Summary: Lisdexamfetamine (Vyvanse), the drug most commonly used to treat ADHD, reduces the risk of hospitalization and death in people with amphetamine use disorders.
Source: Karolinska Institute
The ADHD medication lisdexamfetamine was associated with a lower risk of hospitalization and death in people with amphetamine addiction compared to drugs used among people with substance use disorders in general.
This is the result of a large registry study conducted by researchers at the Karolinska Institute in Sweden, in collaboration with the University of Eastern Finland and the Niuvanmi Hospital. JAMA Psychiatry.
“Our results suggest that lisdexamfetamine is associated with better outcomes, and encourage randomized controlled trials to investigate this further,” said Professor Yari Tihonen of the Department of Clinical Neuroscience and final author of the study.
Amphetamines are the second most widely used illegal drug in the world, and amphetamine-related hospitalizations are on the rise.
However, there are currently no approved pharmacological interventions for treating amphetamine addiction or transition methamphetamine. Some drugs have shown promising results, but to date, the studies are often small and there is no convincing evidence.
In the current study, the researchers examined the relationship between commonly used medications in people with substance use disorders and in people with amphetamine or methamphetamine use disorders, the risk of two main outcomes: 1) substance use disorder or 2) hospitalization for any reason, or death.
The study involved nearly 14,000 individuals; From July 2006 to December 2018, a first-time amphetamine or methamphetamine use disorder was registered among all residents aged 16 to 64 years in Sweden. Individuals with schizophrenia or bipolar disorder were excluded.
The patients were followed from the time of diagnosis until the patient died, moved from Sweden, was diagnosed with schizophrenia or bipolar disorder, or until the end of the study. The median follow-up period was 3.9 years.
The researchers looked at how each individual’s risk of hospitalization or death differed based on whether they were on or off the drug at that time.
“Our results show that lisdexamfetamine, which is approved to treat ADHD and binge eating in some countries, was the only specific drug associated with reduced risk of hospitalization and death,” said Milja Heikkinen, a university researcher and first author of the study. Eastern Finland and Niuvaniemi Hospital.
The risk of hospitalization for a substance use disorder was 18% lower, and the risk of hospitalization for any cause or death was 14% lower during lisdexamfetamine compared to periods without ADHD medication.
Combinations of two or more different drugs are less likely to cause drug addiction or death.
The use of benzodiazepines has been associated with poor outcomes; They were 17% more likely to be hospitalized for a substance use disorder and 20% more likely to be hospitalized for any cause or die, during the use period compared to the non-use period. Antidepressant use is also associated with slightly worse outcomes than no use.
The researchers found that pharmacological treatments are usually stopped when the clinical condition improves, and started when the clinical condition worsens.
Therefore, the results may underestimate the beneficial effect of treatment withdrawal. To control this phenomenon, the researchers used the first 30 days to analyze. The results are then matched with the main analyses.
So psychopharmacology and addiction research news
Preliminary study: Open Access.
“Pharmacological treatments and hospitalization and mortality in individuals with amphetamine use disorder in a Swedish nationwide cohort of 13 965 patients.“In Milja Heikkinen et al. JAMA Psychiatry
Pharmacological treatments and hospitalization and mortality in individuals with amphetamine use disorder in a Swedish nationwide cohort of 13 965 patients.
There are no officially approved drugs for the treatment of amphetamine or methamphetamine dependence, and studies examining the effectiveness of drug treatments on serious outcomes such as hospitalization and death are lacking.
To examine the relationship between pharmacotherapy and hospitalization and mortality outcomes in persons with amphetamine or methamphetamine use disorder.
Design, composition and participants
This nationwide registry-based study was conducted from July 2006 to December 2018 with a median (IQR) follow-up of 3.9 (1.0-6.1) years. Data was analyzed from December 1, 2021 to May 24, 2022. All residents aged 16 to 64 years living in Sweden with a first recorded amphetamine or methamphetamine use disorder and without a previous diagnosis of schizophrenia or bipolar disorder were identified. Nationwide records of inpatient care, specialty outpatient care, sickness absence and disability pensions.
For substance use disorders (SUDs) or attention deficit/hyperactivity disorder, mood stabilizers, antidepressants, benzodiazepines and related drugs, and antipsychotics. Drug use and non-use were modeled using the PRE2DUP (prescription purchase to drug use) method.
Main results and measurements
The primary outcomes were hospitalization for SUD and any hospitalization or death, which were analyzed in individual models comparing use and duration of use to minimize selection bias for 17 specific drugs or drug classes. The secondary outcome was all-cause mortality, studied using between-individual analysis as in traditional Cox models.
There were 13 965 individuals in the group (9671 [69.3%] male That is. [SD] Age, 34.4 [13.0] years). During follow-up, 7543 individuals (54.0%) were taking antidepressants, 6101 (43.7%) benzodiazepines, 5067 (36.3%) antipsychotics, and 3941 (28.2%) ADHD medications (1511). [10.8%] They were taking lisdexamphetamine, 2856 (20.5%) SUD medications, and 1706 (12.2%) mood stabilizers. A total of 10 341 patients (74.0%) were hospitalized for SUIs, 11 492 patients (82.3%) were hospitalized for any cause or died, and 1321 patients (9.5%) died from any cause. In this study, lisdexamfetamine was the only drug that reduced the risk of 3 outcomes (adjusted hazard ratio). [aHR], 0.82; 95% CI, 0.72–0.94 for SUD hospitalization; aHR, 0.86; 95% CI, 0.78–0.95 for any hospitalization or death; aHR, 0.43; 95% CI, 0.24–0.77 for all-cause mortality). Methylphenidate use was also associated with lower all-cause mortality (aHR, 0.56; 95% CI, 0.43-0.74). Benzodiazepine use was associated with a higher risk of SUD hospitalization (aHR, 1.17; 95% CI, 1.12-1.22), any hospitalization or death (aHR, 1.20; 95% CI, 1.17-1.24), and all-cause mortality. (aHR, 1.39; 95% CI, 1.20–1.60). Use of antidepressants or antipsychotics was associated with an increased risk of sudden hospitalization (aHR, 1.07; 95% CI, 1.03-1.11 and aHR, 1.05; 95% CI, 1.01-1.09) as well as any hospitalization or death (aHR). , 1.10; 95% CI, 1.06-1.14 and aHR, 1.06; 95% CI, 1.03–1.10, respectively).
Conclusions and relevance
In this study, lisdexamphetamine use was associated with improved outcomes in people with amphetamine or methamphetamine use disorders, prompting randomized clinical trials. Prescription benzodiazepine use is associated with poor outcomes.