The Center for Drug Safety and Effectiveness at Johns Hopkins University recently conducted a study on prescription drug use.
The study focused on the use of multiple prescription drugs that affect the central nervous system (CNS) at the same time.
The study found that many doctors prescribe combinations of drugs that are classified as Schedule II controlled substances.
These drugs have a high potential for psychological or physical dependence and are often prescribed together without thorough testing of their effects when used in combination.
The study, which was published in BMJ Open, looked specifically at the use of amphetamine and methylphenidate stimulant drugs.
These drugs are commonly used to treat attention-deficit/hyperactivity disorder (ADHD) and have a high potential for addiction.
The study used prescription drug claims from a commercial insurance claims database that had information on over 9.1 million adults aged 19 to 64.
The researchers found that 276,223 individuals (3.0%) used Schedule II stimulants in 2020. These individuals filled a median of eight prescriptions, which provided 227 days of exposure to the drugs.
Of those using the stimulants, 125,781 (45.5%) also used one or more additional CNS-active drugs for a median of 213 days.
Furthermore, 66,996 (24.3%) of stimulant users used two or more additional CNS-active medications for a median of 182 days.
The study found that many adults who use Schedule II stimulants also use other drugs that affect the central nervous system.
This is concerning because these drugs can have tolerance and withdrawal effects and can also be abused recreationally.
The authors of the study suggest that it may be difficult for individuals to discontinue using these drugs, as they may have become dependent or addicted to them.
The study also found that there was a 79% increase in stimulant use in adults over a 5-year span. Additionally, once treatment starts, 75% of patients become long-term users.
This indicates that there may be risks associated with non-medical use of these drugs.
The drugs are classified as having a high potential for psychological or physical dependence and are frequently found in toxicology drug rankings of fatal overdose cases.
The study also found that many patients were taking amphetamine and methylphenidate products in combination with other psychiatric drugs.
In fact, nearly half of the population exposed to these drugs was being prescribed them in combination with one or more other psychiatric drugs.
This is concerning because there have been no clinical trials conducted on taking three or four of these drugs at the same time.
It is unclear what the patient indicators or treatment outcome goals for such interventions should be, meaning patient outcomes are also currently unknown.
The study identified patients who may be getting stimulants or other psychiatric drugs as part of a prescribing cascade.
For example, 9.5% of the population getting a potent stimulant of the CNS were also taking alprazolam, an anxiolytic/sedative/hypnotic drug.
The data does not indicate which intervention may have come first or whether the drugs were added to counteract each other’s effects.
Either way, this highlights the risk of patients becoming dependent on multiple prescription drugs.
The study reveals significant gaps in knowledge and oversight within the medical community when it comes to prescribing multiple CNS-active drugs.
The prescribing of these drug combinations has yet to be thoroughly tested through clinical trials, meaning they are essentially experimental treatments.
This is a concerning issue as strict federal rules exist to protect patients in research trials, and experiments by prescription are missing many of the basic tenets of good clinical practice.
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The study was conducted by Thomas J Moore et al and published in BMJ Open.
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