Stimulant Use to Rising Opioid Dosages, Highlighting Risks of the Twin Epidemic

A 10-year longitudinal study analyzing nearly 3 million U.S. patients has revealed a troubling connection between prescription stimulant use and escalating opioid dosages, a pattern that could be fueling the ongoing opioid crisis. The study, published in The Lancet Regional Health – Americas, suggests that co-prescription of stimulants and opioids significantly raises the risk of high-dose opioid use, increasing concerns about overdose deaths and long-term health effects.

Understanding the “Twin Epidemic”
The study, led by Ping Zhang, an associate professor at The Ohio State University, explored how the simultaneous prescription of central nervous system (CNS) stimulants (such as ADHD medications) and opioids (including oxycodone and morphine) affects opioid intake patterns.

“Combining these two drugs is associated with a rise in overdose deaths. While we knew this was happening, we didn’t understand whether stimulants played a role in escalating opioid use. Our analysis provides strong evidence that they do,” said Zhang.

The researchers analyzed health insurance claims data from 22 million patients, identifying a 2.9 million-patient cohort that had been prescribed opioids between 2012 and 2021. Of these, 160,243 patients (5.5%) were also prescribed stimulants.

Key Findings: Stimulant Use Increases Opioid Dosages
Patients taking both stimulants and opioids were more likely to use high opioid doses.

• Patients prescribed stimulants before starting opioids were at higher risk of escalating opioid use over time.
• The highest opioid doses were seen in patients diagnosed with ADHD, depression, and chronic pain—conditions commonly associated with stimulant use.

To assess opioid intake trends, the researchers categorized patients into five dosage trajectory groups:

1. Very low-dose users
2. Low-dose decreasing users
3. Low-dose increasing users
4. Moderate-dose increasing users
5. High-dose sustained users

Patients in moderate- and high-dose opioid groups not only had higher opioid intake but also higher rates of ADHD and depression.

Geographic and Gender Trends in Opioid Use
The study also found regional and gender disparities in opioid prescription patterns:

• Southern and Western U.S. regions had the highest total opioid intakes.
• The South had the highest prescription rates, while the West had the highest opioid dosage per prescription.
• Men had higher daily opioid intakes than women, suggesting possible differences in prescribing practices or pain management approaches.

Implications: Is Stricter Regulation of Stimulants Needed?
The results suggest that prescription stimulants may be a significant driver behind rising opioid use, raising concerns about how these drugs are prescribed together.

“This cohort represents a very real healthcare issue,” Zhang noted. “Many patients with ADHD and depression are also prescribed opioids for chronic pain, creating a complex and potentially dangerous pattern of drug use.”

Given the increased risk of overdose, cardiovascular events, and mental health complications, researchers suggest that tighter regulations on stimulant prescriptions for patients already taking opioids may be necessary.

With opioid overdose deaths continuing to rise, these findings highlight the need for closer monitoring of patients receiving both stimulants and opioids, as well as further research into safer pain management and mental health treatment alternatives.