Doctors Are Prescribing Drug Combinations That Have A High Potential For Addiction Without Combined Clinical Trial Testing, New Research Found
Johns Hopkins University’s Center for Drug Safety and Effectiveness recently conducted a study examining the use of multiple prescription concurrent central nervous system (CNS)-active drugs.
The research revealed that doctors are prescribing combinations of drugs classified as Schedule II controlled substances without robust combined clinical trial testing– resulting in a greater risk of physical or psychological dependence.
The study, which has since been published in BMJ Open, specifically analyzed patterns of medical methylphenidate and amphetamine drug use. Both of these substances are known to have increased potential for physical or psychological addiction.
To do this, the team used prescription drug claims from a commercial insurance claims database– which is home to over 9.1 million enrolled adults. However, the researchers utilized claims for United States adults between the ages of 19 and 64 and focused on stimulant use.
An adult met the criteria for stimulant use if they filled one or more prescriptions for a stimulant within one year.
In 2020, the study revealed that 276,223 people were prescribed Schedule II stimulants. In fact, eight prescriptions was the median number of prescriptions filled– providing exposure for 227 days.
Within this group, 45.5%– or 125,781 individuals– also used a combination of one or more CNS-active drugs for a median duration of 213 days.
Additionally, about 24.3% of stimulant users– or 66,996 individuals– were prescribed two or more additional CNS-active drugs with a median duration of 182 days.
And among the entire group of stimulant users, about 47.6% of individuals used antidepressants; meanwhile, 30.8% of people filled drug prescriptions for anxiety, sedative, or hypnotic medications, and 19.6% filled opioid prescriptions.
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Many adults who use Schedule II stimulants use one or more additional CNS-active drugs simultaneously. However, due to the drugs’ potential for tolerance forming, withdrawal effects, and recreational abuse, the researchers claim that “discontinuation may be challenging.”
In other words, some individuals may have formed addiction or habitual dependence, which could require rehabilitation or at least intervention.
Additionally, the study revealed many other worrisome patterns. It was found that following the onset of treatment, 75% of patients prescribed stimulants ultimately become long-term users.
Plus, the researchers found that amphetamine and methylphenidate products are being prescribed for more than the treatment of adult ADHD– which is their primary approved application.
More specifically, almost half of the population exposed to stimulants were prescribed a combination of these drugs with at least one or more additional psychiatric drugs.
About 24.3% of individuals were even given an additional two or more psychiatric drugs.
So, while clinical trials have been conducted for each individual drug, no clinical trials have analyzed the simultaneous use of three or four drugs at one time.
And given this lack of research, it remains unclear what treatment outcome goals should be and what the patient indicators are.
The research team also pointed out how conducting a study with specific drug combinations might not even be possible because of ethical concerns and patient safety.
The authors claimed that the individuals who were given these stimulants or other psychiatric drugs were part of a “prescribing cascade.”
For instance, 9.5% of individuals who received a potent stimulant were also prescribed alprazolam– a sedative.
“These data do not indicate which intervention may have come first– a stimulant added to compensate for excess sedation from the benzodiazepine or the alprazolam added to calm excessive CNS stimulation and/or insomnia from the stimulants or other drugs,” the authors wrote.
Regardless, the research revealed that there is a significant gap in both knowledge and oversight when it comes to the prescribing of drug combinations.
“Little scientific evidence is available to assess the risks and benefits of combination therapy with multiple psychiatric drugs. In addition, many combination therapy drugs had their own elevated risks of psychological or physical dependence or non-medical use,” the authors concluded.
To read the study’s complete findings, visit the link here.
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