Adult-Attention Deficit Hyperactive Disorder Symptoms Seem Not to Influence the Outcome of an Enhanced Agonist Opioid Treatment: A 30-Year Follow-Up.

Angelo G I Maremmani,Icro Maremmani,Pasqualina Rocco,Mario Miccoli,Filippo Della Rocca,Giulio Perugi

doi:10.3390/ijerph182010997

Abstract

The role of opioids and opioid medications in ADHD symptoms is still largely understudied. We tested the hypothesis that, in Heroin Use Disorder (HUD), when patients are treated with Agonist Opioid medications (AOT), treatment outcome is associated with the presence of Adult Attention-Deficit/Hyperactive Disorder (A-ADHD) symptomatology. A retrospective cohort study of 130 HUD patients in Castelfranco Veneto, Italy, covering 30 years, was divided into two groups according to the Adult ADHD Self-Report Scale (ASRS) score and compared them using demographic, clinical and pharmacological factors. Survival in treatment was studied by utilizing the available data for leaving treatment and relapsing into addictive behavior and for mortality during treatment as poor primary outcomes. Thirty-five HUD subjects (26.9%) were unlikely to have A-ADHD symptomatology, and 95 (73.1%) were likely to have it. Only current age and co-substance use at treatment entry differed significantly between groups. Censored patients were 29 (82.9%) for HUD patients and 70 (73.9%) for A-ADHD/HUD patients (Mantel-Cox test = 0.66 p = 0.415). There were no significant linear trends indicative of a poorer outcome with the presence of A-ADHD after adjustment for demographic, clinical and pharmacological factors. Conclusions: ADHD symptomatology does not seem to exert any influence on the retention in AOT of HUD patients.

Highlights

In the Castelfranco Veneto Agonist Opioid medications (AOT), the Dole and Nyswander (D&N) methodology of treatment [25,26] has been used since its foundation
We found no statistically significant differences between Heroin Use Disorder (HUD) patients with and without Adult AttentionDeficit/Hyperactive Disorder (A-Attention Deficit Hyperactivity Disorder (ADHD)) symptomatology, the only exceptions being their age at the time of the study and co-substance use (Table 1)
As many as 73.1% of our HUD patients presented A-ADHD symptomatology—a much higher percentage than those reported in the literature [20,21]

Summary

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a pervasive neurodevelopmental disorder affecting both children and adults. It is clinically distinguished by improper levels of inattention, impulsivity and/or hyperactivity, especially in children and adolescents. The disorder is almost invariably accompanied by various internalizing and externalizing psychiatric manifestations [1,2,3,4], confounding its identification and treatment managing [5]. About 50% of the ADHD young adolescents show a reduction of hyperactivity, inattention, and impulsivity when they grow up. In 35% of these cases, ADHD symptomatology remains under the clinical threshold, reducing school performance and

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