What question did this study set out to answer?

To uncover factors contributing to initial opioid prescriptions among ADHD patients receiving stimulant therapy.

January 21, 2026Annals of Pharmacotherapy0 citations

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

MSMina ShresthaPossible Health COChijioke M. OkekeUniversity of Houston CSC ShenPennsylvania State University

Key Points

To uncover factors contributing to initial opioid prescriptions among ADHD patients receiving stimulant therapy.
Conducted a retrospective cohort study using a claims database from 2010-2020.
Identified ADHD patients who started stimulant therapy and monitored them for 1 year.
Utilized Cox proportional hazards models to analyze factors linked to opioid initiation.
14.2% of patients received an opioid prescription within one year after starting stimulants.
Age ≥35 years significantly increased opioid prescription risk (aHR: 10.84).
Female patients had a higher likelihood of opioid prescription (aHR: 1.29).
Multiple chronic conditions and substance use disorders substantially raised opioid initiation risk (aHR: 1.61 and 1.69, respectively).
Behavioral therapy prior to ADHD treatment was linked to a reduced risk of opioid prescriptions (aHR: 0.89).

Abstract

Background: Pharmacotherapy with stimulant or nonstimulant medications is recommended as first-line treatment for attention-deficit/hyperactivity disorder (ADHD). Among patients prescribed stimulants, concomitant opioid use may increase the risk of drug dependence, exacerbate comorbid conditions, and compromise treatment adherence. However, limited evidence exists on the risk factors for initial opioid prescription in this population. Objective: To identify factors associated with incident opioid prescriptions among patients with ADHD prescribed stimulant therapy. Methods: We conducted a retrospective cohort study using the Merative® MarketScan® Commercial Claims and Encounters Database (2010-2020). We identified patients with ADHD who initiated stimulant therapy and followed them for 1 year to assess incident opioid prescription. Cox proportional hazards models were used to evaluate factors associated with opioid initiation. Results: Among 380 494 patients with ADHD initiating stimulants (mean age: 21.2 years; 56.5% male), 14.2% received an opioid prescription within 1 year. Factors significantly associated with incident opioid prescription included age ≥35 years (adjusted hazard ratio aHR: 10.84; 95% CI: 10.43-11.26), gender(aHR female:1.29; 95% CI: 1.27-1.31), geographic region (aHR West: 1.58; 95% CI: 1.52-1.64), multiple chronic conditions (aHR: 1.61; 95% CI: 1.54-1.67), anxiety (aHR: 1.19; 95% CI: 1.17-1.22), depression (aHR: 1.16; 95% CI: 1.14-1.19), severe mental illnesses (aHR: 1.18; 95% CI: 1.13-1.23), substance use disorders (SUDs) (aHR: 1.69; 95% CI: 1.63-1.75). Receipt of behavioral therapy before ADHD pharmacotherapy (aHR: 0.89; 95% CI: 0.87-0.92) was associated with a lower risk of receiving incident opioid prescriptions. Conclusions and relevance: Several demographic factors (e.g., age, gender, geographic region) and clinical factors (e.g., history of mental health conditions and SUDs) are associated with opioid initiation among stimulant-treated patients with ADHD. These findings may inform clinical strategies to mitigate unnecessary opioid exposure and associated harms.

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