Does telehealth prescribing of stimulants for ADHD raise risk of substance use disorder?

Receiving a stimulant prescription for attention deficit hyperactivity disorder (ADHD) via telehealth shows no significant impact on the risk for substance use disorder (SUD) but appears to elevate the risk of subsequent stimulant use disorder (stimUD), suggests a study.

A total of 7,944 patients were included in the analysis. After adjusting for covariates, telehealth did not significantly modify the risk for SUD (adjusted odds ratio [aOD], 0.85, 95 percent confidence interval [CI], 0.60‒1.20) or stimUD (aOR, 1.28, 95 percent CI, 0.34‒4.85) relative to in-person appointment.

Furthermore, a telehealth appointment at the time of the initial stimulant prescription was not associated with a significant change in the risk for subsequent SUD (aOR, 1.15, 95 percent CI, 0.92‒1.44), but it correlated with a significantly greater risk for stimUD (aOR, 6.18, 95 percent CI, 1.34‒28.46) compared with in-person appointment.

“The results, particularly for stimUD, require replication in other healthcare settings,” the researchers said.

In this retrospective cohort study, the researchers used electronic health record data from 1 March 2020 to 25 August 2023 from a not-for-profit, academically affiliated medical system in the Northeastern US.

Individuals aged ≥12 years old with ADHD and who had initially received any stimulant prescription during the study period were eligible for inclusion. However, those with a non-nicotine SUD diagnosis at the time of initial stimulant prescription were excluded.