Patients who are prescribed stimulants for attention-deficit/hyperactivity disorder (ADHD) via telehealth do not have a greater risk of developing a substance use disorder (SUD) compared with those who receive prescriptions in person, according to a study published this week in The American Journal of Psychiatry (AJP). Patients prescribed via telehealth did have a higher risk of developing a stimulant use disorder, but the authors suggested this may be due to confounding factors.
Vinod Rao, M.D., Ph.D., of Massachusetts General Hospital, and colleagues used electronic health record data to identify 7,944 patients ages 12 and older (57% female, 81% White) who received an initial stimulant prescription for ADHD via telehealth (54% of total) or in-person care (46%) between March 2020 and August 2023. Overall, 432 patients developed a stimulant use or other SUD.
The patients who initially received their stimulant prescriptions via telehealth did not have a significantly higher risk for developing an SUD. However, those patients were six times more likely than those who received their initial prescription in-person to develop a stimulant use disorder after adjusting for covariates.
“While this finding may be spurious, it may also suggest a bias toward those receiving telehealth care being at higher risk specifically for [stimulant use disorder],” Rao and colleagues wrote. “It may be that in the present analyses, unmeasured patient characteristics associated with a greater likelihood of engaging in telehealth over in-person care (e.g., difficulty accessing reliable transportation) also produce a bias toward the development of [stimulant use disorder].”
This conclusion was supported by a second AJP study published the same day in which Y. Nina Gao, M.D., Ph.D., and Mark Olfson, M.D., M.P.H., of Columbia University, examined data from 63,795 adults who reported having at least one health care visit in the last year in the 2021-2022 National Survey of Drug Use and Health. The survey included information on past-year prescription opioid, benzodiazepine, or stimulant misuse, as well as whether the participants spoke with a health practitioner via telehealth or in-person.
While the unadjusted odds of past-year misuse of prescription opioids, benzodiazepines, and stimulants were between 25% and 46% higher among respondents reporting telehealth use, this association was no longer significant for any of these substances after controlling for participants’ history of misuse of that substance.
“These findings bear on an ongoing policy debate balancing the desire to maintain increased patient access to care while minimizing the potential harms of controlled substance prescribing,” Gao and Olfson wrote. “Although differences in average risk between in-person and telehealth cohorts have sometimes been interpreted negatively as ‘doctor shopping’ (i.e., differential selection across providers), it is important to recognize that some patients with higher risk for substance misuse also struggle to access appropriate general and behavioral health care.”
For related information, see the Psychiatric News Alert “One in 10 Patients Starts Buprenorphine Treatment for OUD via Telehealth.”
(Image: Getty Images/iStock/FatCamera)
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