BMJ

ADHD medication linked to lower risk of suicide, substance misuse, and criminality

August 15, 2025

Study details: A nationwide Swedish register-based target trial emulation (2007–2020) included 148,581 individuals aged 6 to 64 years with newly diagnosed ADHD, comparing those who initiated drug treatment (primarily methylphenidate) within three months of diagnosis with those who didn't. Outcomes assessed over two years included first and recurrent events of suicidal behaviors, substance misuse, accidental injuries, transport accidents, and criminality.

Results: ADHD drug treatment was associated with significantly lower rates of first-time adverse events. Compared with non-initiators, treated individuals had reduced adjusted incidence rate ratios (IRR) per 1,000 person-years for:

• Suicidal behaviors: 14.5 vs. 16.9; IRR 0.83 (95% confidence interval [CI], 0.78 to 0.88)
• Substance misuse: 58.7 vs. 69.1; IRR 0.85 (95% CI, 0.83 to 0.87)
• Transport accidents: 24.0 vs. 27.5; IRR 0.88 (95% CI, 0.82 to 0.94)
• Criminality: 65.1 vs. 76.1; IRR 0.87 (95% CI, 0.83 to 0.90)

Reduction in accidental injuries wasn’t statistically significant: 88.5 vs. 90.1; IRR 0.98 (95% CI, 0.96 to 1.01). Among individuals with prior events, reductions were more pronounced, with IRRs ranging from 0.79 for suicidal behaviors to 0.97 for accidental injuries. For recurrent events, treatment was associated with significantly lower rates across all five outcomes.

Clinical impact: ADHD pharmacotherapy may offer protective effects beyond symptom control, reducing risks of serious behavioral and safety-related outcomes. These findings support broader consideration of medication in ADHD management, particularly for patients at elevated risk.

Source:

Zhang L, et al. (2025, August 13). BMJ. ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. https://pubmed.ncbi.nlm.nih.gov/40803836/