Am J Psychiatry

Telehealth stimulant prescribing for ADHD not linked to increased SUD risk

June 13, 2025

Study details: This retrospective cohort study analyzed electronic health record data from a large, academically affiliated health system in the Northeastern U.S., including 7,944 patients aged ≥12 years with ADHD who received their first stimulant prescription between March 2020 and August 2023. Patients with pre-existing non-nicotine substance use disorders (SUDs) were excluded. The study compared risk for subsequent stimulant use disorder (stimUD) and other SUDs based on whether the initial stimulant prescription was provided via telehealth or in-person, and whether the prescriber had ever seen the patient in person.

Results: A purely telehealth-based provider relationship didn't significantly alter risk for later SUD (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.60–1.20) or stimUD (aOR, 1.28; 95% CI, 0.34–4.85). However, receiving the initial stimulant prescription via telehealth (vs. in-person) was associated with a significantly higher risk for subsequent stimUD (aOR, 6.18; 95% CI, 1.34–28.46), but not for other SUDs (aOR, 1.15; 95% CI, 0.92–1.44).

Clinical impact: These findings suggest that telehealth initiation of stimulant therapy for ADHD doesn't increase overall SUD risk, but may be associated with increased risk for stimUD specifically. The authors note that these results, particularly for stimUD, require replication in other healthcare settings before informing policy or practice change.

Source:

Rao V, et al. (2025, June 11). Am J Psychiatry. Telehealth Prescribing of Stimulants for ADHD and Associated Risk for Later Stimulant and Substance Use Disorders. https://pubmed.ncbi.nlm.nih.gov/40495525/