Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events.

The authors analyzed 2005–2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not.

In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64–0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67–0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78–0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82–0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women.

These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

物质使用障碍是导致注意力缺陷多动障碍（ADHD）的个体过高死亡率的主要原因，但尚不清楚药理ADHD治疗与药物相关问题之间的关联。这项研究调查了多动症药物治疗与药物相关事件之间的长期和长期关联。

作者分析了2,993,887名（占女性的47.2％）ADHD青少年和成人的2005-2014年商业医疗保健索赔。个体内部分析比较了在患者接受处方药或阿莫西汀治疗的几个月中与药物相关事件（即急诊室与药物滥用相关的风险）的风险，相对于未接受药物治疗的风险。

在调整后的个体内部比较中，相对于未接受ADHD药物治疗的时期，男性患者接受药物治疗时并发物质相关事件的几率降低了35％（优势比= 0.65，95％CI = 0.64-0.67），女性患者并发物质相关事件的几率低31％（几率= 0.69，95％CI = 0.67-0.71）。此外，在服药2年后，男性患者与药物相关事件的几率降低19％（几率= 0.81，95％CI = 0.78-0.85），而女性患者在药物治疗2年后与药物相关事件的几率降低14％。用药时间（赔率= 0.86，95％CI = 0.82-0.91）。敏感性分析支持大多数发现，但对于女性之间的长期关联而言并不一致。

这些结果提供了证据，证明接受ADHD药物不太可能与青春期或成年期与物质有关的问题的更大风险相关。相反，药物治疗与物质相关事件的并发风险较低有关，至少在男性中，与未来物质相关事件的长期风险较低有关。