The following is a summary of “Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13965 Patients,” published in the November 2022 issue of Psychiatry by Heikkinen, et al.
For the treatment of amphetamine or methamphetamine dependency, there are no drugs that have been approved by the authorities, and there wasn’t much research looking at how well pharmacological interventions affected serious consequences like hospitalization and death. For a study, researchers sought to examine the relationship between pharmacotherapies and mortality, hospitalization, and amphetamine use disorder outcomes.
A median (IQR) follow-up time of 3.9 (1.0-6.1) years was used in the countrywide register-based cohort research, which ran from July 2006 to December 2018. From December 1, 2021, to May 24, 2022, data were examined. Sweden’s national registers of inpatient care, specialized outpatient care, sickness absence, and disability pension were used to identify all residents between the ages of 16 and 64 who had been given a first-time diagnosis of amphetamine or methamphetamine use disorder and had no prior diagnoses of schizophrenia or bipolar disorder. Benzodiazepines and related pharmaceuticals, mood stabilizers, antidepressants, antipsychotics, medications for attention-deficit/hyperactivity disorder, substance use disorders (SUDs), and mood stabilizers were the exposures for the study. Using the PRE2DUP (from prescription drug purchases to drug use periods) technique, medication usage vs. nonuse was predicted. To reduce selection bias, within-individual models were used to compare the use and nonuse periods of 17 different drugs or pharmaceutical classes in the same person for the primary outcomes of hospitalization for SUD and any hospitalization or death. Mortality from all causes was the secondary outcome, and it was examined using between-individual analysis in place of conventional Cox models.
The cohort consisted of 13,965 people, with 9,671 (69.3%) men and a mean [SD] age of 34.4 (13.0) years. 7543 people (54.0%) were using antidepressants, 6,101 (43.7%) benzodiazepines, 5,067 (36.3%) antipsychotics, 3,941 (28.2%) ADHD drugs (1,511 [10.8%] were on lisdexamphetamine), 2,856 (20.5%) SUD meds, and 1,706 (12.2%) mood stabilizers at the time of follow-up. A total of 10,341 patients (74.0%) were hospitalized because of SUDs, 11,492 patients (82.3%) because of any cause or because they passed away, and 1,321 patients (9.5%) passed away for any reason. The only drug in the study that significantly reduced the risk of 3 outcomes was lisdexamphetamine (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.72-0.94 for SUD hospitalization; aHR, 0.86; 0.78-0.95 for any hospitalization or death; aHR, 0.43; 0.24-0.77 for all-cause mortality). The usage of methylphenidate was also linked to a decreased all-cause death rate (aHR, 0.56; 95% CI, 0.43-0.74). The risk of SUD hospitalization was significantly increased by using benzodiazepines (aHR, 1.17; 95% CI, 1.12-1.22); the risk of any hospitalization or death was increased (aHR, 1.20; 95% CI, 1.17-1.24); and the risk of all-cause mortality was increased (aHR, 1.39; 95% CI, 1.20-1.60). The risk of hospitalization for SUD, any hospitalization, or mortality was slightly elevated by the use of antidepressants or antipsychotics (aHR, 1.07; 95% CI, 1.03-1.11 and aHR, 1.05; 1.01-1.09), respectively.
The study found a link between lisdexamphetamine usage and better outcomes for those with amphetamine or methamphetamine use problems, which supported the need for more randomized clinical studies. Use of prescription benzodiazepines was linked to negative results.