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ADHD Meds Don't Raise Risk of Drug Abuse in Adulthood: Review

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, May 29 (HealthDay News) -- Children taking stimulants to treat attention-deficit/hyperactivity disorder (ADHD) don't face a greater risk of becoming drug addicts in adulthood, researchers report.

Whether or not these medications (such as Ritalin or Adderall) increase the odds of children becoming addicted later to alcohol, cocaine, marijuana, nicotine or other drugs has been debated for years, with studies coming to conflicting conclusions.

"Previously, there was evidence for both increased risk and decreased risk for substance problems related to stimulant medication in the treatment of ADHD," said study author Kathryn Humphreys, a doctoral student in psychology at University of California, Los Angeles.

"The present study suggests that, on average, children who received stimulant medication treatment for ADHD are at no differential risk for these substance outcomes than their counterparts who did not receive medication treatment," she said.

Many parents face difficult decisions regarding the best course of treatment for their child's ADHD, Humphreys pointed out.

"Pediatricians and child psychiatrists also must weigh the potential costs and benefits of various treatment options. Our study provides an important update to clinicians," she noted.

"Particularly for those who are concerned that stimulant medication is a 'gateway' drug or increases the risk for later substance use, there is no evidence at the group level for this hypothesis," Humphreys stated.

One expert said that an earlier study had even found a protective effect from stimulants that reduced the risk of children with ADHD going on to abuse drugs.

"That was accepted as gospel, and pediatricians had taken comfort in that there was a secondary benefit to treating patients with stimulant medications," said Dr. Andrew Adesman, chief of developmental & behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York in New Hyde Park.

"This study is somewhat disappointing in the sense that these medications don't appear to have the protective effect that we thought that they do," he said.

Adesman noted that children with ADHD are at a higher risk to become dependent on drugs in adulthood. The good news, he said, is that the risk is not the result of stimulant medications, but most likely from the condition itself.

"These drugs may not be protective, but they are not a risk factor," he said. "There is nothing to suggest that medicines like Ritalin are 'gateway' drugs."

Another expert agreed.

"This is a finding that will reassure families that there is no worry later on of the risk of drug abuse," said Dr. Rani Gereige, a professor of pediatrics and director of medical education at Miami Children's Hospital. "This worry should not be an issue [for parents] in deciding whether or not to put their child on stimulant medication."

The report was published online May 29 in JAMA Psychiatry.

In this U.S. National Institutes of Health-funded study, the researchers analyzed data on over 2,500 individuals from 15 studies published between January 1980 and February 2012.

This type of study is called a meta-analysis, in which researchers attempt to uncover patterns among different studies that reveal a consistent trend. The limits of a meta-analysis are that the conclusions are only as good as the data in the original studies, and whether these studies actually provide strong evidence to answer the question the researchers are posing.

Based on data in these studies, Humphreys and colleagues calculated the odds of someone who had taken stimulants to treat ADHD going on to abuse or become addicted to alcohol, cocaine, marijuana, nicotine and other nonspecific drugs, comparing them with children who had not taken ADHD medications.

The researchers found that whether or not children had taken ADHD stimulants, the odds of becoming drug-dependent in adulthood were the same.

More information

For more on ADHD, visit the U.S. National Institute of Mental Health.

SOURCES: Andrew Adesman, M.D., chief, developmental & behavioral pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park; Rani Gereige, M.D., professor, pediatrics, and director, medical education, Miami Children's Hospital; Kathryn Humphreys, M.A., Ed.M., Ph.D. student, University of California, Los Angeles; May 29, 2013, JAMA Psychiatry, online

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