medication and Substance Use Outcomes: A Meta-analysis
Summarized by Charles Li, MD
November 15, 2022
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Do stimulant medications for ADHD increase the risk of substance use later in life?
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This meta-analysis combined data from 15 studies that looked at substance use in individuals who were prescribed stimulants.
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The researchers did not find a statistically significant link between stimulant prescriptions and substance use later in life.
Do stimulant medications lead to substance abuse? Stimulant medications do not significantly increase the risk of substance use later in life.
Background
Stimulants are first-line treatments for ADHD in adults and children.
They are some of the most effective treatments we have for ADHD, and they have been safely prescribed and taken by millions of patients.
However, they are controlled substances with a high risk of addiction. They are closely related in mechanism and chemistry to common illicit drugs.
Researchers in this study wanted to run a meta-analysis to gather data on whether ADHD treatment with stimulants is associated with a higher risk of substance abuse later in life.
Study Quote
Psychostimulant cation is an efficacious treatment for childhood attention-deficit/hyperactivity disorder, yet controversy remains regarding potential iatrogenic effects of stimulant cation, particularly with respect to increasing susceptibility to later substance use disorders. However,...
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Methods
Researchers analyzed data from 15 studies that looked at lifetime substance use risk in patients who had been prescribed stimulants.
These studies covered 2,565 total patients.
By running a meta-analysis, researchers combined insights from different studies into one result for each substance. This result estimates how likely a person prescribed stimulants is to use a particular substance compared to someone who was not.
For example, the chart below shows the data for marijuana abuse. Some studies found positive correlations and others found negative correlations. When combined, the researchers found that the effect size was non-significant.
What is a meta-analysis?
Stimulants for ADHD do not increase the risk of marijuana abuse later in life
Study Quote
Data Sources: Studies published between January 1980 and February 2012 were identified using review articles, PubMed, and pertinent listservs. Study Selection: Studies with longitudinal designs in which cation treatment preceded the measurement of substance outcomes. Data Extraction an...
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Results
For each of the substances studied, researchers gathered data from between three and 11 studies to generate their estimates.
Overall, they found that individuals who were prescribed a stimulant were not more likely to use a potentially addictive substance.
All differences were well within the margin of error.
One meta-analysis found that stimulants did not significantly increase or decrease the risk of substance abuse.
Study Quote
Results: Separate random-effects analyses were conducted for each substance outcome, with the number of studies ranging from 3 to 11 for each outcome. Results suggested comparable outcomes between children with and without cation treatment history for any substance use and abuse or depen...
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Conclusions
This is an encouraging result for those with ADHD and those considering stimulants.
These results tell us that at the moment, there is no conclusive evidence that stimulants increase the risk of substance use later in life.
It’s important to keep in mind however that just because we haven’t found significant risk doesn’t mean that there isn’t a risk of substance use later in life.
Larger studies may be able to uncover significant risks that small studies aren’t powerful enough to unveil.
Study Quote
Conclusions: These results provide an important update and suggest that treatment of attention-deficit/hyperactivity disorder with stimulant cation neither protects nor increases the risk of later substance use disorders.