Adult-Attention Deficit Hyperactive Disorder Symptoms Seem Not to Influence the Outcome of an Enhanced Agonist Opioid Treatment: A 30-Year Follow-Up

Abstract

The role of opioids and opioid medications in ADHD symptoms is still largely understudied. We tested the hypothesis that, in Heroin Use Disorder (HUD), when patients are treated with Agonist Opioid medications (AOT), treatment outcome is associated with the presence of Adult Attention-Deficit/Hyperactive Disorder (A-ADHD) symptomatology. A retrospective cohort study of 130 HUD patients in Castelfranco Veneto, Italy, covering 30 years, was divided into two groups according to the Adult ADHD Self-Report Scale (ASRS) score and compared them using demographic, clinical and pharmacological factors. Survival in treatment was studied by utilizing the available data for leaving treatment and relapsing into addictive behavior and for mortality during treatment as poor primary outcomes. Thirty-five HUD subjects (26.9%) were unlikely to have A-ADHD symptomatology, and 95 (73.1%) were likely to have it. Only current age and co-substance use at treatment entry differed significantly between groups. Censored patients were 29 (82.9%) for HUD patients and 70 (73.9%) for A-ADHD/HUD patients (Mantel-Cox test = 0.66 p = 0.415). There were no significant linear trends indicative of a poorer outcome with the presence of A-ADHD after adjustment for demographic, clinical and pharmacological factors. Conclusions: ADHD symptomatology does not seem to exert any influence on the retention in AOT of HUD patients.

Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review

“…This scoping review identified 18 studies (Figure 1) evaluating important health outcomes among patients with OUD and ADHD within addiction treatment programs. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The sample size of the included studies ranged from 12 to 81 752 patients. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The follow-up period of longitudinal studies ranged from 12 weeks to 30 years.…”

“…6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The sample size of the included studies ranged from 12 to 81 752 patients. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The follow-up period of longitudinal studies ranged from 12 weeks to 30 years. [24][25][26][27][28][29][30][31][32][33][34]38,39 Included in this review were 1 placebo-controlled trial, 24 5 prospective observational studies, 25,…”

“…6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The follow-up period of longitudinal studies ranged from 12 weeks to 30 years. [24][25][26][27][28][29][30][31][32][33][34]38,39 Included in this review were 1 placebo-controlled trial, 24 5 prospective observational studies, 25,26,28,29,39 7 retrospective observational studies, 27,[30][31][32][33][34]38 and 5 cross-sectional studies. 6,9,[35][36][37] Measures used to diagnose patients with ADHD or to identify patients with current ADHD symptoms included clinical interviews that were structured or semistructured,…”

“…Three retrospective reviews (130-899 patients) of patients in outpatient clinics with observation periods between 4 and 30 years found a diagnosis of ADHD did not significantly influence retention time. [31][32][33] It is important to note patients in 2 of the studies had variable follow-up periods, with patients included near the end of the study having shorter follow-up periods than those included in the beginning. 31,32 It is also unclear how ADHD severity changed over the course of clinic participation.…”

“…[31][32][33] It is important to note patients in 2 of the studies had variable follow-up periods, with patients included near the end of the study having shorter follow-up periods than those included in the beginning. 31,32 It is also unclear how ADHD severity changed over the course of clinic participation. Furthermore, in the study by Maremmani et al, 32 the presence of a large difference in cumulative survival probability between individuals with (0.30) and without ADHD (0.71) with the lack of statistical Count and percent of patients retained for <2 years No ADHD: 150 (72%) ADHD: 57 (28%) Gica et al 39 Total: 100 ADHD: not reported ASRS Logistic regression examining relationship between ADHD scale subscores with experiencing an early relapse Attention deficit score*: Exp(B) 95% CI: 0.85 (0.73-0.98) Impulsivity score*: Exp(B) 95% CI: 1.24 (1.01-1.51) Abbreviations: ADHD, attention deficit/hyperactivity disorder; aHR, adjusted hazard ratio; ASRS, Adult ADHD Self-Report Scale; CD, cocaine disorder; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders fourth edition; MAT, medication-assisted treatment; MMT, methadone maintenance treatment; THD, take home dose.…”