Receipt of Lisdexamphetamine Associated With Decreased Risk of Hospitalization and Death in a Cohort of People With Stimulant Use Disorder

Despite increasing prevalence and mortality associated with stimulant use disorders—particularly methamphetamine—treatment options remain limited. Researchers used Swedish national registry data to follow 14,000 persons aged 16–64 with a stimulant use disorder diagnosis. They examined associations of prescription stimulant use and other psychotropic medication use with hospitalization and mortality.

• Among participants (70 percent male, mean age 35), 28 percent were prescribed stimulant medications or atomoxetine; 44 percent were prescribed benzodiazepines. Co-occurring psychiatric illnesses, including co-occurring substance use disorders (SUDs), were common, as were prescriptions for other psychotropic medications.
• During the follow-up period (mean 4 years), 75 percent of participants experienced SUD-related hospitalization(s), and 10 percent died.
• Receipt of the medication lisdexamphetamine was associated with decreased odds of SUD-related hospitalization (adjusted hazard ratio [aHR], 0.82), hospitalization due to any cause or death (aHR, 0.86), and all-cause mortality (aHR, 0.43). Receipt of methylphenidate was also associated with decreased odds of all-cause mortality (aHR, 0.56).
• Receipt of benzodiazepines was associated with increased odds of SUD-related hospitalization (aHR, 1.17), any hospitalization or death (aHR, 1.20), and all-cause mortality (aHR, 1.39).
• Researchers did not assess whether observed associations varied by type of stimulant use disorder (e.g., methamphetamine, cocaine, prescription stimulant, etc).

Comments: Receipt of lisdexamphetamine was associated with decreased odds of hospitalization and death in a large cohort of Swedish persons with stimulant use disorder. Benzodiazepine use was associated with increased odds of these outcomes. Medications that have previously demonstrated potential for treatment of stimulant use disorder in randomized controlled trials, including naltrexone and bupropion, were not associated with beneficial outcomes in this study. These results support the need for randomized controlled trials to test the efficacy of lisdexamphetamine for the treatment of stimulant use disorders.

Carrie Mintz, MD

Reference: Heikkinen M, Taipale H, Tanskanen A, et al. Treatments and hospitalization and death in individuals with amphetamine use disorders in a Swedish nationwide cohort of 13965 patients. JAMA Psychiatry. 2023;80(1):31–39.