Stimulant and non-stimulant ADHD medication prescriptions for homeless veteran service users with mental illness

Prescribing of ADHD medications has not been examined in the US homeless population. This study examined frequency of prescriptions for stimulant and non-stimulant ADHD medications, as well as risky and potentially inappropriate prescribing (RPIP) of stimulants, in three groups of veterans with mental illness.

Using 2021-2022 national VA administrative data, we compared frequency of stimulant and non-stimulant ADHD medication prescriptions using logistic regression between homeless veterans (n = 105,062), veterans in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH; n = 33,884), and independently housed (IH) veterans (n = 1,875,083). We also compared indicators of RPIP of stimulants using chi-square tests between the three groups.

Adjusted for sociodemographic, clinical, and health care utilization characteristics, homeless veterans were less likely to be prescribed stimulants (adjusted odds ratio (aOR) = 0.80, 99 % CI = 0.76-0.85) relative to IH veterans and more likely to be prescribed non-stimulants (aOR = 1.12, CI = 1.06-1.18). However, among veterans prescribed stimulants, homeless veterans had more indicators of RPIP, including being prescribed stimulants in the presence of a psychotic disorder (7.9 % vs. 6.4 % for HUD-VASH vs. 2.2 % for IH, p < .001).

Homeless veterans with mental illness were less likely to be prescribed stimulants and more likely to be prescribed non-stimulant ADHD medications relative to IH veterans with mental illness. However, RPIP of stimulant prescriptions was more common for homeless and HUD-VASH veterans relative to IH veterans.