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Are prescribed stimulants safe for Comorbid OUD, ADHD?

A growing number of patients suffering from opioid use disorder (OUD), have been diagnosed with comorbid attention disorder (ADHD). This raises questions as to whether it is appropriate to prescribe stimulants to this patient population.

A new study revealed that from 2007-2017, there was a threefold rise in OUD and co-occurring ADHD and that a significant proportion of these patients were prescribed stimulants.

“This is the beginning of looking at whether there are risks of prescribing stimulation to patients taking opioid pain medication,” investigator Tae Woo Park, MD told Medscape Medical News.

“More and more people are being identified with ADHD and we need to conduct more research on the best approach to manage this patient group,” Park added.

The results were presented at the American Academy of Addiction Psychiatry (AAAP) 32nd Annual Meeting.

Biological Connection?

Park isn’t sure if there is “an actual biological connection” between ADHD and OUD and OUD, pointing out that there are many reasons why those with ADHD may be more prone to develop a disorder.

Perhaps they did not receive an ADHD diagnosis as an infant, “which led to impairment in their ability to succeed in school and later at work,” which in turn made them more prone to a substance use disorder Park said. Park.

He said that ADHD can adversely affect quality of life and result in “increased impairment” in people suffering from addiction disorders based on his clinical experience and research.

There is evidence that suggests patients who are treated for ADHD early in life are less likely to develop a substance use disorder later on, he said.

Prescription stimulant is the “gold standard” treatment for ADHD. However, it comes with its own addiction risks. Park said that the issue is whether or to prescribe dangerous medication and how to evaluate the risks and benefits.

From an insurance company’s private database, researchers examined the records of patients aged 18-64 years who were taking medication for OUD, such as buprenorphine, methadone, or naltrexone, from 2007-2017.

In the study sample, about 17,000 people were receiving stimulants and 156,000 were not taking these drugs. The age group 18-25 had the largest proportion of participants from both the stimulant and non-stimulant categories.

About 35% of the people receiving stimulants had ADHD and around the same proportion were diagnosed with a mood disorder.

The percentage of ADHD and OUD co-occurring increased from less than 4 percent in 2007 to nearly 14% in 2017. During that time, the incidence of OUD medication and stimulant use also grew.

Park said that the rise in ADHD diagnoses could be due to increasing awareness of the condition. As the opioid problem became more apparent and additional treatments were made available, “there were more health care contacts, more assessments, and more diagnoses, including those of ADHD,” he said.

Risks vs Benefits

Stimulants may also be risky for patients suffering from OUD. Results from another study presented at the AAAP meeting showed these drugs were linked to an increased chance of poisoning in patients receiving buprenorphine.

However, Park is skeptical the combination of buprenorphine and stimulants “leads to an increased risk of overdose in the body.” Park used a hypothetical scenario in which other factors could play into the connection. A patient receives an opiate prescription, develops addiction and then begins using illicit or street stimulants. This leads to an increase in opioids and eventually , an overdose.

Park mentioned the same study that found an increased risk of poisoning in stimulant users, also found that users tend to remain on buprenorphine treatment, providing protection against overdose.

“So there are both benefits and risks to prescribing these drugs and it is difficult to know whether to prescribe them or not,” he said.

Park declared that stimulants are the most effective treatment for ADHD. However, atomoxetine, an antidepressant medication that is non-stimulant and has antidepressant properties, is a different option.

He also stated that the limitation of his study was that only a small percentage of the people included in the study were prescribed methadone.

American Academy of Addiction Psychiatry’s 32nd Annual Meeting. Paper Session IV. The session was held on December 12, 2021.

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