When Stimulants and Opioid Medications Are Prescribed Together

 ADHD Weekly September 6, 2018

The opioid crisis continues across the United States, leaving many healthcare professionals and patients in need of long-term medication management looking for information to help them make healthy choices regarding treatment.

Very often ADHD stimulant medications end up included in well-meaning laws and regulation meant to reduce opioid medication abuse, leaving ADHD patients frustrated. In other situations, people who employ medication to treat ADHD find that their chronic pain from other conditions is undertreated.

Researchers at universities in Florida and Maryland recently collaborated to study how frequently ADHD stimulant medications and opioid medications for pain relief are prescribed together. Their findings encourage more research to better understand the benefits and risks of long-term use of these medications together.

They also noted two factors that play a role in the co-prescribing of these medications: co-occurring conditions such as anxiety and depression, and doctors’ desire to let patients know their health concerns are heard.

“To our knowledge, the present study is among the first to provide population-based data on the long-term concurrent use of stimulants and opioids among adults with ADHD,” the researchers write. “Our findings suggest that long-term concurrent use of stimulants and opioids has become an increasingly common practice among adult patients with ADHD.”

The role of chronic pain

The researchers note there is a frequent co-occurrence between chronic pain and an ADHD diagnosis. The reasons for this aren’t entirely understood, but professionals have some very good ideas. There are two main possibilities for why people affected by ADHD experience chronic pain more often.

“Because of attention-deficit issues and increased risk-taking behavior, patients with ADHD are more prone to accidents causing physical injuries and, thereby, may be more likely to develop musculoskeletal chronic pain,” they say. “Alternatively, some researchers have [suggested] that muscle pain is the long-term consequence of ADHD-associated motor problems.”

Opioid medications are among the most commonly prescribed medications for post-surgical pain and for managing long-term chronic pain. These medications were also more often prescribed to patients older than 40.

Additionally, commonly co-occurring conditions such as anxiety and depression can also produce ongoing achiness as symptoms, which might contribute to the chronic pain experienced by the adults in the study. Prescribers might also try to treat these conditions through pain management medications.

What the study means for ADHD

Max Wiznitzer, MD, co-chair of CHADD’s professional advisory board, has looked at the study. He says adults who employ medication as part of their ADHD treatment plan should not find the study to be something to be overly concerned about.

“The risk of using both ADHD meds and opioids together long term is small, so this applies to a small number of ADHD patients,” Dr. Wiznitzer says. “This study suggests that treated ADHD may not be the driving force [providing a risk] but, rather, comorbid disorders or chronic pain.”

Dr. Wiznitzer says that he does not see a cause and effect relationship between the use of medication for ADHD and possible abuse of opioid medications later on. He adds that previous research has shown that properly used ADHD medication can help prevent the misuse or abuse of other medications or drugs.

Why it’s important to understand concurrent use

“Our study contributes to the understanding of the potential risk factors associated with long-term concurrent stimulant-opioid use among adults with ADHD,” the study researchers say. “Identifying these high-risk patients allows for early intervention and may reduce the number of adverse events associated with the long-term use of these medications. The common long-term use of stimulants and opioids, especially short-acting agents, observed among adults with ADHD deserves further investigation to understand the association of the use of this drug combination with patient health outcomes.”

When prescribers and healthcare providers have a better sense of who could develop a dependence on opioid medications or begin to abuse opioids, they can take steps to better treat patients to prevent complications.

In addition to prescribing opioid medications, healthcare providers can also consider different types of medications, lifestyle adjustments, or complementary approaches that may be better choices for some individuals, depending on their pain management needs. For lawmakers, understanding the uses of these medications to improve the lives of people affected by ADHD and chronic pain is also important when they are considering ways to discourage abuse of medications.

What you can do

Before making any changes to your treatment plan for either ADHD or chronic pain, discuss any concerns you may have with your healthcare provider. Always take medication as prescribed and let your doctor know if you feel that your medication isn’t working as it should.

Working closely with your doctor is the best way to create and sustain a treatment plan that meets your needs.

Learn more about this study: