JAMA — Scott Cunningham MD PhD, et al. | November 22, 2022
The mortality and hospitalization rates due to amphetamine and methamphetamine use are on the rise. Although a number of treatments are available (anti-depressants, anti-psychotics, psychostimulants, anti-convulsants, and opioid agonists and antagonists), none are approved.
The current study showed that among all classes of medications commonly used for amphetamine and methamphetamine use disorders, only lisdexamphetamine (an inactive prodrug of dexamphetamine that is currently used to treat ADHD and binge eating disorder) was effective in reducing hospitalizations and mortality.
This was a nationwide register-based cohort study conducted in Sweden involving patients (age range, 16-64 y) with initial diagnoses of amphetamine or methamphetamine use disorder. The median follow-up time was 3.9 y. The primary outcomes were hospitalization and death.
A total of 13,965 patients were enrolled in this study. The patients were prescribed the following medications during follow-up: anti-depressants, 54%; benzodiazepines, 43.7%; anti-psychotics, 36.3%; and ADHD medications, 28.2%.
Of the 13,965 patients in the cohort, 74.0% were hospitalized for substance use disorder, 82.3% were hospitalized for any cause or death, and 9.5% died due to any cause.
Lisdexamethazine decreased the hospitalization rate due to substance use disorder (aHR=0.82), hospitalization for any cause or death (aHR=0.86), and all-cause mortality (aHR=1.39).
Methylphenidate decreased the all-cause mortality rate (aHR=0.56).
Benzodiazepines increased the hospitalization rate due to substance use disorder (aHR=1.17), hospitalization for any cause or death (aHR=1.20), and all-cause mortality (aHR=1.39).
Anti-depressants and anti-psychotics increased the hospitalization rate due to substance use disorder (aHR=1.07 and 1.05, respectively) and hospitalization rate due to any cause or death (aHR=1.10 and 1.06, respectively).