Stimulant Misuse and Overdose in Children and Adolescents Continues to Trend

What’s happening – Stimulant overdoses among children and teens have been on the rise, with a growing number of cases related to abuse of prescription ADHD medications, as well as stimulants such as cocaine and methamphetamine, according to new data reported by researchers at Boston Medical Center and Brown University. In youth aged 11 to 14, for example, ED visits for stimulant overdoses between April 2016 and September 2019 increased by 4%.

With a growing number of children and adolescents being prescribed stimulants to manage ADHD symptoms, and stimulant use disorder on the rise, researchers point out that pediatricians and clinicians must be proactive in educating patients and families about the dangers of misusing ADHD medications. The researchers also call on HCPs to screen adolescents for drug use and to advocate for prevention programs in schools and communities. Finally, they stress the need to ensure equal access to addiction education and drug treatment programs for young people across all racial and ethnic groups.

The details – Read the full study by Hadland and Marshall in Pediatrics.

Why it’s complicated – While there are approved pharmacological options to treat misuse, abuse, and addiction to opioids,  as well as to reverse an opioid overdose, no similar medications exist for ADHD misuse, abuse, or overdose, making prevention efforts even more critical. In addition, as reported in our deep-dive on stimulant use disorder, there are lasting consequences – studies have shown that using drugs in youth can predispose one to developing an SUD as an adult, not to mention increased risk for delinquency, academic underachievement, teenage pregnancy, and depression.

 The perspectives –

  • CNN Health points out that Hadland and Marshall’s findings should be a “wake-up call” for parents and warns of the potential for more drug overdoses among adolescents and young adults as the COVID pandemic continues.
  • CHOC Children has warned of the dangers of peer pressure, which can trigger stimulant abuse in some children and teens.
  • The CDC analyzed data from its 2009-2019 Youth Risk Behavior Survey and found that 1 in 7 students report lifestyle use of opioids, while 1 in 14 report currently misusing prescription opioids. Youth in the current use group also had high rates of using other substances at the same time.
  • A study in Addiction points out that increases captured in cocaine-related deaths since 2006 involved opioids, while increases in psychostimulant-related overdoses (both fatal and non-fatal) were a mix of those that included opioids and those that did not.
  • An older study out of UCLA found that, while children with ADHD are at increased risk of substance abuse, taking stimulants in childhood does not seem to put them at higher risk for abusing drugs later in life.

The conversation –

  • @The_BMC (Boston Medical Center) shares “In terms of changing stigma about people who use ‪#methamphetamine, that’s a game changer….”
  • KemPharm has filed an IND for Kp879 to treat stimulant use disorder while Vallon Pharmaceuticals calls for abuse-deterrent solutions, tweeting “Prescription Adderall is the most abused medication among high school and college students….”
  • @CDCgov tweets: “Nearly 40% of ‪#opioid and stimulant overdose deaths occurred while a bystander was present. Expanding bystander access to ‪#naloxone, which can reverse opioid overdoses if administered in time, can save lives. Learn more in CDC’s recent ‪#VitalSigns
  • @NIDAnews shared its research report, noting: “The misuse of ‪#methamphetamine, a highly addictive stimulant, remains an extremely serious problem in the United States. ‪#Overdose ‪#deaths from meth are on the rise, caused in part by dealers who mix it with the dangerous synthetic opioid fentanyl.”
  • @VCHhealthcare (Vancouver Coastal Health) provides prevention strategies, asking: “Do you know how to recognize the signs of an opioid, stimulant or alcohol overdose? Learn the signs and how to respond…”

In practice – Psycom Pro provides a deeper look at stimulant use disorder, including helpful screening tools. Plus, tips from AACAP that may help prescribers differentiate the signs of ADHD from other psychiatric diagnoses in children and adolescents, and how cultural and familial perceptions can impact an ADHD diagnosis.

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The Latest on Statins and Psychiatric Outcomes, including Depression and Suicidality

What’s happening – There is growing recognition that statins, commonly used to treat high cholesterol and blood pressure, may also provide some benefits for people with psychiatric disorders such as depression, dementia, suicidality, schizophrenia. But concern exists about possible interactions between statins and anti-depressant medications when both are used together. A recent literature review explored potential negative effects. The authors noted that, although the potential for a drug-to-drug interaction exists when anti-depressants and statins are taken at the same time, the problem is usually mild enough to not be clinically significant. Therefore, in most cases, they contend, it seems safe to take both drugs together.

