Longitudinal patterns of attention‐deficit/hyperactivity disorder medication use and subsequent incident substance use among US youth

Background Understanding potential substance use risks or protection associated with ADHD medication use over time among US youth with ADHD has clinical and public health importance. Using longitudinal nationally representative data and accounting for pre‐existing differences in youth can shed light on these associations. Methods This study used longitudinal prospective data from the Population Assessment of Tobacco and Health Study (2013/14‐2023). Analyses included youth ages 12–17 with a parent‐reported history of an ADHD diagnosis by a doctor, nurse, or health professional ( n = 4,700 observations; n = 2,140 unique individuals). Using propensity score weighting to account for pre‐exposure differences, the effect of ADHD medication initiation compared to no ADHD medication use and the effect of ADHD medication discontinuation compared to continuation on five incident substance use outcomes (alcohol, nicotine/tobacco, e‐cigarettes, cannabis, other drugs) 1 year later were examined. Results Among youth with parent‐reported ADHD, those who initiated ADHD medication did not differ from youth who did not use ADHD medication in subsequent incident substance use risk (adjusted odds ratios ranged from 0.94 to 1.36). Similarly, those who discontinued ADHD medication did not differ from youth who continued ADHD medication in subsequent risk for incident substance use (adjusted odds ratios ranged from 0.98 to 1.02). Conclusions These results add to the evidence that ADHD medication use initiation and medication discontinuation patterns are not related to an increased risk for incident substance use among US youth. This study highlights the importance of considering baseline differences between youth when considering the effect of ADHD medication on future substance use risk.