May 2, 2023: Lizzy P., a 77-year-old retired nurse from Delaware, has been taking Adderall for approximately 10 years.
“The doctor recommended it to me for many reasons,” he said. “I get tired easily, he’s a stimulant, so he thought it would help keep me alert as I was driving long distances at the time. I also have severe depression and he thought he could help with that too.”
Lizzy takes another five medications. Two are for “physical” problems: she takes Synthroid (levothyroxine) to boost thyroid hormones and Norvasc (amlodipine) for her high blood pressure.
“The rest are due to emotional and mental problems,” he said. “I take Lexapro [escitalopram], an antidepressant that I have been taking for decades; i take valium [diazepam] for anxiety or when I have trouble sleeping; And I take an opioid, Vicodin [hydrocodone]for arthritis pain.
Lizzy does not want her full name revealed in this article. “I live in a retirement community where some people can be nosy, and I don’t want them to know about all my health issues and gossip,” she says. “And it’s embarrassing because sometimes I find it confusing to be taking so many pills. It’s often hard to keep them all in order: what I’m taking and when I’m supposed to take it.”
‘High potential’ for abuse
Lizzy is typical of an increasingly common trend: American adults taking a stimulant medication, along with other drugs that attack the central nervous system, such as antidepressants, opioids and anti-anxiety drugs, according to a new study published in the journal BMJ Open.
The drugs are “the old amphetamines and methylphenidate [Ritalin]”, which are schedule II controlled substances, said the study’s lead author. Thomas J. Moore, a faculty associate in epidemiology at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Medicine in Baltimoremy. These drugs have been around and have been used for 85 years.
According to the US Drug Enforcement Administration., amphetamine, and methylphenidate are considered “dangerous” because of their high potential for abuse. They also have a high potential for physical or psychological dependence.
The FDA approved these stimulants to treat attention deficit hyperactivity disorder in children and adults, but they have also been used to treat nasal congestion, narcolepsy, binge eating, depression, and senile behavior, and have been used as mood suppressants. appetite, the authors said. And they are increasingly being used “off-label,” which means they are used to treat conditions for which they were not approved, Moore said.
Moore and his colleagues had previously studied stimulant prescription trends and found a 79% increase in the use of these drugs between 2013 and 2018. The researchers wanted to explore how these stimulants are used and, in particular, wanted to know what types of others the drugs were being taken at the same time.
Use the lowest dose for the shortest period
Moore and her team analyzed prescription drug claims from a large commercial insurance claims database of more than 9.1 million adults (ages 19-64) between 2019 and 2020.
They found that 3% of people in the database (276,223 people) had used a schedule II stimulant in 2020. Of these, 45.5% were also taking a central nervous system medication. Almost a quarter (24.3%) used two or more of these drugs simultaneously.
The most frequently co-prescribed drugs were antidepressants, anxiolytics, and opioids. About half (47.6%) of stimulant users were also taking an antidepressant, while about one-third (30.8%) filled prescriptions for anxiety/sedative/hypnotic meditation, and one-fifth (19, 6%) received opioid prescriptions.
Other medications included anticonvulsants, which are sometimes used to stabilize mood (14%), antipsychotics (8%), and other stimulants (2%).
Most patients using these drugs become “long-term users” once treatment has started, with three-quarters of patients continuing to take them over the 1-year study period.
There isn’t much research examining these types of combinations, so the “additional benefits and risks” of taking them together “remain unknown,” Moore said.
It cautioned that amphetamine stimulants in adults “should be used at the lowest dose that produces results for the shortest period possible and should be closely monitored by the prescribing healthcare professional.”
Complex prescription regimens
These new findings “require research to increase our understanding of the clinical contexts that motivate these complex prescribing regimens, as well as their efficacy and safety,” said Mark Olfson, MD, MPH, professor of psychiatry, medicine and law, and professor of epidemiology. at Columbia University Irving Medical Center in New York City.
Lizzie agrees. “Sometimes she feels like the doctors have just been ‘throwing darts at a board’ hoping something hits the right target. Unfortunately, I still have some depression and anxiety, even though I’m on this complicated cocktail of drugs,” she said.
Meanwhile, Lizzy plans to see her psychiatrist and ask if she can review the regimen. “Maybe we can experiment with adjusting it and removing one or more of the drugs and see if I really need it. That would simplify things and might even improve my symptoms.”
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