Response

We have read with great interest the report by O’Nions et al (Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study).^{Reference O’Nions, El Baou, John, Lewer, Mandy and McKechnie1} The well-documented reduced life expectancy of patients with attention-deficit hyperactivity disorder (ADHD) is worrying and deserves the attention of both physicians and regulators. Among possible explanations, the authors state that they ‘believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions’. We would suggest that another possible explanation is the treatment used for these patients, and probably the authors have data to analyse such a possibility.

Since 2006, drugs for ADHD in the USA, such as methylphenidate and atomoxetine, carry a black box warning imposed by the Food and Drug Administration to alert patients about the potential cardiovascular risks associated with such medications. The issue was, and still is, highly controversial, because it involves several different edges that spill over into other complex subjects, such as medicalisation and overuse that exceed clinical pharmacology, so we are not going to discuss these. However, if O’Nions and colleagues have access to data on the treatment, they can differentiate whether the decreased life expectancy is the result of patients being undertreated or, alternatively, whether it is associated with patients that receive the usual treatment. Such analysis could be interesting and helpful for the whole medical community.

A cross-sectional survey study by Han et al^{Reference Han, Jones, Volkow, Rikard, Dowell and Einstein2} conducted in 2024 revealed that, among those using prescription stimulants, 25.3% (95% CI, 23.8–26.8%) reported misuse and 9.0% (95% CI, 8.0–10.0%) had a misuse and prescription stimulant use disorder (PSUD). Among those with PSUD, 72.9% (95% CI, 68.3–77.6%) solely used their own prescribed stimulants, 87.1% (95% CI, 82.3–90.8%) used amphetamines, 42.5% (95% CI, 36.6–48.5%) reported no misuse and 63.6% (95% CI, 56.8–69.8%) had mild PSUD, with a higher prevalence of misuse among patients using amphetamines compared with those prescribed methylphenidate, primarily affecting males aged 35–64 years.

In our role as faculty members at Facultad de Medicina, Universidad Buenos Aires, who frequently use medical articles as supporting teaching material for pharmacology courses, particularly during the Clinical Pharmacology module of Pharmacology I, we believe that other readers will probably share our concern that the reduced life expectancy in individuals with ADHD may be due to the misuse of medication prescribed for its treatment – medication to which patients have access through both legal and illegal means – and to the lack of adequate follow-up by their treating physicians.