Diagnoses of attention-deficit/hyperactivity disorder (ADHD) among patients with opioid use disorder (OUD) tripled between 2007 and 2017, a study in Psychiatric Services has found. At the same time, the prevalence of ADHD pharmacotherapy increased by 22% for patients with co-occurring ADHD and OUD.
Tae Woo Park, M.D., M.Sc., of the University of Pittsburgh and colleagues conducted two separate analyses of claims data from commercially insured patients between the ages of 13 and 64 years.
In the first analysis, the researchers studied data from 387,980 patients with OUD to estimate the prevalence of ADHD diagnoses and pharmacotherapy. They found that the proportion of patients with OUD and ADHD grew from 4.6% in 2007 to 15.1% in 2017. Among patients with both OUD and ADHD, the rate of those receiving medication for ADHD increased from 42.6% to 51.8%.
In the second analysis, the researchers studied data from 158,591 patients who received medications for OUD to examine the characteristics of those who received concurrent stimulant medication and those who did not. The researchers found that 10.5% of the patients in this analysis received concurrent prescription medications. Those who received concurrent stimulant medications tended to be younger, female, and diagnosed as having one or more psychiatric conditions compared with those who did not receive stimulants. Patients who had been diagnosed with other substance use disorders were less likely to receive a concurrent stimulant medication, the authors found.
The researchers noted that although ADHD diagnoses and treatments have grown steadily worldwide, particularly among adults, increases in ADHD diagnoses appear to have grown faster among patients with OUD than in the general population over the same period.
“Increased recognition of the role of ADHD in developing opioid use disorder and other substance use disorders has likely resulted in this rise in [ADHD] diagnoses,” Park and colleagues wrote. “Conversely, opioid use disorder may exacerbate ADHD symptoms over time and cause greater functional impairment, leading to an increased rate of ADHD diagnoses among patients with opioid use disorder compared with the general population.”
The researchers encouraged health professionals to exercise caution when prescribing stimulants for patients with ADHD who are taking medications for OUD.
“Given the potential for increased overdose risk and the potential risks for diversion and misuse associated with stimulant medications, clinicians managing ADHD symptoms of patients receiving [medication for OUD] should carefully weigh the risks and benefits of stimulant treatment on a per-patient basis,” they wrote.
For related information, see the American Journal of Psychiatry article “Personalizing the Treatment of Substance Use Disorders.”
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