Study on Lisdexamphetamine and Amphetamine Disorders

Lisdexamphetamine is tied with improved outcomes for those with amphetamine disorders according to a new study published in the JAMA Psychiatry.

There are no medications approved by authorities for the treatment of amphetamine or methamphetamine dependence, and studies investigating the effectiveness of pharmacological treatments in hard outcomes, such as hospitalization and death, are lacking.

A study was conducted to investigate the association between pharmacotherapies and hospitalization and mortality outcomes in persons with amphetamine or methamphetamine use disorder.

This nationwide register-based cohort study was conducted from July 2006 to December 2018 with a median (IQR) follow-up time of 3.9 (1.0-6.1) years. Data were analyzed from December 1, 2021, to May 24, 2022. All residents aged 16 to 64 years living in Sweden with a registered first-time diagnosis of amphetamine or methamphetamine use disorder and without previous diagnoses of schizophrenia or bipolar disorder were identified from nationwide registers of inpatient care, specialized outpatient care, sickness absence, and disability pension.

Results

There were 13,965 individuals in the cohort.

During follow-up:

• 7,543 individuals (54.0%) were taking antidepressants
• 6,101 (43.7%) benzodiazepines
• 5,067 (36.3%) antipsychotics
• 3,941 (28.2%) ADHD medications (1,511 [10.8%] were taking lisdexamphetamine)
• 2,856 (20.5%) SUD medications
• 1,706 (12.2%) mood stabilizers

A total of 10,341 patients (74.0%) were hospitalized due to SUDs, 11,492 patients (82.3%) were hospitalized due to any cause or died, and 1,321 patients (9.5%) died of any cause.

Lisdexamphetamine was the only medication in this study that was significantly associated with a decrease in risk of 3 outcomes:

• Methylphenidate use also was associated with lower all-cause mortality
• Use of benzodiazepines was associated with a significantly higher risk of SUD hospitalization, any hospitalization or death, and all-cause mortality
• Use of antidepressants or antipsychotics was associated with a slight increase in risk of SUD hospitalization as well as any hospitalization or death

In this study, use of lisdexamphetamine was associated with improved outcomes in persons with amphetamine or methamphetamine use disorders, encouraging the conduct of randomized clinical trials. Prescription benzodiazepine use was associated with poor outcome.

Reference

Heikkinen M, Taipale H, Tanskanen A, Mittendorfer-Rutz E, Lähteenvuo M, Tiihonen J. Association of Pharmacological Treatments and Hospitalization and Death in Individuals With Amphetamine Use Disorders in a Swedish Nationwide Cohort of 13,965 Patients. JAMA Psychiatry. Published online November 16, 2022. doi:10.1001/jamapsychiatry.2022.3788