Attention-deficit/hyperactivity disorder symptoms among patients receiving opioid agonist therapy: a Norwegian cohort study

Abstract

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is common among patients with opioid dependence and makes treatment for both disorders more challenging. The literature on the extent of ADHD and related cognitive symptoms is scarce. Understanding the link between these ADHD-related symptoms and clinical and sociodemographic characteristics may optimize treatment among patients with opioid dependence. This study examined the prevalence of ADHD, cognitive ADHD symptoms, and the association between these symptoms and clinical and sociodemographic variables among patients receiving opioid agonist therapy (OAT). Methods We used data from health assessments of a cohort of patients in Norway receiving OAT. Data on ADHD-related symptoms obtained from the adult ADHD self-report scale version 1.1 (ASRS-v.1.1), and sociodemographic and clinical factors were collected. In total, 701 patients were included from May 2016 to March 2022. All the patients responded to two ASRS-v1.1 questions on problems with concentration and memory. Two-hundred twenty-five patients completed all the questions in the ASRS-v.1.1, part A. Diagnoses of mental disorders were collected from medical records. Clinical ADHD symptoms were defined as exceeding the symptom cutoff for at least four of six questions in the ASRS-v.1.1 part A. Ordinal regression analyses were performed to investigate whether the exposure variables of age, sex, substance use, injecting use, housing status, and educational attainment were associated with concentration and memory problems (outcome variables) at baseline and over time. The analysis results are presented as odds ratios (OR), with their 95% confidence intervals (CI). Baseline was defined as the time of the first health assessment. Results Forty-five percent of patients receiving OAT exceeded the cutoff for adult clinical ADHD symptoms. Of these, 29% had registered ADHD diagnosis. Using cannabis was associated with problems with concentration (OR: 1.7, 95% CI: 1.1–2.5) and memory (1.7, 1.1–2.6) at baseline and fewer memory problems over time (0.7, 0.6–1.0). At baseline, using stimulants (1.8, 1.0–3.2) and low educational attainment (0.1, 0.0–0.8) were associated with memory problems. Conclusions Nearly half the patients receiving OAT had clinical ADHD symptoms. Using cannabis and amphetamines may contribute to memory and concentration problems in this population.