Research Program Manager Johns Hopkins Bloomberg School of Public Health Baltimore, United States
Background: Amphetamine and methylphenidate stimulants are classified in the US as Schedule II Controlled Substances with a high potential for psychological or physical dependence.
Objectives: To examine patterns of adult medical use of Schedule II stimulants alone, and in combination with other CNS-active drugs.
Methods: Cross-sectional study of prescription drug claims for adults, age 19-65, included in a commercial insurance claims database with 9.1 million continuously enrolled adults from October 1, 2019 through December 31, 2020. Schedule II stimulant use was defined as adults filling 1 or more prescriptions for a Schedule II stimulant during calendar 2020. The primary outcome was an outpatient prescription claim, service date, and days’ supply for CNS-active drugs among stimulant users. Combination-2 was defined as 60 days or more of combination treatment with a Schedule II stimulant and 1 or more additional CNS-active drugs. Combination-3 therapy was defined as the addition of 2 or more additional CNS-active drugs. Using service date and days’ supply, we examined the number of stimulant and other CNS-active drugs for each of the 366 days of 2020.
Results: Among 9 141 877 continuously enrolled adults, the study identified 276 223 individuals (3.0%) using Schedule II stimulants during 2020. They filled a median (interquartile range [IQR]) of 8 (IQR, 4-11) prescriptions for these stimulant drugs that provided 227 (IQR, 110-322) treatment days of exposure. Among this group, 125 781 (45.5%) combined use of 1 or more additional CNS active drugs for a median (IQR) of 213 (IQR, 126-301) treatment days. Also, 66 996 (24.3%) stimulant users also used 2 or more additional CNS-active drugs for a median (IQR) of 182 (IQR, 108-276) days. Among stimulants users, 131 485 (47.6%) were also exposed to an antidepressant, 85 166 (30.8%) also filled prescriptions for anxiety/sedative/hypnotic medications, and 54 035 (19.6%) received opioid prescriptions.
Conclusions: A large proportion of adults using Schedule II stimulants are simultaneously exposed to 1 or more other CNS-active drugs, many with tolerance, withdrawal effects, or potential for non-medical use. There are no approved indications and limited clinical trial testing of these multi-drug combinations.
