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

Abstract

Objectives: To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). Data Sources: Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. Study Selection and Data Extraction: Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. Data Synthesis: This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. Relevance to Patient Care and Clinical Practice: This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. Conclusions: Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.

Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk

“…Our data also support the prescription of PAs for individuals with OUD receiving buprenorphine regardless of their PSUD status, as there appears to be no difference in risk for drug-related poisoning across PSUD status. A significant portion of individuals (21%) with OUD have ADHD30; existing literature shows that appropriate treatment is warranted as it improves ADHD outcomes 10. The findings of the present study show the initiation of PAs for ADHD in people initiating buprenorphine may be associated with improved OUD treatment retention, without marked increases in overdose risk.…”

“…This result is consistent with previous work by Mintz et al and extends the literature base by showing that people with co-occurring OUD and PSUD may also benefit from PA treatment. Improving retention in buprenorphine-based OUD treatment has been a challenge for clinical care and the present findings suggest that treatment of patients with co-occurring ADHD with prescription psychostimulants may improve their retention in OUD treatment 10. Furthermore, the treatment of ADHD in a SUD context is associated with improved ADHD symptoms,14 and it is well-established that patients with comorbid ADHD and SUDs should be treated for their ADHD with stimulant medications 28.…”

“…Improving retention in buprenorphine-based OUD treatment has been a challenge for clinical care and the present findings suggest that treatment of patients with co-occurring ADHD with prescription psychostimulants may improve their retention in OUD treatment. 10 Furthermore, the treatment of ADHD in a SUD context is associated with improved ADHD symptoms, 14 and it is well-established that patients with comorbid ADHD and SUDs should be treated for their ADHD with stimulant medications. 28 Improving retention in treatment with buprenorphine has been shown to significantly decrease the risk of and related medical costs and therefore it confers those benefits in the population additionally treated with PAs.…”

“…The opioid partial agonist buprenorphine is the most common maintenance medication used in treatment of OUD. Patients in treatment for OUD may need prescription stimulant medications for the treatment of attention-deficit and hyperactivity disorder (ADHD), as recent evidence has demonstrated that treating ADHD among patients with OUD may improve retention in treatment and reduce illicit substance use 10. Moreover, a recent meta-analysis shows that prescription amphetamines (PAs) in particular, are a potentially useful tool to treat PSUD, especially CUD, as it is able to promote abstinence and reduce drug use 11.…”

“…Patients in treatment for OUD may need prescription stimulant medications for the treatment of attention-deficit and hyperactivity disorder (ADHD), as recent evidence has demonstrated that treating ADHD among patients with OUD may improve retention in treatment and reduce illicit substance use. 10 Moreover, a recent meta-analysis shows that prescription amphetamines (PAs) in particular, are a potentially useful tool to treat PSUD, especially CUD, as it is able to promote abstinence and reduce drug use. 11 Examples of benefits of PA use for individuals with PSUD include increased treatment retention 12 and reduction in all-cause mortality.…”