Ann Pharmacother

Which clinical factors predict opioid prescribing in adults treated for ADHD?

January 23, 2026

A retrospective cohort study of 380,494 patients with ADHD initiating stimulant therapy found that 14.2% received an opioid prescription within one year. Key risk factors, with their corresponding adjusted hazard ratios (aHRs), were as follows:

• Age ≥35 years: 10.84
• Substance use disorders: 1.69
• Multiple chronic conditions: 1.61
• West geographic region: 1.58
• Female gender: 1.29
• Severe mental illnesses: 1.18
• Anxiety: 1.19
• Depression: 1.16

Receipt of behavioral therapy before pharmacotherapy was associated with lower risk of receiving incident opioid prescriptions (aHR, 0.89).

Clinical takeaway: Monitor older adults and those with mental health or chronic conditions closely and consider non‑opioid pain strategies when possible.

Source:

Shrestha M, et al. (2026, January 19). Ann Pharmacother. Risk Factors Associated With Incident Opioid Prescription Among Attention-Deficit/Hyperactivity Disorder Patients Prescribed Stimulants. https://pubmed.ncbi.nlm.nih.gov/41552888/