Risk Factors Associated With Incident Opioid Prescription Among Attention-Deficit/Hyperactivity Disorder Patients...

Area of Science:

• Pharmacology
• Psychiatry
• Public Health

Background:

• Stimulant and non-stimulant medications are first-line treatments for attention-deficit/hyperactivity disorder (ADHD).
• Opioid use in stimulant-treated ADHD patients may increase risks of dependence, worsen comorbidities, and reduce treatment adherence.
• Limited data exists on risk factors for initial opioid prescription in this population.

Purpose of the Study:

• To identify factors associated with incident opioid prescriptions among patients with ADHD receiving stimulant therapy.

Main Methods:

• Retrospective cohort study using the Merative® MarketScan® Commercial Claims and Encounters Database (2010-2020).
• Identified patients with ADHD initiating stimulant therapy and followed for 1 year for incident opioid prescription.
• Cox proportional hazards models evaluated factors associated with opioid initiation.

Main Results:

• Among 380,494 ADHD patients initiating stimulants, 14.2% received an opioid prescription within 1 year.
• Factors associated with opioid prescription included age ≥35 years, female gender, specific geographic regions, multiple chronic conditions, anxiety, depression, severe mental illnesses, and substance use disorders (SUDs).
• Receipt of behavioral therapy before ADHD pharmacotherapy was associated with a lower risk of opioid prescription.

Conclusions:

• Demographic and clinical factors are linked to opioid initiation in stimulant-treated ADHD patients.
• Findings suggest potential clinical strategies to reduce unnecessary opioid exposure and associated harms in this population.