Association between Adult Attention Deficit/Hyperactivity Disorder and Intravenous Misuse of Opioid and Benzodiazepine in Patients under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

Abstract

Background: Intravenous misuse and attention-deficit/hyperactivity disorder (ADHD) are common in patients under opioid maintenance treatment (OMT), who often misuse benzodiazepine (BZD). Objectives: To explore the rate of adult ADHD among patients under OMT in Italy and whether screening positive for adult ADHD is associated with OMT and BZD misuse and emergency room (ER) admission because of misuse. Methods: We recruited 1,649 patients from 27 addiction units (AUs) in Italy and collected data on the self-reported rate of OMT intravenous misuse (prevalence, repeated misuse, main reason, temporal pattern in relation to AU access, experience), concurrent intravenous and intra-nasal BZD misuse (prevalence, type of misused BZD), ADHD and ER admissions because of misuse complications. Results: Screening positive for adult ADHD was found in 11.2% patients (ADHD+), with a significant gender difference (women: 15.3%, men: 10.3%). OMT misuse was reported by 24.4 and 18.5% patients during lifetime and in the previous 6 months respectively. BZD misuse was reported by 20.0 and 8.6% patients for intravenous and intranasal route respectively. Misuse was significantly more common in ADHD+ (OMT 27.4-33.1%, BZD 14.5-31.5%) than ADHD-group (OMT 17.4-23.3%, BZD 7.9-18.3%). The multivariate logistic regression model showed positive screening for ADHD to be significantly associated with intravenous OMT misuse in the previous 6 months, and intravenous/intranasal BZD misuse, independently of age, gender and route of previous heroin administration. Conclusions: Screening positive for adult ADHD was associated with OMT and BZD misuse. AU physicians and medical personnel should focus on OMT patient's features that are associated with a higher likelihood of misuse, in particular ADHD.

Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users

“…The prevalence of adult ADHD symptoms in our sample was 8-12 times that in the general population (i.e., 2.5-5%) [13,14], and in accordance with previous studies in SUD patients [17][18][19][20][21]. The prevalence of patients positive to adult ADHD screening in this study was slightly higher than that in our previous report from a similar population and using the same screening test (31.7%) [27], probably because of the differences between the 2 populations, including the larger number of men, which are reported to be more prone to ADHD [32], in the present report.…”

“…This finding survived correction for potential covariates, in that ADHD was the factor that, together with age, influenced all QoL measures in the multivariate analysis. Despite the prevalence of adult ADHD is known to be higher in SUD patients than the general population [17][18][19][20][21], studies on the Here are reported only covariates that turned out to be significant in the multivariate linear regression analysis. Please note that higher SF-36 scores indicate higher QoL, while higher GHQ-12 scores indicate worse QoL.…”

“…Many ADHD cases persist into adulthood, where the prevalence reaches 2.5-5% [13,14]. Childhood/adolescence ADHD is a risk factor for future SUD [15,16], and the prevalence of adult ADHD in SUD patients is higher than in the general population [17][18][19][20][21]. ADHD worsens the SUD course and the response to treatment, leading to frequent hospitalizations, higher rates of suicide attempts, and exacerbations [17,[22][23][24].…”

“…Exploring the presence of adult ADHD may be helpful to improve the treatment and prevent relapses in patients with SUD [21]. The diagnosis of adult ADHD may be complex because of the elaborated and time-consuming diagnostic interview that requires a retrospective investigation of childhood symptoms [27], and different diagnostic criteria across DSM versions might influence estimates of ADHD prevalence [17].…”

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

“…The prevalence estimates may differ according to the type of substance used and the subpopulations or treatment modality. For example, the following populations of patients in opioid maintenance treatment (OMT) were screened positively for ADHD: in Norway, 33% of OMT patients [5], in Austria, in 50% of children and 17% of adults of the mainly male prison inmates in OMT [6], and in Italy, 11.2% of OMT patients [7]. In the methamphetamine-using population of one hospital’s psychiatric center, the prevalence of the ADHD diagnosis went up to 55.6% [8].…”