Telehealth can make health care easier to access for patients with attention-deficit/hyperactivity disorder (ADHD) who need treatment, but experts worry about an increased risk of substance use disorder for patients being prescribed controlled medications such as stimulants for ADHD during these appointments. Mass General Brigham researchers scrutinized this concern with the first-ever study comparing substance use disorder rates in patients with ADHD who were prescribed stimulant medications during in-person versus virtual appointments. They found that, overall, telehealth was not associated with increased risk of substance use disorder. Still, the researchers noted the importance of comprehensive diagnoses and routine follow-ups. Results are published in the American Journal of Psychiatry.
"Our study suggests that, generally, telehealth-based relationships – which make health care more accessible – can be safe and don't increase the risk of substance use disorder," said lead author Vinod Rao, MD, PhD, lead author of the paper and addiction psychiatrist and medical director of Adult Ambulatory Psychiatry at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system.
The researchers examined the electronic health records of 7,944 ADHD patients between March 2020 and August 2023, a time when many physicians pivoted to online care in response to the COVID-19 pandemic. The researchers found that 91% of the patients had at least one in-person visit with the prescriber around the time they received a stimulant prescription, while 9% of the patients had a telehealth-only relationship with their doctor.
The study found that, overall, patients who only had telehealth visits to access their ADHD medication were not more likely to develop a substance use disorder compared to patients who initially met their prescribers in person, after adjusting for other factors like age and income. However, patients who received their initial stimulant prescription through telehealth were at a higher risk of developing a stimulant use disorder after adjusting for other factors. Stimulant use disorder involves drugs such as prescription medications, cocaine or methamphetamine, among other drugs. Patients aged 26 years and above who received an initial stimulant prescription during a telehealth appointment were at a higher risk of developing substance use disorders than younger patients.
The authors note that, given that only 19 patients in the study developed a stimulant use disorder, the finding could be coincidental. Another possibility is that those who opt for telehealth care are at higher risk for stimulant use disorder.
"While we think the findings should be replicated, the vast majority of the data show no increase in substance use disorder developing when patients exclusively use telehealth," said corresponding author Timothy Wilens, MD, chief of the Division of Child and Adolescent Psychiatry and co-director of the Center for Addiction Medicine at MGH. "Our study supports the use of telehealth for ADHD stimulant therapy in clinical settings."
Authorship: Mass General Brigham authors include Vinod Rao, Sylvia Lanni, and Timothy Wilens. Additional authors include Amy Yule, Sean McCabe, Philip Veliz, and Ty Schepis.
Disclosures: Wilens has co-edited several books on ADHD, holds licensing agreements with Ironshore and 3D Therapeutics, serves as a clinical consultant to multiple organizations including U.S. Minor/Major League Baseball, and has received funding from NIDA. Yule has received research funding from the NIH, the Doris Duke Charitable Foundation, and the National Center for Advancing Translational Sciences, as well as support for clinical program development and consulting roles with various organizations.
Funding: The development of this study was supported by a research award 75F40121C00148 from the US Food and Drug Administration and research award UH3DA050252 from the National Institute on Drug Abuse
Paper cited: Rao V et al "Telehealth prescribing of stimulants for ADHD and associated risk for later stimulant and substance use disorders" AJP DOI: 10.1176/appi.ajp.20240346
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