ADHD Drugs Reduce Risk of Suicidal Behavior, Criminality, and More

New research showed that drugs for ADHD reduce the risk of suicidal behavior, substance misuse, transport accidents, and criminality, but not accidental injuries.¹

“The observed reduced rates were more pronounced among patients with a history of outcome events and for stimulants versus non-stimulants,” wrote study investigator Le Zhang, PhD Candidate, from the department of medical epidemiology and biostatistics at Karolinska Institutet in Stockholm, Sweden, and colleagues.¹

Several ADHD medications sit on the market, from methylphenidate-based or amphetamine-based stimulants to atomoxetine or antihypertensives nonstimulants.² These drugs address the 3 core ADHD symptoms: inattention, hyperactivity, and impulsivity. As seen in public discourse and media coverage, many people do not know the risks and benefits of ADHD drug treatment.¹

Several pharmacoepidemiologic studies demonstrated the link between ADHD and several adverse outcomes, including suicidal behaviors, substance misuse, accidental injuries, transport accidents, and criminality, demonstrated in several pharmacoepidemiologic studies. Despite reports of these associations, the pharmacoepidemiologic studies are constrained by time-varying confounding, carryover effects, and the reliance on treated patients who had experienced the outcomes. A team from Sweden recognized the need for rigorous population-based studies using routine clinical data to better reflect diverse patient populations and enable comparison with trial evidence.¹

Investigators applied the target trial emulation framework to assess the effects of drug treatment for ADHD on 5 critical outcomes: suicidal behaviors, substance misuse, accidental injuries, transport accidents, and criminality. The primary outcome of this study was the first and recurrent events of the 5 critical outcomes over 2 years after an ADHD diagnosis.¹

Leveraging national registers in Sweden (2007 – 2020), the team included 148,581 individuals aged 6 – 54 years (mean age, 17.4 years; 41.3% females) with a new ADHD diagnosis. The sample had a mixture of participants who started or did not start drug treatment for ADHD within 3 months of diagnosis. Slightly more than half (56.7%; n = 84,282) started drug treatment for ADHD, with methylphenidate being the most commonly prescribed (88.4%).¹

Compared with no drug treatment initiation, the study found that ADHD drug treatment initiation was linked to reduced rates of suicidal behaviors (14.5 vs 16.9 1000 person years; adjusted incidence rate ratio (aIRR), 0.83; 95% confidence interval [CI], 0.78 to 0.88), substance misuse (58.7 vs 69.1 per 1000 person years; aIRR, 0.85; 95% CI, 0.83 – 0.87), transport accidents (24.0 vs 27.5 per 1000 person years; aIRR, 0.88; 95% CI, 0.82 – 0.94), and criminality (65.1 vs 76.1 per 1000 person years; aIRR, 0.87; 95% CI, 0.83 – 0.90) at the first occurrence. The link between ADHD drugs and the reduction of accidental injuries was not statistically significant (88.5 vs 90.1 per 1000 person years; IRR, 0.98; 95% CI, 0.96 – 1.10).¹

The reduced rates were prominent among participants with previous events; incidence rate ratios ranged from 0.79 (95% CI, 0.72 – 0.82) for suicidal behaviors to 0.97 (0.93 to 1.00) for accidental injuries. When it came to recurrent events, ADHD drugs were significantly associated with reduced rates of suicidal behaviors (iRR, 0.85; 95% CI, 0.77 – 0.93), substance misuse (iRR, 0.75; 95% CI, 0.72 – 0.78), accidental injuries (iRR, 0.96; 95% CI, 0.92 – 0.99), transport accidents (iRR, 0.84; 95% CI, 0.76 – 0.91), and criminality (iRR, 0.75; 95% CI, 0.71 – 0.79).¹

Furthermore, the study showed that stimulants were linked to lower event rates than non-stimulants in substance misuse (iRR, 0.74; 95% CI, 0.72 – 0.76), accidental injuries for first event (iRR, 0.95; 95% CI, 0.93 – 0.98), criminality (iRR, 0.71; 95% CI, 0.69 – 0.73), and accidental injuries for recurrent events (iRR, 0.97; 95% CI, 0.95 – 0.99).¹

“This is the first target trial emulation study showing beneficial effects of ADHD drug treatment on broader clinical outcomes in the entire ADHD population,” investigators concluded.¹ “These results… should inform clinical practice and the debate on the drug treatment of ADHD.

References

1. Zhang L, Zhu N, Sjölander A, et al. ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ. 2025;390:e083658. Published 2025 Aug 13. doi:10.1136/bmj-2024-083658

2. Medications Used in the Treatment of ADHD. CHADD. https://chadd.org/for-parents/medications-used-in-the-treatment-of-adhd/. Accessed August 25, 2025.