The details – Read the full study by Palleria et al in the Journal of Clinical Pharmacology and Therapeutics.

Noteworthy – A separate study, which appeared in the Journal of Affective Disorders, explored concerns that statin use could cause depression. The researchers performed a systematic review and analysis to ultimately rule out this relationship, reporting that they did not find any clear association; however, more research is needed.

The perspectives –

  • Oxford University led an 8-year population-based study of over 1 million adults regarding statin use and neuropsychiatric outcomes (eg, new suicidal behavior, depression, anxiety, or seizures). They concluded that the medications are safe for people with common psychiatric diagnoses.
  • An older report in Drug Safety–Case Reports included research on the mechanisms behind reported psychiatric adverse events related to statin use and low cholesterol levels and found potential for some people using statins to experience behavioral changes and adverse moods. In some cases, these changes negatively impacted people’s jobs and relationships or led them to self-harm.
  • BBC shared insights into people whose personalities have changed using statins, and how they impact the brain.

The conversation –

  • @EvidentlyBetter (a community and mental health news provider) shared its take on the “associations between statin use and suicidality, depression, anxiety and seizures…”
  • In 2018, @IMPACTDeakin (the Institute for Mental and Physical Health and Clinical Translation) tweeted: “Move over #antidepressants! This study reveals how drug repurposing can be beneficial in #psychiatry. The use of low-dose aspirin, statins, allopurinol and angiotensin agents may help decrease the rate of incident #depression.”
  • @seenafazel (co-author of the Oxford paper noted above) tweeted: “…We found no association between statin use and suicidality, anxiety, or seizures, and reduced hazards for depression. Cohort study of all Swedes over 8 yrs (>1.1M) using a within-individual design.”

In practice – More medication management topics and primers in our psychopharmacology section.

New Treatment Approaches for Sleep Disturbance in Individuals with Traumatic Injury, Stroke

What’s happening – It’s common for people who experience a stroke or traumatic brain injury (TBI) to have difficulty sleeping, including via insomnia or obstructive sleep apnea. In search of how best to treat the problem, researchers in the UK conducted a systemic literature review of conservative interventions. They discovered that, for adults with TBI, psychotherapy might be an effective way to address sleep disturbance while acupuncture may improve post-stroke insomnia or post-TBI sleep disturbance.

The UK team also explored exercise and bright light therapy (which can shift sleep patterns) but found that the evidence was not compelling enough to make a strong case for the benefits of these alternative approaches.

A related 2020 study published in Frontiers of Neurology revealed that the extent of sleep disturbances in TBI patients is widespread, impacting as many as half of all cases. Related insomnia is unlikely to resolve without treatment, even after TBI symptoms improve. These authors point out that CBT therapy as a front-line intervention for insomnia can be highly effective.

The details – Read the literature review by Lowe et al in Disability and Rehabilitation.

The perspectives —

  • The American Stroke Association talks about the sleep-related problems faced by stroke survivors.
  • The Rowe Neurology Institute shares research revealing that people who suffer from insomnia are also at increased risk of experiencing a stroke or heart attack.
  • The American Occupational Therapy Association’s Journal offers a recent literature review on CBT use for TBI.

 The conversation –

  • @CNRMStudies (Center for Neuroscience and Regenerative Medicine) tweets: “Service Members with #TBI often experience insomnia. Cognitive behavioral therapy (CBT) can be an effective treatment but there can be barriers to in-person sessions. CNRM will test an internet-guided CBT program for Service Members with TBI and insomnia. #BIAMonth #BrainInjury”
  • @CHESTSleep (Chest Sleep Medicine Network) tweets: “Observational study in post-9/11 veterans @ResearchSleep finds 57.2% at high risk for #Insomnia with increased risk with #PTSD #TBI #Pain @VASanDiego authors encourage increased screening and access to #CBT #SleepTwitter #SleepMed”
  • Researcher, Clinical Sleep Technologist @A_Sweetman1 shares: “Cognitive behavioral therapy for #insomnia #CBTi facilitates withdrawal from sedative-hypnotic medicines. A review of 95 studies and 10,000+participants coming soon.”

In practice – The Mayo Clinic offers a guide to using CBT, as compared to sleep medications, to treat insomnia.

Last Updated: Apr 20, 2021