A recent study from the Ohio State University shows that a combination of prescribed central nervous system stimulants — like some that relieve ADHD symptoms — and prescribed opioid medication has a correlation to escalating opioid intake.

What You Need To Know

  • Researchers used data from a massive U.S. health insurance database

  • They analyzed nearly 3 million patients with claims of prescribed stimulants' impact on prescription opioid use over 10 years

  • A trend they found included those who were taking a stimulant and an opioid at the same time were likely to be taking higher doses of the opioid

The study, published in The Lancet Regional Health – Americas, used data on 22 million patients with 96 million opioid prescriptions from MarketScan Commercial Claims and Encounters, which is a large U.S. health insurance database. With this data, researchers examined 2.9 million patients with an average age of 44 who were prescribed at least two independent opinion prescriptions between 2012 and 2021.

Of these nearly 3 million patients, researchers analyzed health insurance claims of prescribed stimulants’ impact on prescription opioid use over 10 years, according to the study.

“Combining the two drugs is associated with an increase in overdose deaths. This is something we know. But we didn’t know whether stimulant use has a causal role in high use of opioids, so we conducted a big data analysis of how these two patterns interacted over a long period of time,” said senior study author Ping Zhang, associate professor of computer science and engineering and biomedical informatics at The Ohio State University.

Researchers found that someone who was taking a stimulant and an opioid at the same time was likely to be taking a high dose of the opioid, and if the individual took the stimulant before beginning opioid use, they were more likely to have higher doses of subsequent opioids.

To make the cohort balanced, the researchers have to standardize every prescription the individuals were taking to the morphine milligram equivalent, since the prescriptions included a wide range of oral formulas, such as codeine, oxycodone and more. This was how they calculate each patient’s monthly intake of opioids.

“Some patients had stable low-dose opioid use, while others had increasing or high dose patterns over time,” said first author Seungyeon Lee, a Ph.D. student in Zhang’s lab.

The researchers found that the most common diagnoses that were linked to the co-prescription of stimulants and opioids were depression and ADHD, or ADHD and chronic pain.

The most common diagnoses linked to co-prescription of stimulants and opioids were depression and ADHD or ADHD and chronic pain. 

“This was an important finding, that many patients with ADHD and depression, also experiencing chronic pain, have an opioid prescription,” said Zhang.  “This cohort represents a very realistic health care problem.” 

Additionally, the study found that stimulant use before initiating opioids and stimulant co-prescription with opioids were associated with increased opioids doses.

“We want to reduce the risk of opioid- or stimulant-related adverse drug events in real-world practice,” Zhang said.