Westover AN, et al. - The clinicians performed this study to determine the demographics of stimulant medication users compared with nonusers. Furthermore, they investigated temporal trends of stimulant medication use and estimated risk factors for the development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. Between 2001 to 2012, comorbid substance use disorders were found to be common and were presented as risk factors for the development of an AUD, in a US national cohort of adult incident stimulant medication users in the Veterans Affairs health-care system. They observed increased mortality risk among incident users of stimulant medications among both those who later developed an AUD and those whose use was defined as off-label.

Methods

• The design of this study was Cox proportion hazards regression in a retrospective cohort adjusted by baseline covariates.
• This study was performed at United States, national administrative database of the Veterans Affairs (VA) Health-care system.
• Participants were adult incident users of stimulant medications (n=78,829) from fiscal years (FY) 2001 to 2012.
• Time-to-event: Occurrence of AUD diagnosis and death were constituted the primary outcomes.
• Demographic information, FDA-approved indications for stimulant use, substance use disorders (SUD), and depression were included as baseline covariates.

Results

• Compared with nonusers, stimulant users were younger, more likely non-Hispanic white, and female.
• In this study, a 3-fold increase was noted in the incident stimulant medication users from FY2001 to FY2012, along with an 8-fold increase among adults 18 to 44 years of age.
• A comorbid baseline SUD was observed in nearly 1 in 10 incident users in FY2012.
• In FY2012, off-label use was common in nearly 3 of every 5 incident users.
• Among incident stimulant medication users, comorbid SUDs were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.62 (p < 0.05).
• The clinicians observed increased mortality risk with occurrence of AUD during follow-up (AHR: 1.55, 95% confidence interval [CI] 1.13 to 2.14, p=0.007), while on-label prescribing was protective against death (AHR: 0.686, 95% CI 0.63 to 0.75, p < 0.0001).