Abstract
While attention deficit hyperactivity disorder is common among people with addiction, the risks and benefits of attention deficit hyperactivity disorder medication in pregnant people with opioid use disorder are poorly understood. Here, using US multistate administrative data, we examined 3,247 pregnant people initiating opioid use disorder treatment, of whom 5% received psychostimulants. Compared to peers not receiving psychostimulants, the psychostimulant cohort had greater buprenorphine (adjusted relative risk 1.81 (1.50–2.18)) but lower methadone initiation (adjusted relative risk 0.39 (0.19–0.78)). Among psychostimulant recipients who initiated buprenorphine, we observed lower buprenorphine discontinuation associated with the psychostimulant cohort compared to nonrecipients (adjusted hazard ratio 0.77 (0.67–0.88)). In within-person case-crossover analyses, person-days defined by psychostimulant fills were associated with fewer substance use disorder-related admissions compared to days without fills (odds ratio 0.50 (0.33–0.76)). Overall, our data suggest that psychostimulant use in pregnancy may be associated with increased buprenorphine initiation, decreased methadone initiation and improved buprenorphine retention. Decreased substance use disorder-related admissions were associated with person-days of psychostimulant receipt, although other risks of psychostimulant use in pregnancy warrant further investigation.
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Data availability
The MarketScan data are proprietary and can be accessed via a request to Merative (marketscan.support@merative.com). No additional data are available.
Code availability
Relevant code is available on written reasonable request to the corresponding author.
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Acknowledgements
We acknowledge the contributions of the following individuals: L. Bierut (Washington University), T. Fidalgo (Federal University of Sao Paulo) and V. Tardelli (University of Toronto) for their thoughtful insights that contributed to this manuscript; J. Goldbach and K. Bucholz of the Transdisciplinary Training in Addictions Research (TranSTAR) T32 Program of Washington University for obtaining funding to support effort for personnel (K.Y.X.); P. Cavazos-Rehg and L. Bierut of the NIDA K12 Program of Washington University for obtaining funding to support effort for personnel (K.Y.X.); M. Keller, J. Sahrmann and D. Stwalley from the Center for Administrative Data Research (CADR) of Washington University for technical support of the MarketScan Databases. Merative and MarketScan are trademarks of Merative Corporation in the United States, other countries or both. This project was funded by R21 DA044744 (K.Y.X., principal investigator (PI): R.A.G./L. Bierut). Effort for some personnel was supported by grants T32 DA015035 (K.Y.X., PI: K. Bucholz, J. Goldbach) and K12 DA041449 (KYX, PI: L. Bierut, P. Cavazos-Rehg), St. Louis University Research Institute Fellowship (R.A.G.) and K23 DA053507 (C.E.M.), but these grants did not fund the analyses of the Merative MarketScan Multi-State Medicaid Database data performed by K.Y.X. C.A.D.R. is supported in part by the Washington University Institute of Clinical and Translational Sciences via grants UL1 TR002345 (from the National Center for Advancing Translational Sciences of the National Institutes of Health).
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Concept: K.Y.X., T.D.M.B., C.E.M. and R.A.G. Design: K.Y.X., T.D.M.B., C.E.M. and R.A.G. Analysis of data: K.Y.X. Interpretation of data: K.Y.X., T.D.M.B., C.E.M., H.E.J., E.B.C., J.C.K., C.M.M., F.R.L. and R.A.G. Drafting of manuscript: K.Y.X., T.D.M.B., C.E.M. and R.A.G. Obtained funding: R.A.G. Administrative, technical or material support: R.A.G. Critical revision for important intellectual content: K.Y.X., T.D.M.B., C.E.M., H.E.J., E.B.C., J.C.K., C.M.M., F.R.L. and R.A.G. Per Center for Administrative Data Research Data Use Agreement guidelines, K.Y.X. was the only individual who had access to the data and the only one to perform analyses. All the other authors did not have access to the data, although they contributed to the interpretation of data.
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R.A.G. reported receiving grants from the NIH and Arnold Ventures LLC during the conduct of the study, consulting for Janssen Pharmaceuticals and receiving personal fees for grant reviews from the NIH outside the submitted work. These funding sources had no influence on the design and analysis of the present study. The remaining authors declare no competing interests.
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Supplementary Protocols 1–4.
Supplementary Table 1
Models illustrate adjusted relative risks estimated from multivariable Poisson regression models. CI, confidence interval; D/o, disorder; UD, use disorder.
Supplementary Table 2
Models illustrate adjusted hazard ratios estimated from multivariable Cox regression models. CI, confidence interval; D/o, disorder; UD, use disorder.
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Xu, K.Y., Berkel, T.D.M., Martin, C.E. et al. Prescription psychostimulant use, admissions and treatment initiation and retention in pregnant people with opioid use disorder. Nat. Mental Health (2024). https://doi.org/10.1038/s44220-024-00270-w
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DOI: https://doi.org/10.1038/s44220-024-00270-w
