Prevalence, correlates, and consequences of attention‐deficit/hyperactivity disorder in a clinical sample of adults with tramadol use in Egypt

Abstract

Background and Objectives Many studies investigated the association between attention‐deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) but none focused on the association between ADHD and nonmedical prescription opioids such as tramadol. The objective of this study was to assess the prevalence, correlates, and consequences of co‐occurrence of ADHD and tramadol use among adults. Methods This study included 122 Egyptian adults with opioid use disorders attributed to tramadol (N = 122). Participants were recruited from the psychiatric outpatient clinic and inpatient unit of Zagazig University Hospital, Egypt. ADHD and SUDs were assessed by using the Adult ADHD Self‐Report Scale (ASRS—v 1.1) and SCID‐I criteria of DSM‐5, respectively. All participants were screened for drugs by urinalysis. Results Forty percent of the participants used tramadol alone, whereas the remaining used it with other substances, such as alcohol (51.6%) and cannabis (48.4%). Thirty‐eight cases (31%) had adult ADHD and most of them had inattentive or mixed types. Adults with tramadol use and ADHD were more likely to have a younger age of onset of tramadol use, use a higher dose of tramadol, and use it for a longer duration than those with tramadol use without ADHD. Conclusions and Discussion ADHD in adults with tramadol use is common and is associated with early‐onset, high dose, and long duration of tramadol use. Scientific Significance This is the first study to investigate the co‐occurrence of ADHD and tramadol misuse among adults.

Attention Deficit Hyperactivity Disorder in the General Adult Population in Benin (Parakou 2022)

“…It is the second most represented clinical form in this survey. However, other authors have reported much higher proportions: Bassiony et al [23] in 2022 in Egypt (82%) and Umar et al (54%) [22] in 2017 in Nigeria (54%). For these authors, ADHD in its combined presentation was the most represented clinical form.…”

Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review

“…The second category includes professionals such as drivers and their assistants (motorcycle, tricycle, taxi, bus, private car, and truck) [41][42][43][44][45][46][47][48][49][50][51][52], workers in the construction and textile industries [42], skilled workers (hairstylists and mechanics) [53], hospital cleaners [54], and coffee shop workers [55]. The third category includes patients with tramadol dependence or opioid use disorders attributed to tramadol [56][57][58][59][60][61][62][63][64][65], patients with unintentional intoxication [66], patients with substance use disorders or drug addiction [67,68], patients admitted to Neuro-Psychiatric Hospital [69], patients with seizures or psychotic episodes [70,71], treatment-seeking men [72] or trauma victims [73], adults attending family medicine center [74], pharmacy/dispensary customers [75], patients undergoing surgery [76] or admitted for acute myocardial infarction [77], women admitted to addiction treatment center [78], patients attending psychiatric clinic [79][80][81]…”

Attention Deficit Hyperactivity Disorder: A Risk Factor for Premature Discontinuation of Inpatient Opioid Withdrawal Treatment

“…ADHD, in particular, has been associated with a more severe course of substance use, social and mental health impairment, and an increased likelihood of developing SUDs at a younger age [ 19 , 28 , 29 ]. Recognizing the importance of early diagnosis, experts advocate for initiating the diagnostic process for ADHD among SUD patients promptly when there are neither serious withdrawal symptoms nor serious intoxication [ 30 ].…”