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The mix of prescribed central nervous system stimulants, similar to medication that relieve ADHD signs, with prescribed opioid drugs is related to a sample of escalating opioid consumption, a brand new research has discovered.
The evaluation of medical insurance claims information from virtually 3 million U.S. sufferers investigated prescribed stimulants’ influence on prescription opioid use over 10 years, in search of origins of the so-called “twin epidemic” of mixing the 2 lessons of medicine, which might improve the chance for overdose deaths.
“Combining the two drugs is associated with an increase in overdose deaths. This is something we know. But we didn’t know whether stimulant use has a causal role in the high use of opioids, so we conducted a big data analysis of how these two patterns interacted over a long period of time,” mentioned senior research creator Ping Zhang, affiliate professor of pc science and engineering and biomedical informatics at The Ohio State College.
“What we found is that if someone is taking a stimulant and an opioid at the same time, they’re generally taking a high dose of the opioid,” he mentioned. “And if the patient in this study population takes the stimulant before beginning opioid use, they are more likely to have higher doses of subsequent opioids.”
The research was revealed Feb. 17 in The Lancet Regional Well being—Americas.
The analysis group obtained information on 22 million sufferers with 96 million opioid prescriptions from MarketScan Industrial Claims and Encounters, a big U.S. medical insurance database. Researchers established a cohort for this research of two.9 million sufferers with a mean age of 44 who had no less than two unbiased opioid prescriptions between 2012 and 2021.
As a result of these prescriptions included a variety of oral formulation—codeine, hydrocodone, methadone, oxycodone, morphine and others—researchers standardized each prescription to morphine milligram equivalents (MME) and calculated every affected person’s month-to-month consumption of opioids. The MME computation from digital well being information was beforehand co-developed by co-senior creator Wenyu Track, an teacher at Harvard Medical Faculty.
First creator Seungyeon Lee, a Ph.D. pupil in Zhang’s lab, used statistical modeling and labeled sufferers into 5 baseline teams of opioid dosage trajectory over the 10-year research interval: very low-dose, low-dose lowering, low-dose growing, moderate-dose growing and high-dose sustained use.
“Some patients had stable low-dose opioid use, while others had increasing or high-dose patterns over time,” Lee mentioned.
Trajectories of opioid doses from (a) the opioid baseline mannequin and (b) the opioid-stimulant mannequin. Credit score: The Lancet Regional Well being – Americas (2025). DOI: 10.1016/j.lana.2025.101030
Of the entire cohort, 160,243 sufferers (5.5%) additionally have been prescribed stimulants. The addition of a month-to-month calculated cumulative variety of stimulant prescriptions to the mannequin and statistical evaluation confirmed a shift within the trajectory teams. Traits that might function threat components for growing opioid use additionally emerged within the information, Lee mentioned.
Average-dose growing and high-dose teams had an total greater common MME and a better proportion of sufferers with diagnoses of despair, nervousness and attention-deficit/hyperactivity dysfunction in comparison with different teams. The low-dose growing group additionally had a better proportion of sufferers with ADHD in comparison with the low-dose lowering group.
The commonest diagnoses linked to co-prescription of stimulants and opioids have been despair and ADHD or ADHD and power ache.
“This was an important finding, that many patients with ADHD and depression, also experiencing chronic pain, have an opioid prescription,” mentioned Zhang, additionally a core college member within the Translational Knowledge Analytics Institute at Ohio State. “This cohort represents a very realistic health care problem.”
Even taking these components under consideration, the mannequin confirmed that stimulant use was key to driving up the chances that sufferers who took each stimulants and opioids would belong to a bunch of people that elevated their doses of opioids.
“Stimulant use before initiating opioids and stimulant co-prescription with opioids are both positively associated with escalating opioid doses compared to other factors,” Lee mentioned.
Evaluation of geographic and gender information additionally provided some clues to opioid use patterns in america. Sufferers within the South and West areas had greater whole opioid intakes over the 10-year research interval in comparison with the Northeast and North Central areas, with the best frequency of opioid prescriptions within the South and better MMEs per prescription within the West. Males additionally had greater common each day opioid intakes than females.
The outcomes linking excessive opioid doses and stimulant use recommend stimulants could also be a driving pressure behind the emergence of the dual epidemic and supply proof that regulation of stimulant prescribing could also be wanted for sufferers already taking prescription opioids, the researchers mentioned. Along with the elevated threat of overdose dying, co-using prescription stimulants and opioids can improve the chance of cardiovascular occasions and psychological well being issues, earlier analysis has proven.
Zhang’s Synthetic Intelligence in Drugs Lab focuses totally on utilizing AI to assist in clinician decision-making, and these findings are half of a bigger undertaking aimed on the improvement of safer personalised therapy suggestions for people who find themselves prescribed each opioids and stimulants.
“We want to reduce the risk of opioid- or stimulant-related adverse drug events in real-world practice,” Zhang mentioned.
Extra data:
Seungyeon Lee et al, The latest development of dual epidemic in america: a 10-year longitudinal cohort research of co-prescriptions of opioids and stimulants, The Lancet Regional Well being—Americas (2025). DOI: 10.1016/j.lana.2025.101030
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A ‘twin epidemic’: Co-prescribed stimulants and opioids linked to greater opioid doses (2025, February 21)
retrieved 21 February 2025
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