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1.
EClinicalMedicine ; 50: 101524, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35812998

ABSTRACT

Background: Stimulant prescriptions increased by 250% in the United States from 2006-2016 while diagnoses for ADHD minimally increased. There is insufficient data regarding who may be the recipients of these new stimulant prescriptions and safety of stimulants have come under scrutiny in some populations. We aim to describe trends in stimulant prescriptions across biopsychosocial patient level factors between 2010 and 2020. Methods: We applied a retrospective observational cohort design utilizing electronic health records from 52 healthcare organizations sourced from the TriNetX research network database in the United States. We assessed new stimulant prescriptions across biopsychosocial variables for recipients of prescriptions. We utilized linear regression to assess longitudinal trends of all participants and also conducted an age stratified logistic regression analysis. Findings: There was an increase in stimulants to people categorized as white (OR 1.24 CI 1.20-1.28), female (OR 1.28 CI 1.23-1.31), and to those with diagnosed anxiety disorders (OR 1.39 CI 1.35-1.44) as well as obesity (OR 1.34 CI 1.28-1.41). The average age of recipients increased throughout the study, and among people sixty-five and older, there was an increase in prescriptions to people with multiple cardiovascular risk factors. Interpretation: Prescription stimulant dispensing may have liberalized during the study period in some demographics as a greater number of new prescriptions were dispensed to individuals with risk of adverse outcomes (i.e. older individuals, obese individuals, and geriatric patients with CV risk factors) between 2010 and 2020. Similar trends in prescription medications were witnessed through the opioid epidemic and warrant attention given concerning trends with illicit stimulants. Additional research that investigates patient and provider motivation for stimulant prescriptions, as well as risk perception of stimulants, may be warranted. Funding: This study was made possible by institutional resources at Penn State Hershey Medical Center.

2.
J Gerontol A Biol Sci Med Sci ; 77(12): 2459-2463, 2022 12 29.
Article in English | MEDLINE | ID: mdl-35137053

ABSTRACT

BACKGROUND: Prescription amphetamines are utilized for treatment of depression in older adults, yet cardiovascular risks in this population are not well described. The purpose of this study is to evaluate risk of cardiovascular events among adults aged 65 and older with depression who were prescribed amphetamines. METHODS: We conducted a retrospective matched cohort study utilizing the TriNetx database and statistical software. The 1:1 propensity score matching technique was performed using logistic regression to balance the baseline characteristics of the population. Inclusion criteria were a diagnosis of depression and age 65 years and older. We excluded individuals with an adverse cardiovascular event or diagnosis of attention deficit and hyperactivity disorder prior to enrollment. Individuals were followed from January 1, 2018 to December 31, 2020. Those prescribed an amphetamine were considered exposed and others served as controls. We used descriptive statistics and calculated risk ratios to assess the relationship between amphetamine prescriptions and cardiovascular events in these cohorts. RESULTS: There were 4 434 included in the exposed cohort and 4 434 matched controls in the unexposed group. The cohort exposed to amphetamines had higher high-density lipoprotein along with lower low-density lipoprotein, total cholesterol, hemoglobin A1C, systolic blood pressure, and body mass index than the control group, but increased risk of cardiovascular events (risk ratio: 8.9; 95% confidence interval: 6.39, 12.48). CONCLUSIONS: Amphetamines offer potential benefits to people with depression; however, these data suggest increased risk of cardiovascular events among older individuals. Additional research is warranted to fully characterize risk among subpopulations of older adults and inform patient-provider decision making.


Subject(s)
Cardiovascular Diseases , Central Nervous System Stimulants , Humans , Aged , Central Nervous System Stimulants/adverse effects , Retrospective Studies , Cohort Studies , Depression/drug therapy , Depression/epidemiology , Amphetamines/adverse effects , Amphetamine/adverse effects , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/diagnosis
3.
J Am Board Fam Med ; 34(6): 1074-1081, 2021.
Article in English | MEDLINE | ID: mdl-34772763

ABSTRACT

BACKGROUND: Prescription amphetamines are the most common pharmacological treatment for attention deficit hyperactivity disorder (ADHD) and use among older age groups is increasing. The purpose of this study is to assess the risk of adverse cardiovascular events among individuals older than 65 years. METHODS: We conducted a retrospective matched cohort study using TriNetX database with propensity score matching (PSM) to assess the odds of a cardiovascular event among individuals with ADHD exposed to amphetamine compared with individuals with ADHD who were not exposed to this medication. During the index period of January 1, 2018, through December 31, 2020, 13,233 individuals older than 65 years (mean age = 69 years) met the study criteria. RESULTS: The cohort exposed to amphetamine had increased blood pressure and increased odds of cardiovascular events (odds ratio [OR], 6.16; absolute risk difference = 3.31%) compared with the control group. CONCLUSIONS: Amphetamines have clear safety data in younger age cohorts; however, this safety data may not generalize to older populations. Additional research is warranted to clarify further exposure and subpopulation-level risk factors associated with adverse cardiovascular events among older patients.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Cardiovascular Diseases , Central Nervous System Stimulants , Aged , Amphetamines/adverse effects , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/epidemiology , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Central Nervous System Stimulants/adverse effects , Cohort Studies , Humans , Retrospective Studies
4.
J Addict Dis ; 39(3): 421-424, 2021.
Article in English | MEDLINE | ID: mdl-33616013

ABSTRACT

Opioid overdose continues to be the leading cause of accidental death in the United States, and the prevalence of OUD continues to increase. Increased access to health insurance-specifically in regard to state-funded Medicaid programs-as well as robust formularies and limited prior authorization have been demonstrated to be effective both in treating patients with OUD, as well as producing cost savings for government and commercial payors.


Subject(s)
Health Services Accessibility/economics , Medicaid , Opiate Substitution Treatment/economics , Opioid-Related Disorders/prevention & control , Prior Authorization , Humans , Policy Making , United States
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