Pharmacotherapies for Co-Occurring Stimulant Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Network Meta-Analysis.

Objective

To evaluate the benefit of pharmacotherapies for adults with co-occurring stimulant use disorder (StUD) and attention-deficit/hyperactivity disorder (ADHD) using network meta-analysis. Data Sources: Searches were conducted of PubMed, Embase, Scopus, Web of Science, and ClinicalTrials.gov from inception to February 2026, without language restrictions. Study Selection: Of 4,152 studies retrieved, 6 were included. These evaluated pharmacologic treatments in co-occurring StUD and ADHD, reporting stimulant use parameters and ADHD symptom-related outcomes. We excluded studies not including both disorders, reviews, and abstracts. Data Extraction: Data extracted included continuous abstinence from stimulants, negative urine toxicologies, and ADHD severity. Pharmacotherapies included methylphenidate (MPH), mixed amphetamine salt (MAS), and bupropion. Standardized mean differences (SMDs) or odds ratios (ORs) were calculated; treatment ranking probabilities were assessed using P-scores.

Results

Higher-dose MPH and MAS were associated with superior outcomes. For continuous abstinence, MAS produced the greatest benefit versus placebo (OR=8.45; 95% CI, 2.55-27.98; P=.0005), with the 80-mg dose ranking highest in the network analysis (P-score=0.846). Similarly, pharmacotherapy increased the odds of negative urine tests (OR=1.65; 95% CI, 1.01-2.71; P=.05), and the highest MAS dose again ranked first (P-score=0.890). Regarding improvement in ADHD symptom severity (SMD=-0.59; 95% CI, -0.94 to -0.23; P=.001), the greatest reduction was observed with MPH 180 mg (P-score=0.899). Safety profiles for pharmacotherapies were comparable with placebo.

Conclusions

Stimulant-based pharmacotherapies, particularly higher-dose MPH and MAS, were associated with superior outcomes for both stimulant-use indicators and ADHD symptoms. These findings support consideration of optimized stimulant dosing when treating co-occurring StUD and ADHD, though further trials are warranted to refine clinical recommendations.