Telehealth Prescribing of Stimulants for ADHD and Associated Risk for Later Stimulant and Substance Use Disorders

The authors sought to determine 1) whether receiving an initial stimulant prescription for attention deficit hyperactivity disorder (ADHD) from a provider whom a patient has never seen in person is associated with increased risk for stimulant use disorder (stimUD) or other substance use disorders (SUDs), and 2) whether receiving an initial stimulant prescription during a telehealth versus in-person appointment is associated with increased risk for stimUD or SUD.

This was a retrospective cohort study using electronic health record data from March 1, 2020, to August 25, 2023, from a not-for-profit, academically affiliated medical system in the Northeastern United States. Eligible study subjects were ≥12 years old with ADHD and initial receipt of any stimulant prescription during the study period. Exclusion criteria included a non-nicotine SUD diagnosis at the time of initial stimulant prescription.

The sample included 7,944 patients. After adjustment for covariates, a purely telehealth-based relationship versus any in-person relationship did not significantly alter risk for SUD (adjusted odds ratio=0.85, 95% CI=0.60, 1.20) or stimUD (adjusted odds ratio=1.28, 95% CI=0.34, 4.85). A telehealth versus in-person appointment at the time of the initial stimulant prescription did not significantly alter risk for subsequent SUD (adjusted odds ratio=1.15, 95% CI=0.92, 1.44) but was associated with significantly higher risk for stimUD (adjusted odds ratio=6.18, 95% CI=1.34, 28.46).

The results suggest that receipt of a stimulant prescription for ADHD via telehealth does not alter the risk for SUD, but receipt of an initial stimulant prescription via telehealth may signal increased risk of subsequent stimUD. The results, particularly for stimUD, require replication in other health care settings.