ArticleThe Lancet regional health. Europe2026
Prescription psychostimulants or atomoxetine and the risk of stimulant-related hospital admissions in adults with and without stimulant use disorder: a Swedish population-based within-individual observational study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Concerns exist that psychostimulant treatment increases the risk of misuse, particularly in individuals with a history of stimulant use disorder (SUD). This study assessed changes in the risk of stimulant-related hospitalizations after initiating treatment with psychostimulants or atomoxetine in individuals with and without SUD. Methods: This population-based study used Swedish registers to identify adults with and without history of SUD, who used psychostimulants or atomoxetine, a non-stimulant prescription medication, between 2008 and 2021. A within-individual design was used to compare the rate ratios (RR) of stimulant-related hospitalizations in two six months periods before and after treatment initiation. Stimulant-related hospitalizations were defined as any hospital visit with a stimulant-related main diagnosis. Findings: Of the 132,666 adults receiving psychostimulants or atomoxetine, 2·4% (3161/132,666) had a history of SUD, while 97·6% (129,505/132,666) did not. The RR for stimulant-related hospitalizations in the six months following treatment initiation was 0·79 (95% CI 0·62-0·99) for individuals with a history of SUD and 0·84 (0·70-1·02) for those without, compared to the 6-month period before treatment initiation. Results were similar across sexes, age groups, and medication classes and sensitivity analyses comparing 8-/12-/52-week periods before and after treatment initiation were consistent with the main findings. Interpretation: We did not observe higher rates of stimulant-related hospitalizations in the 6-month period after initiation of treatment with psychostimulants or atomoxetine in individuals with or without a history of SUD. The observed associations are consistent with a reassuring safety profile and may help inform clinical decision-making when considered alongside clinical guidelines. Funding: This research was funded by FORTE (2020-00467), Karolinska Institutet (KID, 2020-02653), and Region Stockholm (FoUI-977024).
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